An outbreak of typhoid fever in the Middle East

Abstract

1. An outbreak of typhoid fever in a Royal Air Force camp in the Middle East is discussed.2. A total of 110 cases occurred of which 105 are analysed. The case-fatality rate was 10%.3. Of the 105 cases 59% gave a positive blood culture. The percentages of diagnostic isolations from stools and urine were small.4. Clearance tests of stools and urine showed that 8.4% of patients excreted Salm. typhi during convalescence.5. Leucocyte counts during the first 2 weeks of the illness showed that only 30% of the patients had a count below 5000 per cu.mm.; 62% of these low figures were encountered in severe cases.6. Autopsies on seven fatal cases showed considerable variability in the macroscopic appearance of the intestinal lesions.7. Serological investigation confirmed that higher percentages of cases with low titres of O agglutinin were found in the severe and mild clinical groups, and that most O titres in the moderately severe cases exceeded 1:200.8. Of the patients 52% showed Vi titres exceeding 1:20 during convalescence.9. The significance of various findings is discussed.

Antibodies and the Aberdeen typhoid outbreak of 1964: I. The Widal reaction

“…The conclusions drawn from findings in the investigation described agree with those of Anderson & Richards (1948) that a high 'Vi' titre was not invariably associated with a temporary carrier state and that high titres were occasionally found in convalescence in the absence of a demonstrable carrier state. These conclusions, however, differ from those of Bhatnagar (1944) who considered that the presence of 'Vi' agglutinins was invariably associated with the presence of S. typhi within the body.…”

“…The findings with regard to the titres of 'Vi' agglutinins extend the observation of Anderson & Richards (1948) in that out of 303 non-immunized patients followed up after discharge, 196 (64.6%) still had demonstrable 'Vi' agglutinins present 12-24 months after discharge.…”

“…These conclusions, however, differ from those of Bhatnagar (1944) who considered that the presence of 'Vi' agglutinins was invariably associated with the presence of S. typhi within the body. Anderson & Richards (1948) were of the opinion that it seemed unwise to lay down such a hard and fast rule, as it had been established that a small percentage of persons in whom there is no evidence to suggest typhoid infection or the carrier state may have low titres of 'Vi' agglutinins in their serum possibly because of the presence in their intestine of 'Vi'-containing strains of Esch. coli.…”

The immunizing potency of alcohol-killed and alcohol-preserved typhoid vaccine after storage for ten Years

“…vaccine before the necessary precautions in the handling of the vaccine had been introduced. This applies also to the observations on the value of the alcoholized vaccine recorded by one of us in a report on an outbreak of typhoid fever in the Middle East in 1945 (Anderson & Richards, 1948).…”

Ampicillin for persistent typhoid excreters, including a clinical trial in convalescence.

“…Approximately 30% of patients may still excrete Salmonella typhi immediately after completing treatment, but almost 90% of those become negative within one month (Vogelsang and B0e, 1948). Anderson and Richards (1948) found that all nine convalescent excreters out of 110 cases cleared spontaneously. However, usually about 3% of patients contracting typhoid fever become chronic carriers-that is, they are found to be excreting Salm.…”