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Abbreviations

The document provides abbreviations related to typhoid fever and acknowledges various contributors to its preparation. It discusses the causative agent, Salmonella typhi, its genetic characteristics, and its distinction from Salmonella paratyphi A. The document also outlines the disease's transmission and the biological mechanisms involved in infection.

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11 views5 pages

Abbreviations

The document provides abbreviations related to typhoid fever and acknowledges various contributors to its preparation. It discusses the causative agent, Salmonella typhi, its genetic characteristics, and its distinction from Salmonella paratyphi A. The document also outlines the disease's transmission and the biological mechanisms involved in infection.

Uploaded by

mirz42653
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Abbreviations

Ig immunoglobulin (IgG, IgM)

i.m. intramuscular

i.v. intravenous

LPS lipopolysaccharide

MDR multi-drug resistant

Mp macrophages

NARST nalidixic-acid-resistant Salmonella typhi

Vi virulent (antigen)

v
Acknowledgements

We would like to thank the following for their participation in the preparation of
this document:

Dr Camilo Acosta, International Vaccine Institute, Seoul, Republic of Korea

Dr M. John Albert, Faculty of Medicine, Kuwait University, Kuwait

Dr M.K. Bhan, All India Institute of Medical Sciences, New Delhi, India

Dr Zulfiqar Bhutta, Aga Khan University, Karachi, Pakistan

Dr Robert Breiman, International Centre for Diarrhoeal Diseases Research, Dhaka,


Bangladesh

Dr John Clemens, International Vaccine Institute, Seoul, Republic of Korea

Dr Jeremy Farrar, Oxford University and the Hospital for Tropical Diseases,
Ho Chi Minh City, Viet Nam

Dr Asma Ismail, Universiti Sains Malaysia, Kelantan, Malaysia

Dr Keith Klugman, Emory University, Atlanta, USA

Dr Claudio F. Lanata, Instituto de Investigación Nutricional, Lima, Peru

Dr Myron M. Levine, University of Maryland School of Medicine, Baltimore, USA

Dr Pakleong Lim, Clinical Immunology Unit, The Prince of Wales Hospital, Shatin,
Hong Kong, People’s Republic of China

Dr Maria Neira, Department of Communicable Disease Prevention, Control and


Eradication, World Health Organization, Geneva, Switzerland

Dr Henk L. Smits, KIT Biomedical Research, Royal Tropical Institute/Koninklijk


Instituut voor de Tropen, Amsterdam, Netherlands

Dr Tikki Pang, Department of Evidence and Information for Policy, World Health
Organization, Geneva, Switzerland

Dr Christopher Parry, Department of Medical Microbiology University of Liverpool,


United Kingdom

vii
Dr Narain Punjabi, US NAMRU-2, Jakarta, Indonesia

Dr Philippe Sansonetti, Institut Pasteur, Paris, France

Dr Shosun Szu, NIH, Bethesda, USA

Dr John Wain, Imperial College Medical School, London, United Kingdom

under the coordination of

Dr Bernard Ivanoff, Department of Vaccines and Biologicals

and

Dr Claire Lise Chaignat, Department of Communicable Disease Surveillance


and Response

viii
Chapter 1:
The organism, the disease
and transmission

1.1 The organism

Typhoid fever is caused by Salmonella typhi, a Gram-negative bacterium. A very similar


but often less severe disease is caused by Salmonella serotype paratyphi A.
The nomenclature for these bacteria is confused because the criteria for designating
bacteria as individual species are not clear. Two main views on the nomenclature of the
genus Salmonella have been discussed. Le Minor and Popoff suggested that two species
should be recognized: Salmonella bongori and Salmonella enterica. S. enterica included
six subspecies, of which subspecies I (one) contained all the pathogens of warm-blooded
animals. S. typhi was a serotype within subspecies I: Salmonella enterica subspecies I
serotype typhi. This proposal was rejected by the International Judicial Commission
because the name was not well known to clinicians and its use might cause accidents
endangering health or life. The original rules therefore remain in force. Ezaki and
colleagues have noted in the International Journal of Systematic and Evolutionary
Microbiology that the correct nomenclature for the causal agent of typhoid fever is
Salmonella typhi and have requested that the current subspecific status of serotype
paratyphi A should be raised to specific status, i.e. Salmonella paratyphi A.

S. typhi has several unique features, the genetic basis of many of which is known as
a result of early genetic studies and the recent sequencing of the whole genome.
Although many genes are shared with E. coli and at least 90% with S. typhimurium,
there are several unique clusters of genes known as pathogenicity islands and many
more single genes that seem to have been acquired by S. typhi during evolution.
S. typhi can be identified in the laboratory by several biochemical and serological tests
(see Chapter 2). One of the most specific is that of polysaccharide capsule Vi, which is
present in about 90% of all freshly isolated S. typhi and has a protective effect against
the bactericidal action of the serum of infected patients. This capsule provides the basis
for one of the commercially available vaccines (see Chapter 4). Vi antigen is present in
some other bacteria (Citrobacter freundii, Salmonella paratyphi C and Salmonella
dublin) but not in exactly the same genetic context. The ratio of disease caused by
S. typhi to that caused by S. paratyphi is about 10 to 1 in most of the countries where
this matter has been studied.

1.2 The disease

During an acute infection, S. typhi multiplies in mononuclear phagocytic cells before


being released into the bloodstream. After ingestion in food or water, typhoid organisms
pass through the pylorus and reach the small intestine. They rapidly penetrate the
mucosal epithelium via either microfold cells or enterocytes and arrive in the lamina
propria, where they rapidly elicit an influx of macrophages (Mp) that ingest the bacilli
but do not generally kill them. Some bacilli remain within Mp of the small intestinal

WHO/V&B/03.07 1

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