Objective: To analyze the incidence trend and epidemiological characteristics of typhoid fever and paratyphoid fever in China from 2004 to 2020, understand the high-incidence population and hotspot areas, and provide evidences to develop more targeted prevention and control measures. Methods: The descriptive epidemiological method and spatial analysis method were applied to analyze the epidemiological characteristics of typhoid fever and paratyphoid fever in China during this period by using the surveillance data collected from the National Notifiable Infectious Disease Reporting System of Chinese Center for Disease Control and Prevention. Results: A total of 202 991 cases of typhoid fever were reported in China from 2004 to 2020. More cases occurred in men than in women (sex ratio: 1.18∶1). Most cases were reported in adults aged 20-59 years (53.60%). The incidence rate of typhoid fever decreased from 2.54/100 000 in 2004 to 0.38/100 000 in 2020. The highest incidence rate was reported in young children aged <3 years after 2011, ranging from 1.13/100 000 to 2.78/100 000, and during this period the proportion of cases in this age group increased from 3.48% to 15.59%. The proportion of the cases in the elderly aged ≥60 years increased from 6.46% in 2004 to 19.34% in 2020. The hotspot areas existed in Yunnan, Guizhou, Guangxi and Sichuan Provinces and expanded to Guangdong, Hunan, Jiangxi, and Fujian Provinces. A total of 86 226 paratyphoid fever cases were reported from 2004 to 2020, the male to female ratio of the cases was 1.21∶1. Most cases were reported in adults aged 20-59 years (59.80%). The incidence rate of paratyphoid fever decreased from 1.26/100 000 in 2004 to 0.12/100 000 in 2020. The highest incidence rate of paratyphoid fever was in young children aged <3 years after 2007, ranging from 0.57/100 000 to 1.19/100 000, and during this period the proportion of the cases in this age group increased from 1.48% to 30.92%. The proportion of the cases in the elderly aged ≥60 years increased from 4.52% in 2004 to 22.28% in 2020. The hotspot areas expanded to the east, including Guangdong, Hunan and Jiangxi Provinces, from Yunnan, Guizhou, Sichuan, and Guangxi Provinces. Conclusions: The results showed a low level of incidence of typhoid fever and paratyphoid fever in China with a trend of decreasing per year. The hotspots were mainly in the of Yunnan, Guizhou, Guangxi and Sichuan Provinces, with an expanding trend to eastern China. It is necessary to strengthen the typhoid fever and paratyphoid fever prevention and control in southwestern China, among young children aged <3 years and the elderly aged ≥60 years.
Adult ; Aged ; Child, Preschool ; Female ; Humans ; Male ; China/epidemiology* ; Paratyphoid Fever/epidemiology* ; Sex Ratio ; Typhoid Fever/epidemiology* ; Young Adult ; Middle Aged

We report a case of hemophagocytic syndrome (HPS) secondary to brucellosis, in which typhoidal cells were found in bone marrow, suggesting typhoidal cells present not only in Salmonella typhi infections but also in other bacterial infections. Typhoidal cells in bone marrow can be used to quickly identify the presence of bacterial infection pending the results of bone marrow and/or blood cultures.
Female ; Humans ; Typhoid Fever/microbiology* ; Lymphohistiocytosis, Hemophagocytic/etiology* ; Brucellosis/complications*

Objective: To identify a suspected clustered Typhoid fever by whole genome sequencing(WGS) and pulsed field gel electrophoresis (PFGE) subtyping. Methods: The nature of the epidemic was determined by combination of subtyping results of isolates and epidemiological information. Results: Five S. typhimurium isolates showed identical PFGE patterns and almost the same whole genome sequence. Epidemiological survey showed that five cases had dined in the same restaurant on the same day. Conclusion: Combined with the longest incubation period of typhoid fever, molecular subtyping of pathogenic bacteria and the field epidemiological survey, it can be preliminarily determined that the five cases have common infection sources.
Electrophoresis, Gel, Pulsed-Field ; Epidemics ; Humans ; Typhoid Fever/microbiology*

Aims: Typhoid fever is a life-threatening disease in the developing world that claims >600,000 deaths per year. Its causative agent Salmonella Typhimurium (S. Typhi) can be treated with ciprofloxacin, an effective broad-spectrum antibiotic that enhances the natural host defenses. However, the emergence of resistant bacterial strains may be a warning alarm against the clinical use of this antibiotic. This study was aimed to investigate the efficiency of ciprofloxacin treatment (250 mg/mL) against S. Typhi by altering the production of serum cytokines IL-10, 1L-6 and TNF-α in acute typhoid fever patients in Diwanyah Hospitals. Methodology and results: ELISA and Western Blot methods were used to investigate cytokine levels in patients and healthy controls sera. Our results showed that all cytokines’ levels before treatment with ciprofloxacin were significantly higher than the control (healthy group). However, treated patients with ciprofloxacin revealed a significantly reduced concentration of IL-10 and TNF-α compared to untreated control samples. However, the level of IL-6 was higher even with ciprofloxacin treatment. Conclusion, significance and impact of study The study concluded that ciprofloxacin (250 mg/mL) might significantly alter serum cytokines IL-6, IL-10 and TNF-α levels in acute typhoid fever patients. Therefore, further molecular studies are essential to understand the effect of ciprofloxacin on the production of cytokines.
Typhoid Fever ; Ciprofloxacin ; Salmonella typhimurium ; Cytokines

Humans ; Panuveitis/etiology* ; Retinal Detachment/etiology* ; Typhoid Fever/diagnosis* ; Visual Acuity

Background: Typhoid fever, also known as enteric fever, is a severe systemic illness characterized by fever and gastrointestinal manifestations that commonly affects children and young adults. It is most prevalent in SouthCentral Asia, Southern Africa, and Southeast Asia. Alternative drugs for the treatment of enteric fever have been studied to decrease toxicity and increase compliance. Oral azithromycin has been proposed and is widely studied as a suitable treatment alternative. Objective: The objective of this study is to compare oral azithromycin with intravenous ceftriaxone in the treatment of uncomplicated typhoid fever in terms of cure, duration of fever, relapse, and adverse events. Methodology: A systematic review and meta-analysis were done with eligible studies taken from PUBMED, MEDLINE, and Cochrane Clinical Trial Registry. Six studies passed the eligibility criteria and were analyzed using Review Manager 5.3. Results: Azithromycin showed comparable results with ceftriaxone in terms of cure, duration of fever and adverse events. However, azithromycin proved superior in decreasing relapse. Conclusion: Azithromycin is comparable to ceftriaxone in the treatment of uncomplicated typhoid fever in terms of cure, duration of fever, and occurrence of adverse events. Azithromycin likewise had a lower incidence of relapse. Recommendations We recommend conducting local trials in pediatric patients, to compare azithromycin with standard antibiotic regimen for typhoid fever, to help update local recommendations and expand choices for antibiotic use.
Typhoid Fever ; Azithromycin ; Ceftriaxone

The Committee on Infectious Diseases of the Korean Pediatric Society recommended immunization schedule for children and adolescents aged 18 years or younger in the 9th (2018) edition of Immunization guideline. This report provides the revised recommendations made by the committee and summarizes several changes from the 2015 guideline. National immunization program (NIP) launched a human papillomavirus (HPV) immunization for girls aged 12 years in 2016. NIP has also expanded age indication for inactivated influenza vaccine (IIV) to 12 years of age in the 2018-2019 season. Quadrivalent IIVs with a full dose (0.5 mL) are approved for all children of 6 months or older. Recommendations of live attenuated influenza vaccine were removed. For inactivated Japanese encephalitis vaccine, first 2 doses are considered as the primary series. Recommendations for use of newly introduced vaccines (diphtheria-tetanus-acellular pertussis/inactivated poliovirus/Haemophilus influenzae type b, 9-valent HPV, new varicella vaccine, new quadrivalent IIV, and attenuated oral typhoid vaccine) were added. Lastly, monitoring system for adverse events following immunization was updated. Other changes can be found in the 9th edition of Immunization guideline in detail.
Adolescent ; Chickenpox Vaccine ; Child ; Communicable Diseases ; Encephalitis, Japanese ; Female ; Humans ; Immunization Programs ; Immunization Schedule ; Immunization ; Infant ; Influenza Vaccines ; Influenza, Human ; Korea ; Seasons ; Typhoid Fever ; Vaccines

Acute myocarditis is clinically rare in children, but poses a significant risk for morbidity and mortality. Children with myocarditis show a wide variety of clinical manifestations ranging from subclinical myocarditis to heart failure, hemodynamic compromise, arrhythmia, and even sudden death. Salmonella species are associated with clinical presentations including gastroenteritis, enteric fever, bacteremia, and extra-intestinal focal infections. Non-typhoidal Salmonella infections usually cause self-limiting gastroenteritis, but are rarely associated with myocarditis. In this report, we present a case of myocarditis associated with Salmonella serogroup B gastroenteritis in a previously healthy 15-year-old boy.
Adolescent ; Arrhythmias, Cardiac ; Bacteremia ; Child ; Death, Sudden ; Focal Infection ; Gastroenteritis ; Heart Failure ; Hemodynamics ; Humans ; Magnetic Resonance Imaging ; Male ; Mortality ; Myocarditis ; Salmonella Infections ; Salmonella ; Serogroup ; Typhoid Fever

Introduction: Typhoid fever usually presents with prolong fever associated with constitutional symptoms of headache and abdominal pain. Patients living in far flung areas often downplayed this condition with a viral infection causing delay in diagnosis. We present a case of a 30-year-old male diagnosed with typhoid fever who developed upper gastrointesitinal bleeding with intraoperative finding of periappendicitis. Case presentation: This is a case of a 30-year-old male patient presented in the emergency room with abdominal pain and high fever for three weeks. Physical examination showed he was fairly dehydrated with dry lips and tongue and abdominal examination revealed epigastric pain on deep palpation. Initially, his laboratory tests were unrevealing. Over the course of his confinement he was given multiple transfusion due to profused hematochezia and with sudden reduction in hematocrit count thus was referred to surgical service for emergency laparotomy. Intraoperative findings showed bleeding ulcers in the ileum accompanied by histologic findings of periappendicitis which originally thought of as acute suppurative appendicitis. Conclusion It is important to consider in patients with three or more weeks with typhoid fever its complications of intestinal bleeding. However, the finding of periappendicits contributes a rare and not easily diagnosed pathology which is not within the context of an enteric infection.
Typhoid Fever ; Salmonella

Previously, we genetically engineered a Salmonella Typhi bacterial ghost (STG) as a novel inactivated vaccine candidate against typhoid fever. The underlying mechanism employed by the ghost in stimulating the adaptive immune response remains to be investigated. In this study, we aimed to evaluate the immunostimulatory effect of STG on mouse bone marrow-derived dendritic cells (BMDCs) and its activation of the adaptive immune response in vitro. Immature BMDCs were stimulated with STG, which efficiently stimulated maturation events in BMDCs, as indicated by upregulated expressions of CD40, CD80, and major histocompatibility complex class II molecules on CD11⁺ BMDCs. Immature BMDCs responded to STG stimulation by significantly increasing the expression of interleukin (IL)-6, which might indicate the induction of dendritic cell maturation in vivo (p < 0.05). In addition, ghost-stimulated murine BMDCs showed significant expressions of interferon gamma and IL-4, which can drive the development of Th1 and Th2 cells, respectively, in co-cultured CD4⁺ T cells in vitro. These results suggest that STG can effectively stimulate maturation of BMDCs and facilitate subsequent immune responses via potent immunomodulatory cytokine responses.
Adaptive Immunity ; Animals ; Bacteriophages ; Dendritic Cells ; Immunity, Innate ; In Vitro Techniques ; Interferons ; Interleukin-4 ; Interleukins ; Major Histocompatibility Complex ; Mice ; Salmonella typhi ; Salmonella ; T-Lymphocytes ; Th2 Cells ; Typhoid Fever