The Medical Treatment of Chronic Typhoid and Paratyphoid Carriers; Review of Records of 111 Cases Contributed from Various Parts of Japan

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  • HIRAISHI Ko
    The Department of Infectious Disease, Tokyo Municipal Toshima Hospital

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Other Title
  • チフス性疾患の胆道系長期保菌者に対する内科的治療わが国における現況とその検討
  • チフスセイ シッカン ノ タンドウケイ チョウキ ホキンシャ ニ タイスル ナイカテキ チリョウ ワガクニ ニ オケル ゲンキョウ ト ソノ ケントウ

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Recent prevalence of typhoid and paratyphoid carriers has been posing a problem to public health in this country. Although much effort has been devoted toward improvement of the medical treatment of these disorders, there is still almost as much difficulty as in pre-antibiotic era.<BR>Since surgery is sometimes inadequate and removal of the gallbladder is not always successful in eradicating the carrier state, search for effective medical treatment should be continued.<BR>For this purpose, it is believed useful to grab the present situation and judge the effectiveness of vari ous methods adopted in this field. In this attempt, the author asked many clinical organizations in various parts of Japan to contribute to him their case-records as many as possible. Finally, the author was able to review 111 case-records from 20 clinical organs and carried out an analysis of the data from the therapeutical point of view.<BR>Some remarks to the definition of the carrier state and the recognition of the perfect cure are described first, and then an analysis of the data was summed up.<BR>1) The criterion adopted in this paper for the chronic biliary carrier state from the autor's empirical and practical viewpoint is that the finding of positive bile or stool cultures persists for over one year. (The recent progress in the field of the germ culture made the stool culture almost equivalent to the bile culture as far as the isolation rate is concerned.)<BR>2) Likewise, the author believed that at least one year period of negative follow-up examinations is necessary to confirm the cure of the carrier state.<BR>3) If strictly applied the above mentioned standard, only one case treated with the combination of Aminobenzyl-Penicillin (AB-PC) and Nalidixic Acid could be considered cured.<BR>4) Based on comparative observations of the lenghth of the pause of negative culture after the medical treatment, AB-PC seemed to be moderately effective and gave the impression that larger daily -dose and longer administration period are recommendable.<BR>5) Chloramphenicol, as being pointed out by many other authors, has shown no effectiveness to any extent.<BR>6) Though tried to only a few cases, T-ran (a compound of nitrofuran and thiadiazole) seemed pro -duced fairly good results. Further trial is needed.<BR>7) The other formulas of medical treatment, amounting as many as more than 40, have no value to be described here.<BR>8) Any mehods tried to those 16 cases who were still in carrier state after surgery failed to show any encouraging data, except that in only one case the stool cultures turned negative for about three months after i.m. Penicillin administrations for consecutive 5 days.

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