Duodenal intubation as a source of typhoid fever

Typhoid fever developed in three patients during a period of 13 weeks. Although each of these patients was admitted to a different London hospital, the patients became ill approximately 10 days after undergoing duodenal intubation in one gastroenterology unit. All other patients who had undergone duodenal intubation in the unit during that period of time were investigated. Salmonella typhi was isolated from bile and feces of two out of the 20 other patients (carriers). In each of the three patients who developed typhoid fever, intubation followed within two days of intubation of one of the carriers. After use in each patient, the polyvinyl tubes had been thoroughly washed with disinfectant and detergent. There were no further cases of typhoid fever when a new tube was used for each patient.