TYPHOID ABSCESS 57 YEARS LATER.
THE typhoid bacillus is well-known as a pyogenic organism and one which may be long in producing this effect; in the present case the interval was fifty-seven years.
CLINICAL AND BACTERIOLOGICAL REPORT.
A man of 68 and a clear witness was admitted to hospital on May 30th, 1936, with a swelling in the left popliteal fossa which had been present for six months, and with a history of some sweating at night for about two weeks before admission. His only previous illness was typhoid fever at eleven years, and this was fixed in his mind, as it came on very soon after a Sunday school outing.
There was no history of injury, and X-rays revealed no bony lesion. The swelling was incised and drained of its yellow creamy contents. Direct film of this pus showed no B. tuberculosis or other organisms, but on aerobic cultivation at 37 C. for eighteen hours a pure growth of B. typhosus was obtained. The patients blood serum agglutinated B. typhosus to a dilution of 1 in 50, but no further-a technical “positive”. B. paratyphosus A and B were not agglutinated. The patients own organism was agglutinated to a dilution of 1 in 125.
No pathogenic organisms were obtained from the faces and urine at two examinations. B. typhosus was again isolated from the abscess two days later, but no subsequently; the wound healed slowly under antiseptic treatment.
[N.B.-In this case the latent disease took 57 years to “ultimate.”-ED.].
E. N. Wardle (1935) reported the isolation of B. typhosus from a bone abscess at the mid-length of the right tibia, opened at operation in August, 1934, on a man aged 34 with a history of typhoid fever ten years previously. There was a remote history of trauma. The mans serum agglutinated the organism to a dilution of 1 in 125. Wardle also quoted Keen as mentioning a case reported by Buschke, in which the organism was obtained in pure culture from a tibial abscess seven years after the fever.
Brock (1937) described a case of Post-typhoid Chondritis with Abscess Formation” in a medical practitioner aged 32. Here a pure growth of B. paratyphosus B was obtained from the “1 c.cm. of thin yellow pus” found by operation on October, 1934) upon a subacute abscess of the first left costal cartilage. The patients serum agglutinated B. paratyphosus up to a dilution of 1 in 500. There was an indefinite history of paratyphoid fever fourteen years previously but blood culture and Widal reactions were then negative.
Van Dyk (1933), in a symposium on enteric fever, recalled a man who had typhoid fever during the siege of Mafeking, passed the next twenty-four years as a soldier and a policeman, was kicked by a horse on the lower part of the right thigh, and straightaway developed an osteomyelitis at the site. The pus gave a pure growth of B. typhosus.
We are indebted to Emeritus Professor Walker Hall and Dr. D. M. Stone, clinical pathologist in the Preventive medicine Laboratories, for advice and permission to report this case; to Dr. Peters of Ham Green Isolation Hospital for the progress notes and for pointing out the rarity of such a young patient entering the carrier state; and to Mr. T. J. Shields, B. M. A. librarian, for obtaining the references for us.
Brock, R. L. (1935). Brit. J. Surg., July, P. 321. Van Dyk, C.G.L. (1933). S. Afr. Med. J., May 13th, P. 288. Wardle, E. N. (1935). Clin. J., March, P. 121.
P. PHILLIPS, M.D., M.Sc., Ch.B.,.
Medical Superintendent, Southmead Hospital, Bristol.