General considerations in the management of typhoid fever and dysentery.

Typhoid fever is diagnosed on the basis of isolation of Salmonella typhi from blood, bone marrow, or bile. S. typhi found in stool or urine may reflect chronic asymptomatic carriage. Although antimicrobial therapy may not eliminate carriage, it is effective for the treatment of clinically evident acute disease. Among the drugs currently available, chloramphenicol is the most widely used. Chloramphenicol is effective and inexpensive, but it is associated with a 3% rate of chronic carriage, a high relapse rate, and, in rare cases, aplastic anemia. For these reasons, and because of the emergence of chloramphenicol-resistant strains of S. typhi, alternative drugs need to be considered. Dysentery is characterized by the passage of unformed stools that commonly contain blood and mucus and in which large numbers of leukocytes can be detected on microscopic examination. Invasion of the intestinal epithelium is the distinguishing characteristic, and Shigella sp are the most frequent cause. Although oral rehydration is useful in dehydrated patients, dehydration is not a common problem in acute dysentery, and antimicrobial treatment is indicated for this disease. An antimicrobial agent should be selected on the basis of knowledge of the susceptibility patterns of locally isolated Shigella strains.