Search

Fifty-nine adult Filipino patients suffering from typhoid fever documented by blood culture were randomly allocated to one of three different drug regimens. Nineteen patients received 3 g ceftriaxone iv once daily for three days. Twenty patients received 4 g ceftriaxone iv once daily for three days and 20 patients received oral chloramphenicol 3 g daily in divided doses for two days followed by 2 g daily for 12 days. Eighteen patients were cured (95%) with 3 g of ceftriaxone for three days. All patients receiving 4 g ceftriaxone per day for three days or chloramphenicol for 14 days were cured. In the ceftriaxone groups two patients developed typhoid fever 30 and 45 days respectively after completion of treatment and one further patient had evidence of reinfection. Three patients relapsed within 15 to 17 days in the chloramphenicol group. Fever subsided in most patients between six and eight days, with three patients having a prolonged and moderate fever for 11 days in the ceftriaxone groups. This study suggests that a short treatment of three days of typhoid fever with ceftriaxone (3 or 4 g once daily) is adequate and not hazardous as far as relapses are concerned.

Sixty-four out of 189 jaundiced patients at San Lazaro Hospital were defined as acute viral hepatitis cases. Of this number, 22 (34.4%) were positive for hepatitis A markers while 26 (40.6%) were positive for hepatitis B markers. Hepatitis D infection accounted for 1.6%, while non-A, non-B hepatitis accounted for 21.9%.

Forty-six patients with Plasmodium vivax malaria were evaluated for their clinical and parasitological response to the two single doses of mefloquine in comparison with the standard 3-day treatment with chloroquine. The patients were randomly distributed into 3 groups. Group 1 with 13 patients were treated with a single dose 250 mg mefloquine, Group 2 with 15 patients were treated with a single dose 500 mg mefloquine and Group 3 with 18 cases were treated with the standard 3-day treatment course of 1,500 mg chloroquine. All patients in the three treatment group showed similar parasite, clearance time, fever clearance time and clearance time of signs and symptoms. There were no statistically significant differences between any of the groups. The age and weight, as well as the initial parasite count of the three groups were comparable. This study shows that mefloquine at the dosages used were as effective as the 3-day standard treatment with 1,500 mg chloroquine.

A long term study was carried out at San Lazaro Hospital, Manila, Philippines, monitoring the in vitro response of Plasmodium falciparum to chloroquine, amodiaquine, mefloquine, and quinine. The in vitro effective dose giving 50% inhibition of schizogony was: 0.68 X 10(-6) M/liter blood for chloroquine; 0.18 X 10(-6) for amodiaquine; 0.2 X 10(-6) for mefloquine; and 1.12 X 10(-6) for quinine. The percent of isolates determined to be resistant in vitro was 85.2% for chloroquine, and 1.2% for both mefloquine and quinine. These figures were relatively unchanged over the course of 3 years studied. The in vitro resistance rate to amodiaquine increased from 5.1% in 1982 to 22.2% in 1984.

The dose response of Plasmodium falciparum isolates in the standard in vitro assay for drug resistance was compared using blood specimens which were centrifuged and washed before cultivation. Washing of the cultures increased the success of cultivation by greater than 100%. Eight cultures which grew using both methods gave similar results in the determination of resistance or sensitivity. The ED50 as determined by probit analysis, was approximately 50% higher in parasites which had been washed before cultivation.

Eight hundred blood cultures were tested in parallel in three conventional systems: tryptic soy broth containing 0.05% sodium polyanethosulfonate (TSB-SPS), whole blood in bile (BILE-BLOOD), and blood clots in bile (BILE-CLOT). Sixty-eight cultures were Salmonella typhi positive and 29 were positive for S. paratyphi A in at least one of the systems. Analysis of the isolation rates of the 97 Salmonella-positive specimens showed that BILE-BLOOD was significantly more sensitive (p less than 0.05) than either TSB-SPS or BILE-CLOTS, and that the latter two were not significantly different. The time required for positive results was shortest in BLOOD-BILE which was significantly quicker than BILE-CLOTs (p less than 0.05), but not TSB-SPS (p greater than 0.05). Possible explanations for the observed, superior performance of the BILE-BLOOD system are discussed and recommendations for efficient recovery of enteric fever salmonellae from blood are presented.

101 patients with a clinical suspicion of typhoid or paratyphoid (enteric) fever admitted to San Lazaro Hospital, Manila, Philippines, were studied by bacteriological culture of blood, rectal swab, urine and duodenal string capsule; 35 also had bacteriological culture of bone marrow aspirate. 44 of the patients were culture-confirmed as having enteric fever; the remainder were classified as non-enteric fever cases. Analysis of the pretreatment Widal agglutination titres of all patients revealed that using as a diagnostic criterion an antibody titre of greater than or equal to 1:80 to the O antigen of Salmonella typhi yielded a test specificity of 100%, although the corresponding sensitivity was only 64%. The sensitivity of the test could be increased to 80% by using different cut-off values for titres to flagellar antigens, but this concomitantly decreased the test specificity from 100 to 82%. The data indicate that a single pretreatment Widal test in suspected enteric fever cases is of definite diagnostic value, but that the results must be interpreted with caution and foreknowledge of the test's shortcomings and limitations.