This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Wain, J.
Right arrow Articles by Day, N. P. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Wain, J.
Right arrow Articles by Day, N. P. J.

 Previous Article  |  Next Article 

Journal of Clinical Microbiology, April 2001, p. 1571-1576, Vol. 39, No. 4
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.4.1571-1576.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Quantitation of Bacteria in Bone Marrow from Patients with Typhoid Fever: Relationship between Counts and Clinical Features

John Wain,1,2,* Phan Van Be Bay,3 Ha Vinh,4 Nguyen M. Duong,4 To Song Diep,4 Amanda L. Walsh,1,2 Christopher M. Parry,1,2 Robert P. Hasserjian,5 Vo Anh Ho,3 Tran T. Hien,4 Jeremy Farrar,1,2 Nicholas J. White,1,2 and Nicholas P. J. Day1,2

Wellcome Trust Clinical Research Unit, Centre for Tropical Diseases,1 and Centre for Tropical Diseases,4 Ho Chi Minh City, and Dong Thap Provincial Hospital, Cao Lanh, Dong Thap,3 Vietnam, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, John Radcliffe Hospital, Oxford,2 and Department of Histopathology, Imperial College School of Medicine, Hammersmith Campus, London, W12 0NN,5 United Kingdom

Received 29 August 2000/Returned for modification 11 December 2000/Accepted 30 January 2001

Enteric fever is the only bacterial infection of humans for which bone marrow examination is routinely recommended. A prospective study of the concentrations of bacteria in the bone marrow and their relationship to clinical features was conducted with 120 Vietnamese patients with suspected enteric fever, of whom 89 had confirmed typhoid fever. Ninety-three percent of the Salmonella enterica serovar Typhi samples isolated were resistant to ampicillin, chloramphenicol, and co-trimoxazole. For 81 patients with uncomplicated typhoid and satisfactory bone marrow aspirates, the number of serovar Typhi CFU in bone marrow aspirates was a median value of 9 (interquartile range [IQR], 1 to 85; range, 0.1 to 1,580) compared to 0.3 (IQR, 0.1 to 10; range, 0.1 to 399) CFU/ml in simultaneously sampled blood. The ratio of individual blood counts to bone marrow counts was 10 (IQR, 2.3 to 97.5). The number of bacteria in blood but not bone marrow was correlated inversely with the duration of preceding fever. Thus, with increasing duration of illness the ratio of bone marrow-to-blood bacterial concentrations increased; the median ratio was 4.8 (IQR, 1 to 27.5) during the first week compared with 158 (IQR, 60 to 397) during the third week. After lysing the host cells, the median ratio of viable bone marrow to blood increased, reflecting the higher concentration of intracellular serovar Typhi in the bone marrow. Effective antibiotic pretreatment had a significantly greater effect in reducing blood counts compared to bone marrow counts (P < 0.001). Thus, bacteria in the bone marrow of typhoid patients are less affected by antibiotic treatment than bacteria in the blood. The numbers of bacteria in bone marrow correlated negatively with the white blood cell (R = -0.3, P = 0.006) and platelet counts (R = -0.32, P = 0.01) and positively with fever clearance time after treatment (R = 0.4, P < 0.001). The bacterial load in bone marrow therefore may reflect the clinical course of the infection, and high levels may suppress neutrophil proliferation.

* Corresponding author. Present address: Department of Infectious Diseases and Microbiology, Imperial College Medical School, Norfolk Place, London, W2 1PG, United Kingdom. Phone: 020-7594-3715. Fax: 020-7262-6299. E-mail: j.wain{at}ic.ac.uk.

Journal of Clinical Microbiology, April 2001, p. 1571-1576, Vol. 39, No. 4
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.4.1571-1576.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


This article has been cited by other articles:

  • Sheikh, A., Bhuiyan, M. S., Khanam, F., Chowdhury, F., Saha, A., Ahmed, D., Jamil, K. M. A., LaRocque, R. C., Harris, J. B., Ahmad, M. M., Charles, R., Brooks, W. A., Calderwood, S. B., Cravioto, A., Ryan, E. T., Qadri, F. (2009). Salmonella enterica Serovar Typhi-Specific Immunoglobulin A Antibody Responses in Plasma and Antibody in Lymphocyte Supernatant Specimens in Bangladeshi Patients with Suspected Typhoid Fever. CVI 16: 1587-1594 [Abstract] [Full Text]  
  • Munford, R. S. (2008). Sensing Gram-Negative Bacterial Lipopolysaccharides: a Human Disease Determinant?. Infect. Immun. 76: 454-465 [Full Text]  
  • Reeves, R. K., Fultz, P. N. (2008). Characterization of Plasmacytoid Dendritic Cells in Bone Marrow of Pig-Tailed Macaques. CVI 15: 35-41 [Abstract] [Full Text]  
  • HATTA, M., SMITS, H. L. (2007). DETECTION OF SALMONELLA TYPHI BY NESTED POLYMERASE CHAIN REACTION IN BLOOD, URINE, AND STOOL SAMPLES. Am J Trop Med Hyg 76: 139-143 [Abstract] [Full Text]  
  • Vollaard, A. M., Ali, S., van Asten, H. A. G. H., Widjaja, S., Visser, L. G., Surjadi, C., van Dissel, J. T. (2004). Risk Factors for Typhoid and Paratyphoid Fever in Jakarta, Indonesia. JAMA 291: 2607-2615 [Abstract] [Full Text]  
  • Parry, C. M., Hien, T. T., Dougan, G., White, N. J., Farrar, J. J. (2002). Typhoid Fever. NEJM 347: 1770-1782 [Full Text]  
  • Mehta, G., Arya, S. C. (2002). Capsular Vi Polysaccharide Antigen in Salmonella enterica Serovar Typhi Isolates. J. Clin. Microbiol. 40: 1127-1128 [Full Text]  
  • Butler, T. (2001). Effect of increased inoculum of Salmonella typhi on MIC of azithromycin and resultant growth characteristics. J Antimicrob Chemother 48: 903-906 [Abstract] [Full Text]  


Copyright © 2009 by the American Society for Microbiology.   For an alternate route to Journals.ASM.org, visit: http://intl-journals.asm.org | More Info»