الفهرس 
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Abstract
Typhoid fever remains an important public health problem in many
parts of the world. Rapid and Sensitive laboratory methods for diagnosis of
typhoid fever are essential for prompt and effective therapy (Song et al.,
1993).
Typhoid fever may mimic a variety of infections diseases during the
initial phase, many patients have already been on antibiotics before
admission, especially in countries where diagnostic facilities are limited
(Hoffman et al., 1984).
This study was designed to compare differentculturing and serological
techniques used in the diagnosis of enteric fever, to find the most rapid,
sensitive and specific test for early diagnosis of typhoid fever. The study also
aimed to evaluate the problem of salmonella multi drug resistance in Egypt.
The study was done on 312 patients admitted to Abbassia fever
hospital from April 2000 to April 2002. One hundred ninety one patients
proved to have typhoid fever by laboratory diagnostic tests including
different diagnostic blood culturing techniques and stool culture and
serologicaltests.
from this study it was found that:
1- The most rapid blood culture technique was lysis centrifugation
culture (Isostate culture) with average time 1 day, but it was less
sensitive (43%) than conventional blood culture (55%). Isostate
culture is easy to perform, needs only 30 minutes centrifugation.
2- The simplest blood culturing technique was bile streptokinase culture
(Clot culture) which had nearly the same sensitivity (58%) as the
conventional blood culture (58%). It takes nearly the same average
time 2.6 days as the conventional blood culture 2.8 days. The
advantages of this technique are: (1) it is selective for salmonella
species and (2) it inhibits the growth of skin contaminants. (3) It is
economic method and (4) can be performed in laboratories when blood
culture technique is not available, also (5) the separated serum can be
used for serological diagnosis of typhoid fever.
3- The conventional blood culture is still a seneitive blood culture
technique (55%) but it takes more average time (2.8 days) for isolating
the organism. It has advantage of isolating different micro-organisms
other than salmonella.
4- Stool culture had a limited value in the diagnosis of acute typhoid
fever with sensitivity (13%).
5- Serological examination for salmonella antibodies by widal tube
agglutination test helped in the diagnosis of76.4% of typhoid cases. It
is of great importance especially in young age.
6- Modified widal test using 2 mercaptoethanol help in confirmation of
acute typhoid cases.
7- The highest isolation rate of salmonella strains from blood (47%) was
obtained by using both conventional blood culture can detect
salmonella species within 24 hours and in case of false negative results
due to low number of bacteria (C.F.U. ml) we still have the chance for
isolation of salmonella by the convential blood culture.
8- All salmonella strains 127 (100%) isolated in the study were sensitive
to third generation cephalosporins and quinolones and only 41 (32%)
were resistant to chloramphenicol which is still the drug of choice in
treatment of typhoid fever in fever hospitals.
usion and Recommendation
1- Blood culture and serological tests should be used together in the
diagnosis of typhoid fever.
2- A combination of convential blood culture and isostate culture is
proved to be the most rapid technique and it gives the highest isolation
rate of salmonella strains. Only 10 m1blood could be enough for both
techniques the cost will be reduced as the lytic solution will be
prepared.
3- Antibiotic sensitivity test should be done for all salmonella isolates to
detect multi drug resistant strains (MDR).
4- As only 32% of isolated salmonella strains found to be resistant to
chlorampheniocol it is recommended to begin therapy of enteric fever
by chloramphenicol in the proper dose and route. If the general
condition of the patient does not improve after 5 days therapy or if
complications as typhoid haemorrhage or perforation or blood culture
revealed M.D.R. salmonella, the patient should be treated by either
quinolones or third generation cephalosporins.