Endotoxin Tolerance in Patients with Chronic Bacteremia and Bacteriuria Due to Salmonella

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Abstract
Chronic salmonella bacteremia frequently accompanies urinary-tract carriage in Egyptian patients with concurrent schistosomiasis. Sustained fever and toxicity are not characteristic of this infection. The febrile and toxic response to ivadministered, formalin-killed Salmonella typhi (Quailes strain) was measured in afebrile patients: five with chronic salmonella bacteremia and bacteriuria, one with bacteremia only, four with bacteriuria only, and seven controls. Patients with bacteremia showed tolerance for endotoxin, which was maintained up to four months after cessation of bacteremia. Two patients who had bacteriuria but no demonstrable bacteremia appeared to be less tolerant. Patients became tolerant despite the apparent absence of an initial overt febrile and toxic illness. Intermittent febrile episodes recurred during sustained bacteremia despite the presence of tolerance. It is concluded that prolonged exposure to circulating endotoxin determines a state of tolerance to endotoxin. However, endotoxemia is probably not responsible for the presence or absence of fever in patients with chronic salmonella bacteremia.

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