In this issue on page 452, Roopa et al have discussed a case report of breast abscess caused by Salmonella Typhi. If the salmonella can be isolated from the breast abscess, sure enough we should be able to isolate salmonella from the blood culture in patients having typhoid fever. For this to happen, the habits of General Practitioners and the Pathologists will have to change.
1. The blood culture must be collected before antibiotics are given.
2. Minimum quantity - 15 ml of blood should be collected for salmonella culture.
3. The blood should be collected atleast on 2-3 occasions, during two days period (one of them may be at the height of fever).
Sometimes, manual blood cultures done in "enriched" media, are better than bactec automated cultures. Though almonella is a common organism causing gastroenteritis and food poisoning, stool culture done in a suspected typhoid case is of very little significance.
It is also worth remembering that in our country, if a patient who is diagnosed as tuberculous osteomyelitis does not respond to the treatment, salmonella osteomyelitis must be thought of, specially if the lesion is in the spine.
Finally, just as Roopa et al have discussed a case report of salmonella abscess in the breast, salmonella abscess can occur in the liver and the brain.
Thus, the practitioners must become very familiar with the salmonella organism and should forget about an antibody test like Widal test to pick up the same.
INTENSITY OF WARFARIN THERAPY TO PREVENT RECURRENT VENOUS THROMBOEMBOLISM
In an attempt to reduce the risk of bleeding, some have recently proposed lowering the intensity of anticoagulant therapy with warfarin for the prevention of recurrent venous thromboembolism. This randomized trial found that low-intensity warfarin therapy is not as effective as conventionalintensity therapy in the prevention of recurrent thrombo-embolic events. Furthermore, low-intensity therapy did not reduce the risk of bleeding complications.
This study does not support the use of low-intensity warfarin therapy in this clinical setting.
NEJM, 2003; 349(7) : 625