Laboratory manual for physicians : aids in diagnosis and treatment.

  • New York (State). Department of Health. Division of Laboratories and Research.
Date:
1940
Catalogue details

Licence: Public Domain Mark

Credit: Laboratory manual for physicians : aids in diagnosis and treatment. Source: Wellcome Collection.

    83/108 (page 81)
    8] Typhoid and Paratyphoid Fevers The present sanitary environment of urban districts in New York State is such that the incidence of typhoid fever is very low. The source of the incitant in most cases can be traced to carriers of typhoid bacilli. Carriers who are food handlers represent a particular menace. The Sanitary Code requirement (Chap. II, Reg. 15) which necessitates the submission of specimens from convalescents who have had typhoid or paratyphoid fever before release from observa- tion should result in the detection of most of the individuals who develop the carrier condition. Nearly all of these carriers have a focus of infection in the gall bladder. Gall stones or other evidence of cholecystitis are usually found when the gall bladder removed from a chronic typhoid carrier is examined. In hospitals and other institutions, the ease with which incitants of enteric disease can be transmitted with the rectum as the portal of entry must be kept in mind. Improperly sterlized rectal catheters may be the means of transmission. Simply washing enema tubes or soaking them in an antiseptic gives inadequate protection, since the inside of the tubing may remain contaminated. The results of serologic tests for evidence of typhoid fever are seldom of diagnostic value during the first week after onset of symptoms. When the clots of blood are cultured, however, the incitant is usually isolated, definite confirmation of the diagnosis thus being provided. After the patient has been ill for from ten days to two weeks, the blood usually agglutinates B. typhosus markedly. Total and differential leucocyte counts are useful, since a leucopenia and the presence of a relatively high percentage of lymphocytes are characteristic findings in typhoid fever. Specimens of feces collected a day or two after onset of symptoms may not be found to contain typhoid bacilli, but the micro- organisms can usually be readily isolated from those collected later during the acute stages of the illness and they may be present for a considerable time after convalescence. When these bacteria are found in specimens from a person who has not suffered from typhoid fever within one year, he is considered a chronic typhoid carrier (Sanitary Code, Chap. II, Reg. 31). Typhoid bacilli are present in the urine of a fairly high per- centage of patients with typhoid fever. They are found also in discharges from focal infections and occasionally in cerebrospinal fluid and sputum.