The majority of cases were in children and were typhoidal
22,26,27) Exposure to aerosolized F tularensis principally manifests as typhoidal
or pneumonic disease and produces greater mortality (30-60%) if untreated.
It is not known whether typhoidal
tularemia is associated with distinct radiographic signs that could be used to differentiate it from other types of tularemia.
Salmonella antibodies are known to cross-react with other antigens including those from non-typhoidal
Salmonella and malaria antigens, the use of Widal test as diagnostic tool in patients with malaria may lead to misleading results as demonstrated by some studies from Nigeria.
Pneumonia also occurs in 10% to 15% of patients with ulceroglandular tularemia and in one-half of those patients with typhoidal
Adequate sanitary measures have led to a decrease in cases of typhoidal
Salmonellae in developed countries, such as the USA and the UK, where the incidence is low, and most cases are associated with travellers returning from endemic areas of developing countries (5).
The case-fatality rate among humans can reach 30%-60% in untreated typhoidal
For surveillance purposes, OSDH staff categorized the clinical presentations as ulceroglandular (nine), typhoidal
(one), and pneumonic (one) .
Tularemia, a severe epizootic disease caused by the gram-negative, intracellular coccobacillus Francisella tularensis (1,2), has 5 clinical forms: glandular/ ulceroglandular, oculoglandular, pneumonic, typhoidal
, and oropharyngeal (2).
Poor specificity, is a consequence of pre-existing base line antibodies in endemic areas , cross reactivity with other Gram negative bacteria and non typhoidal
salmonella, anamnestic reactions in unrelated infections and prior TAB or oral typhoid vaccination .
The disparity in isolation between typhoidal
serogroups may be due to increased exposure or higher recurrent susceptibility as a result of the indiscriminate use of antibiotics in the general population.
The epidemiology and management of non typhoidal