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Association between specific plasmids and relapse in typhoid fever.

E Gotuzzo1, J G Morris, L Benavente

  • 1Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.

Journal of Clinical Microbiology
|September 1, 1987
PubMed
Summary

Clinical relapse in typhoid fever patients can occur, sometimes due to multiple Salmonella typhi strains. Specific plasmids were associated with relapse, suggesting a strain-dependent factor in recurrent typhoid fever.

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Area of Science:

  • * Infectious Diseases
  • * Microbiology
  • * Epidemiology

Background:

  • * Typhoid fever, caused by Salmonella typhi, remains a significant public health concern, particularly in endemic regions like Lima, Peru.
  • * Clinical relapse after initial treatment for typhoid fever is a recognized complication, impacting patient recovery and disease transmission.
  • * Understanding the factors contributing to relapse is crucial for developing effective treatment and prevention strategies.

Purpose of the Study:

  • * To investigate the incidence and potential causes of clinical relapse in patients hospitalized with typhoid fever in Lima, Peru.
  • * To explore the role of multiple Salmonella typhi strains and plasmid profiles in typhoid fever relapse.
  • * To identify potential epidemiologic markers associated with recurrent typhoid fever.

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Main Methods:

  • * Analysis of Salmonella typhi isolates from 73 hospitalized typhoid fever patients in Lima, Peru.
  • * Clinical data collection, including monitoring for fever and positive blood cultures for relapse within 3 months.
  • * Plasmid profiling of Salmonella typhi strains to identify epidemiologic markers and assess for multiple strain infections.

Main Results:

  • * 15% (11 out of 73) of patients experienced a clinical relapse within 3 months.
  • * Three patients who relapsed were initially infected with more than one strain of Salmonella typhi.
  • * Isolation of a strain with a 24- or 38-kilobase plasmid at the time of original infection was significantly associated with relapse.

Conclusions:

  • * Infection with multiple Salmonella typhi strains is common in this endemic area and may contribute to clinical relapse.
  • * The presence of specific plasmids (24- or 38-kilobase) in the infecting strain is linked to an increased risk of relapse.
  • * Relapse in typhoid fever may be partly dependent on the specific characteristics of the infecting Salmonella typhi strain(s).