title: Association of carcinoma of the gallbladder with typhoid carriage in a typhoid endemic area using nested PCR.
abstract: BACKGROUND
  Although well studied the association between chronic typhoid carrier state and carcinoma of the gallbladder (CaGB) remains unproven.
  
  
  METHODS
  The study was performed at a tertiary care medical center in North India and involved 52 patients with CaGB, 223 patients with benign gallbladder diseases, 508 healthy individuals and, 424 corpses. For the detection of Salmonella enterica serovar Typhi, hepatobiliary specimens were subjected to DNA extraction for specific nested- PCR amplification of the S. Typhi flagellin gene. Anti-Vi S. Typhi antibodies were detected in serum samples from patients by indirect haemagglutination.
  
  
  RESULTS
  Thirty five of the 52 (67.3%) CaGB patients were PCR-positive for the S. Typhi flagellin gene; significantly higher than for patients with benign gallbladder diseases (95/223, 42.6%; p<0.01) and corpses (35/424, 8.2%; p<0.001). The numbers of individuals that had significant anti-Vi antibody titres (> or = 160) in their serum were 20/52 (38.5%) for CaGB patients, 31/223 (13.9%) for patients with benign gallbladder diseases, and 47/508 (9.2%) for healthy individuals.
  
  
  CONCLUSIONS
  Specific nested-PCR amplification of the S. Typhi flagellin gene in hepato-biliary specimens was more sensitive for detection of S. Typhi carriage than anti-Vi antibody titres in serum. The results demonstrate an association between typhoid carriage and gallbladder diseases, both CaGB and benign. S. Typhi specific immunosuppression is also suggested in patients with gallbladder diseases.
authors.affiliation: Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, India. gopalnath@gmail.com
authors.forename: Gopal
authors.initials: G
authors.lastname: Nath
authors.forename: Yogesh Kumar
authors.initials: YK
authors.lastname: Singh
authors.forename: Kailash
authors.initials: K
authors.lastname: Kumar
authors.forename: Anil Kumar
authors.initials: AK
authors.lastname: Gulati
authors.forename: Vijay Kumar
authors.initials: VK
authors.lastname: Shukla
authors.forename: Ajay Kumar
authors.initials: AK
authors.lastname: Khanna
authors.forename: Sunil Kumar
authors.initials: SK
authors.lastname: Tripathi
authors.forename: Ashok Kumar
authors.initials: AK
authors.lastname: Jain
authors.forename: Mohan
authors.initials: M
authors.lastname: Kumar
authors.forename: Tej Bali
authors.initials: TB
authors.lastname: Singh
mesh_terms: D000328:Adult; D002353:Carrier State / Q000382:microbiology*; D016022:Case-Control Studies; D019353:Endemic Diseases; D005260:Female; D005408:Flagellin / Q000235:genetics / Q000302:isolation & purification; D005706:Gallbladder Neoplasms / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011135:Polysaccharides, Bacterial / Q000276:immunology; D012485:Salmonella typhi / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D017678:Sex Distribution; D014435:Typhoid Fever / Q000150:complications* / Q000453:epidemiology
chemical_list: D011135:Polysaccharides, Bacterial; D005408:Flagellin