Laval Enrique, Ferreccio Catterina
Programa de Estudios Médicos y Humanísticos, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Rev Chilena Infectol. 2007 Dec;24(6):435-40. Epub 2007 Dec 13.
This article presents the history of typhoid fever in Chile since its definition as a clinical entity until our days. From this history is evident the long lasting confusion with typhus (rickettsial spotted fever) in Chile although the identity and characteristics of typhoid fever had been established in the first half of nineteenth century in Europe. This confusion could be explained because some clinical features are similar in both diseases (high fever and delirium) and because of its occurrence in poor hygienic conditions. This misconception was resolved only during 1918 on occasion of a major typhus outbreak that allowed physicians to clearly diagnose this rickettsial disease. Once typhoid fever was recognized it was possible to describe its epidemiological pattern with high endemic incidence mainly in urban districts, with summer increases and epidemic cycles. In the contemporary history of typhoid fever it is remarkable a huge outbreak during 1976-1985, associated to abrupt socioeconomical and environment crisis, as well as an abrupt diminution of the disease in 1992, with a marked reduction that persists until now. This last phenomenon was the consequence of a quasi-experimental public health intervention and sanitary education conducted in 1992 to avoid the cholera epidemic that was spreading in Perú, a neighboring country. We conclude that, although the hypothesis of environment contamination as the cornerstone in typhoid persistence was present since the recognition of the disease in 1894, it was faced efficiently only and perhaps in a definitely manner only almost 100 years later.
本文介绍了伤寒在智利的病史,从其被定义为一种临床实体至今。从这段历史可以明显看出,在智利,伤寒长期以来一直与斑疹伤寒(立克次体斑疹热)混淆,尽管伤寒的特征和特性在19世纪上半叶的欧洲就已确立。这种混淆可以解释为,两种疾病的一些临床特征相似(高烧和谵妄),且都发生在卫生条件差的环境中。这种误解直到1918年一次大规模斑疹伤寒疫情爆发时才得以解决,那次疫情让医生能够明确诊断这种立克次体疾病。一旦确认了伤寒,就有可能描述其流行病学模式,其主要在城市地区具有高地方发病率,夏季发病率上升且有流行周期。在伤寒的当代历史中,值得注意的是1976 - 1985年期间的一次大规模疫情爆发,这与社会经济和环境的突然危机有关,以及1992年该病的突然减少,这种显著减少一直持续至今。最后这一现象是1992年为避免邻国秘鲁正在蔓延的霍乱疫情而进行的准实验性公共卫生干预和卫生教育的结果。我们得出结论,尽管自1894年认识到该病以来,环境污染作为伤寒持续存在的基石这一假设就已存在,但直到大约100年后才可能有效地、或许也是决定性地应对这一问题。