Intrahepatic Typhoid Carriers

Abstract

The typhoid-carrier state among the Chinese in Hong Kong differs from that reported in Europe and the U.S.A. in that there is an equal sex incidence and cholecystectomy fails to eradicate the infection. Evidence is presented which is consistent with the carrier state being maintained by a focus of infection within the liver, a focus which is indistinguishable from the early lesion encountered in pyogenic cholangitis due to E. coli, the common disease of the biliary tract in Hong Kong. It is concluded that the absence of the gall-bladder carrier may be attributable to the rarity of chronic cholecystitis. The factors responsible for the persistence of the salmonellae within the liver have not been determined. In view of a significantly higher incidence in typhoid carriers of infection of the bile-ducts with a liver fluke, C. sinensis, it is concluded that this infection may be a factor, though it cannot be the only one. While the majority of carriers remain symptomless excreters, in a minority the infection extends, and the syndrome of recurrent pyogenic cholangitis which develops can be distinguished from that due to E. coli only by bacteriological investigation. It would appear that approximately 5% of cases of recurrent pyogenic cholangitis are due to salmonellae. Sulphonamides and a variety of antibiotics have been used in an attempt to eradicate the infection, but to no avail. A six-months course of ampicillin and probenecid similarly failed to eradicate the infection in symptomless carriers, symptomless cholecystectomized carriers, and carriers with recurrent pyogenic cholangitis who had been treated surgically. The public health implications of the reported findings are obvious. These are not restricted to Hong Kong. For example, there are some thousands of Chinese, recent emigrants from Hong Kong, employed in restaurants in the United Kingdom. © 1966, British Medical Journal Publishing Group. All rights reserved.