Seminar Typhoid and paratyphoid fever M K Bhan, Rajiv Bahl, Shinjini Bhatnagar Typhoid fever is estimated to have caused 21·6 million illnesses and 216 500 deaths globally in 2000, affecting all Lancet 2005; 366: 749–62 ages. There is also one case of paratyphoid fever for every four of typhoid. The global emergence of multidrug- All India Institute of Medical resistant strains and of strains with reduced susceptibility to fluoroquinolones is of great concern. We discuss the Sciences, New Delhi 110029, occurrence of poor clinical response to fluoroquinolones despite disc sensitivity. Developments are being made in India (Prof M K Bahn MD, R Bahl PhD, S Bhatnagar PhD) our understanding of the molecular pathogenesis, and genomic and proteomic studies reveal the possibility of new Correspondence to: targets for diagnosis and treatment. Further, we review guidelines for use of diagnostic tests and for selection of Professor M K Bhan antimicrobials in varying clinical situations. The importance of safe water, sanitation, and immunisation in the
[email protected] presence of increasing antibiotic resistance is paramount. Routine immunisation of school-age children with Vi or Ty21a vaccine is recommended for countries endemic for typhoid. Vi vaccine should be used for 2–5 year-old children in highly endemic settings. Typhoid fever is a systemic infection caused by have important limitations, however. They are based on Salmonella enterica serotype typhi (S typhi). A very data from only a few countries, with only one study similar but often less severe disease is caused by providing data from Africa. Placebo groups from typhoid S paratyphi A, B, and sometimes C.