Chronic Urinary Salmonella Carriers with Intermittent Bacteraemia
NAVAL MEDICAL RESEARCH UNIT NO 3 FPO NEW YORK 09527
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Fifteen Egyptian male farmers aged eight to 29 years, known urinary excretors of S. typhi or paratyphi A, were observed in hospital for periods varying between six to 12 months. Blood cultures were performed twice weekly using a Castaneda type two-phase bottle and 10 per cent ox bile. Urine samples were plated on Selenite media directly. Salmonella typhi or paratyphi A were recovered from the blood in every case though the clinical picture did not resemble typhoid fever. These bacteraemic phades were transient and were in some patients accompanied by a low-grade fever with occasional spikes of high fever. All patients were malnourished, debilitated, and has an anaemia refractory to treatment with oral ferrous sulphate. Intravenous pyelography demonstrated damaged urinary tracts caused by schistosomal infection in all patients such as hydronephrosis and hydroureters, bladder nodular filling-defects, bladder calcification stricture of the ureters, and reflux. It is suggested that these patients harbour the salmonella organisms in the urinary tracts from which intermittently they are shed intravascularly. Treatment therefore should aim at relieving the bilharzial obstruction by anti-schistosomal treatment followed by treatment with either ampicillin or chloramphenicol to clear any remaining foci of infection in the kidneys.
- Medicine and Medical Research