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Gallbladder Carriage of Salmonellaparatyphi A May Be an Important Factor in the Increasing Incidence of This Infection in South Asia
- Nely Shrestha Khatri, MD;
- Pukar Maskey, MD;
- Sanjay Poudel, MD;
- Vijay Kumar Jaiswal, MD;
- Abhilasha Karkey, MSc;
- Samir Koirala, MD;
- Nikki Shakya, MD;
- Krishna Agrawal, MD;
- Amit Arjyal, MD;
- Buddha Basnyat, MD;
- Jeremy Day, MD;
- Jeremy Farrar, MD;
- Christiane Dolecek, MD; and
- Stephen Baker, PhD
- From Patan Hospital, Lalitpur, Nepal, and Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
Background: Enteric fever is a burden in developing countries, in which poor sanitary conditions facilitate its persistence. Most cases are attributed to the bacterium Salmonella typhi. However, S. paratyphi A is an emerging agent of enteric fever. This trend is apparent in Kathmandu, Nepal, where the proportion of enteric fever cases at Patan Hospital caused by S. paratyphi A increased from 17.5% in 1993 to 34% in 2003 (1).
Salmonella typhi and S. paratyphi A are atypical with respect to the majority of the genus Salmonella because they can survive and replicate in deeper tissues. Systemic dissemination causes organisms to be found in the gallbladder. This ability of S. typhi to remain in the gallbladder is considered central to the transmission of typhoid fever (2). An estimated 10% of untreated patients continue to shed bacteria for …
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