Typhoid fever is still prevalent in Korea. For preventive purpose rather than merely diagnostic, we have to devise a more effective method to detect Salmonella in bile. The purpose of this study is to evaluate the ability of the enteric string capsule test to isolate Salmonella in bile. Bile culture has long been neglected in spite of a vast number of papers concerning typhoid fever. The study group consisting of 101 febrile patients had undergone enteric string capsule test with blood, urine, and stool cultures simultaneously. The results were as follows:
1) Pathogen was isolated in 25 patients (24.8%), 20 (80%) of whom yielded Salmonella typhi and the other 5 (20%), Salmonella paratyphi.
2) Among these 25 cases, Salmonella was isolated from the cultures of bile in 24 (96%). In contrast, Salmonella was recovered from blood in only 7 (28%), and from stool in 12 (48%), showing that bile culture was superior to those of blood and stool (P<0.01). Bile culture was also superior to the combined result of blood and stool cultures (96% versus 72%, P<0.05). If cultures had been limited to blood, stool, and urine, the bacteriological diagnosis would have been missed in 7 patients.
3) Positive bile cultures were obtained in the late stage of the illness as well as the early stage. The durations of clinical illness in 24 patients prior to positive bile cultures were as follows:
7 patients (28%) within 1 week, 8 (32%) in 2 weeks, 5 (20%) in 3 weeks, 1 (4%) in 4 weeks, 2 (8%) in 5 weeks, and 1(4%) in 9 weeks. In contrast, positive cultures of stool or blood occurred mainly in the first 3 weeks of clinical illness.
4) 27 patients (26.7%) had Widal titers of more than 1:160 in serum. Sixteen (59.2%) of them gave negative culture and the remaining 11 (40.8%) were positive.
The result suggested that isolation of Salmonella in bile was more significant than in blood or stool, regardless of the duration of illness, and the enteric string capsule test would be a simple and useful diagnostic method for both clinically ill patients and for the detection of typhoid carriers.
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