A CASE OF RECURRENT TYPHOID-FEVER IN THE UNITED-STATES - IMPORTANCE OF THE GRANDMOTHER CONNECTION AND THE USE OF LARGE RESTRICTION FRAGMENTPATTERN-ANALYSIS OF GENOMIC DNA FOR STRAIN COMPARISON

An 8-year-old girl was infected for a second time with Salmonella typh i by contact with her grandmother, a known typhoid carrier. The S. typ hi from both patient and grandmother had closely related genomic pulse d field gel electrophoresis patterns that differed from epidemiologica lly unrelated strains. The girl responded well to a 14-day course of o ral trimethoprim-sulfamethoxazole. The grandmother was treated success fully with a 28-day regimen of oral ciprofloxacin. Typhoid fever remai ns an endemic disease in the United States, largely because of recogni zed chronic stool carriers. Most of these carriers had typhoid in the preantibiotic era and remain potential sources of disease when they pr ovide meals for others, not uncommonly grandchildren. The importance o f this ''grandmother'' connection to endemic typhoid fever is reviewed , as is the potential use of pulsed field gel electrophoresis pattern analysis for comparison of strains of S. typhi.