Recent advances in enteric fever
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Recent advances in enteric fever diagnosis and treatment include new diagnostic tests and vaccines. The IDL Tubex速 test and Typhidot速 test can rapidly detect IgM antibodies to aid in diagnosing current Salmonella infections. Typhidot-M速 detects IgM only and can replace Widal tests. PCR methods also show promise but may not be cost-effective. Newer treatments include azithromycin and combination therapies with quinolones and zidovudine. Vaccines including the Vi polysaccharide vaccine and live attenuated vaccines like CVD 908 and CVD 908-htrA show effectiveness above 65% and are well tolerated.
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Recent advances in enteric fever
- 1. Recent advances in ENTERIC FEVER By DIWAN SHRESTHA INTERN Department of Paediatrics, NMCTH
- 2. Newer Diagnostic Methods 1. Recent advances include the IDL Tubex速 test by a Swedish company, which reportedly can detect IgM O9 antibodies. The O9 antigen used in the test is extremely specific because its immunodominant epitope is a rare dideoxyhexose sugar in nature. This antigen has been found in serogroup D salmonellae but not in other microorganisms. A positive result given by Tubex速 invariably suggests a Salmonella infection.
- 3. Newer Diagnostic Methods Cntd Tubex速 detects IgM antibodies but not IgG. This makes it invaluable as an aid in the diagnosis of current infections. 2. Another rapid serological test, Typhidot速, makes use of the 50 kD antigen to detect specific IgM and IgG antibodies to S. Typhi and takes three hours to perform.
- 4. Newer Diagnostic Methods Cntd This dot enzyme immuno assay (EIA) test offers simplicity, speed, specificity (75%), economy, early diagnosis, sensitivity (95%) and high negative and positive predictive values. The detection of IgM reveals acute typhoid in the early phase of infection The detection of both IgG and IgM suggests acute typhoid in the middle phase of infection
- 5. Newer Diagnostic Methods Cntd 3. A newer version of the test, Typhidot-M速, was recently developed. It detects specific IgM antibodies only. This test can replace the Widal test, when used in conjunction with the culture method, for the rapid and accurate diagnosis of typhoid fever.
- 6. Newer Diagnostic Methods Cntd 4. The typhoid IgM dipstick assay is also being designed for the serodiagnosis of typhoid fever , through the detection of S.Typhi specific IgM antibodies in serum or whole samples. 5. Salivary IgM test has also been used, though not yet available.
- 7. Newer Diagnostic Methods Cntd 6. There has been study on validation of a PCR for diagnosis of typhoid fever and salmonellosis by amplification of the hilA gene in clinical samples from Colombian patients. But, it may not be cost-effective.
- 8. Newer Treatment methods Resistance to third and fourth generation cephalosporins is emerging and will gain significance in the coming decade. Azithromycin has shown promise in a limited number of trials. The main advantage of aztreonam and azithromycin is that they can be used in children and in pregnant or nursing females.
- 9. Newer Treatment methods Quinolones and zidovudine have a synergistic antibacterial effect against Salmonella administration of both drugs may dramatically decrease the risk of recurrent infection. The use of glucocorticoid has been advocated for the treatment of severe typhoid fever based on a randomized, double blind, placebo controlled trial carried out in Indonesia This study showed a significant reduction in mortality in patients with severe typhoid fever
- 10. Vaccines against Typhoid Fever Two vaccines against typhoid fever (Parenteral Vi polysaccharide and oral Ty21a) have been licensed in many countries A new typhoid vaccine composed of the Vi capsular polysaccharide has been reported The Vi polysaccharide vaccine has been put to trial and provided more than 65% protection
- 11. Vaccines against Typhoid Fever Attenuated Salmonella type vaccine Strain CVD 908, which harbors deletion mutation, in aro-C and aro-D has been shown to be well tolerated and highly immunogenic A further derivative prepared by introducing a deletion in htr-A resulted in CVD 908-htr A Both CVD 908 and CVD 908-htrA are useful as live vector vaccines to deliver foreign antigens to the immune system