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andtrimethoprim-sulfamethoxazole,� whicharetraditionallyfirst-lineagentsfor� thetreatmentofentericfever.�Themultid- rugresistancephenotypehasbecomecom- moninS. typhiand,�toalesserextent,�S. paratyphi� (ParryandThrelfall,� 2008)� and� thishasledtogreaterrelianceonother� agents,�particularlyfluoroquinolones.� Promisingresultswithciprofloxacin� suggestedthatitwasmoreeffectiveinthe� treatmentofuncomplicatedentericfever� inareaswithhighratesofmultidrugresist- ancesalmonellae� (Alametal,� 1995)� and� quinolonesalsohavesignificantlyreduced� failureratescomparedwithsomefirst-line� agentsinentericfevercausedbysuscepti- bleisolates� (Thaveretal,� 2008).� Unfortunately,� overthepastdecade,� iso- lateswithdecreasedciprofloxacinsuscepti- bilityhavebecomemorecommonandare� associatedwithtreatmentfailureand� relapse� (Chuangetal,� 2009).� Atthe� HospitalforTropicalDiseases,� London,� salmonellaewithdecreasedciprofloxacin�

A rare case is recorded of typhoid osteomyelitis with characteristic diaphyseal involvement of the right radius and the left ulna with sequestrum formation and microbiological confirmation from the tissues removed at operation. The literature is reviewed.

THIS CASE is reported because of the rarity of the type G typhoid bacillus, the infrequency of typhoid osteomyelitis in the United States and the promising status of chloramphenicol (chloromycetin ® ) in treatment of patients with typhoid infections. REPORT OF CASE History. —R. C. was a 27 year old man who first presented himself at the infirmary at Emory University in March 1948, because of recurrent attacks of pain in the right shoulder. During the war he had served as a Royal Air Force pilot and had been stationed in Eastern Canada, the United States, Great Britain, Spain, Gibraltar, France, Malta, French Morocco, Algeria, Tunisia, Cyprus, Palestine, Iraq, Iran, India, Ceylon, Saudi Arabia and Egypt. From July 1946 until the time of writing he had been residing in southeastern United States. He had received his first immunization against typhoid in 1940 and continued booster shots at yearly intervals. It is surmised

A 14-year-old boy sustained a transverse subtrochanteric fracture after a fall. Investigations suggest that the fracture occurred through an area of typhoid osteomyelitis in a patient free from enteric fever or any other disease.