Clegg A
Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
P N G Med J. 1995 Dec;38(4):315-9.
In typhoid-endemic areas the results obtained from the laboratory are important in confirming the clinical diagnosis of typhoid and may also contribute to decisions made on the management and treatment of typhoid cases. Isolation of Salmonella typhi remains the gold standard, with culture from bone marrow aspirate or a combination of specimens from other body sites resulting in the greatest sensitivity. Antibody detection techniques may still provide valuable information, but only if the results are interpreted in the context of the background antibody levels in the local population. None of the available antigen detection techniques have been consistently demonstrated to be of diagnostic value and a recently developed polymerase chain reaction (PCR) for the detection of Salmonella typhi has yet to undergo a full-scale clinical evaluation. The initial identification of chronic typhoid carriers relies upon the detection of elevated Vi capsular antibody levels, but seeking out chronic carriers will be of limited value in controlling the spread of typhoid in areas where transmission is principally mediated by convalescent excretors. Whilst resistance of Salmonella typhi to antibiotics has emerged as an increasing problem in some areas of the world, it is still uncommon in isolates from Papua New Guinea. However, monitoring of antibiotic susceptibility patterns will ensure that signs of developing resistance are detected early and that the appropriate action is taken.
在伤寒流行地区，实验室检测结果对于确诊伤寒临床诊断很重要，也有助于对伤寒病例的管理和治疗做出决策。伤寒杆菌的分离仍然是金标准，骨髓穿刺培养或来自其他身体部位的标本组合培养具有最高的敏感性。抗体检测技术可能仍能提供有价值的信息，但前提是结果要结合当地人群的背景抗体水平来解读。现有的抗原检测技术均未被一致证明具有诊断价值，最近开发的用于检测伤寒杆菌的聚合酶链反应（PCR）尚未进行全面的临床评估。慢性伤寒带菌者的初步识别依赖于检测Vi荚膜抗体水平升高，但在主要由恢复期排菌者介导传播的地区，寻找慢性带菌者对控制伤寒传播的价值有限。虽然在世界某些地区，伤寒杆菌对抗生素的耐药性已成为一个日益严重的问题，但在巴布亚新几内亚分离出的菌株中仍不常见。然而，监测抗生素敏感性模式将确保早期发现耐药性发展迹象并采取适当行动。
