The Chronic Typhoid Carrier: I. The Natural Course of the Carrier State

Oral humatin (paromomycin) in chronic enteric carriers

“…Browning and his fellow workers (1933), however, cite several instances in the early literature in which such a cure has been stated to have occurred. Littman, Vaichulis, Ivy, Kaplan & Baer (1948) reported that in nineteen (24 %) of their series of seventy-five cases, bacteriological examination of urine and faeces had remained negative for an average period of 49 months in the absence of therapy, the range being from 33 to 66 months. They believed that these cases could be referred to as spontaneously cured cases, and expressed the view that in patients cured spontaneously of the disease the gall-bladder condition had undergone spontaneous improvement, or, alternatively, that chronic inflammation and fibrosis of the gall-bladder had progressed to such an extent as to result in a functional cholecystectomy.…”

“…Apart from the rare urinary carrier with a persistent focus of infection which may be amenable to surgical treatment, there is only one group of carriers, the chronic biliary, in which any measure of success has resulted from these efforts. There is little doubt that in certain cases belonging to this group the operation of cholecystectomy is accompanied by a high proportion of permanent cures, provided certain criteria are fulfilled in selecting the case for surgery (Haaland & Haaland, 1927;Whipple, 1929;Bigelow & Anderson, 1933;Senftner & Coughlin, 1933;Coller &Forsbeck, 1937 andIvy, 1949).…”

Chronic Salmonella Typhi carriage at sites other than the gallbladder

“…Main anatomic sites of carriage Gallbladder [19] Kidney [19,[23][24][25][26][27]53] Peak age Middle-age adults [50,53,64] Potentially second to fourth decades. Paucity of primary data to support an answer, based on pre-antibiotic era data [27] Female:male ratio Female > male [19,50,53,64] Equal [19] Clinical specimens tested to detect and monitor carriers Bile and stool cultures [12,13] Urine [13,21,23] Typhoidal serovars reported S. Typhi > S. Paratyphi A or B [50,64] Paucity of primary data to support an answer Level of excretion (colony forming units [CFU]/ ml or CFU/gm) Role of point-of-care-ultrasound as an adjunct to screening for chronic carriers May be helpful [73] Paucity of primary data to support an answer https://doi.org/10.1371/journal.pntd.0011168.t001…”

“…Since the classic physiological niche for chronic S. Typhi infection is the gallbladder, most modern studies have understandably focused on biliary carriers, the role of cholelithiasis, and S. Typhi's ability to create biofilms on gallstones [50,52]. The prevalence of chronic S. Typhi carriers in endemic populations parallels the prevalence of cholelithiasis and chronic gallbladder disease [50,53]. Thus, chronic carriage is several-fold higher in females than males, and in older adults (>40 years of age) than younger adults and teenagers (Table 1) [50,53].…”

“…The prevalence of chronic S . Typhi carriers in endemic populations parallels the prevalence of cholelithiasis and chronic gallbladder disease [ 50 , 53 ]. Thus, chronic carriage is several-fold higher in females than males, and in older adults (>40 years of age) than younger adults and teenagers ( Table 1 ) [ 50 , 53 ].…”