Digestive Diseases and Sciences

, Volume 45, Issue 5, pp 900–903 | Cite as

Carcinoma of the Gallbladder—Is It a Sequel of Typhoid?

  • Vijay K. Shukla
  • Harbans Singh
  • Manoj Pandey
  • S.K. Upadhyay
  • Gopal Nath


Gallbladder diseases, including carcinoma, are common in the northern part of India and so are Salmonella typhi infection and typhoid carrier state. This study was aimed to find out the association of typhoid carrier state in patients with cholelithiasis, carcinoma of the gallbladder, and controls. The three groups are comparable in age and sex composition. This is the first study of its kind from an area of high endemicity for both typhoid infection and carcinoma of the gallbladder. A case–control study was carried out to detect typhoid carrier state among the patients with biliary diseases and healthy controls, using indirect haemagglutination assay measuring antibodies against highly purified S. typhi Vi polysaccharide antigen. A significantly high Vi positivity was observed in patients with gallbladder carcinoma (29.4%) compared to controls (5%) (χ2 = 6.325, P < 0.004, OR = 7.19) and patients with cholelithiasis (10.7%) (χ2 = 5.066, P < 0.01, OR = 3.86). There is 8.47 times more risk of developing carcinoma of the gallbladder in culture-positive typhoid carriers than the noncarriers. The present study suggests the typhoid carrier state to be one of the possible mechanisms of gallbladder carcinogenesis.

gallbladder carcinoma typhoid bacterial infection bile acids typhoid carrier 


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  1. 1.
    Shukla VK, Khandelwal C, Roy SK, Vaidya MP: Primary carcinoma of the gallbladder: A review of a 16 year period at the University Hospital. J Surg Oncol 28:32-35, 1985Google Scholar
  2. 2.
    Welton JC, Marr JS, Friedman SM: Association between hepatobiliary cancer and typhoid carrier state. Lancet 1:791-794, 1979Google Scholar
  3. 3.
    Hill MJ: Microbes and Human Carcinogenesis. London, Edward Arnold, 1986Google Scholar
  4. 4.
    Kinoshita N, Gelboin HV: β-Glucoronidase calatysed hydrolysis of benzo[a]pyrene-3-glucoronide and binding to DNA. Science 199:307-310, 1978Google Scholar
  5. 5.
    Shukla VK, Tiwari SC, Roy SK: Biliary bile acids in cholelithiasis and carcinoma of the gallbladder. Eur J Cancer Prev 2:155-160, 1993Google Scholar
  6. 6.
    Ledingham JCG: The carrier problem in enteric fever. In The Carrier Problem in Infectious Diseases. JCG Ledingham, JA Arkwright (eds). London, Edward Arnold, 1912Google Scholar
  7. 7.
    Pandey M, Vishwakarma RA, Khatri AK, Roy SK, Shukla VK: Bile, bacteria and carcinogenesis. J Surg Oncol 58:282-283, 1995Google Scholar
  8. 8.
    Lin FYC, Becke JM, Croves C, Lim BP, Israel E, Becker EF, Helfrich RM, Swetter DS, Caramton T, Robbins JB: Restaurant associated outbreak of typhoid fever in Maryland: Identification of carrier facilitated by measurement of serum VI antibodies. J Clin Microbiol 26:1194-1197, 1988Google Scholar
  9. 9.
    Lanata CF, Levine MM, Ristori C, Black RE, Jimenez L, Salcedo M, Garcia J, Sotomayor V: Vi serology in detection of chronic Salmonella typhoid carriers in an endemic area. Lancet 1:441-442, 1983Google Scholar
  10. 10.
    Shioler H, Christiansen ED, Haybye G: Biliary calculi in chronic Salmonella carriers and healthy controls: A controlled study. Scand J Infect Dis 15:17-19, 1983Google Scholar
  11. 11.
    Mellemgaard A, Gaarslev K: Risk of hepatobiliary cancer in carriers of Salmonella typhi. J Natl Cancer Inst 80:288, 1988Google Scholar
  12. 12.
    Caygill CPJ, Hill MJ, Braddick M, Sharp JCM: Cancer mortality in chronic typhoid and paratyphoid carriers. Lancet 343:83-84, 1994Google Scholar
  13. 13.
    Caygill CPJ, Braddick M, Hill MJ, Knowles RL, Sharp JCM: The association between typhoid carriage, typhoid infection and subsequent cancer at a number of sites. Eur J Cancer Prev 4:187-193, 1995Google Scholar
  14. 14.
    Nolan CM, Freeley JC, White PC, Hombie EA, Browo SL, Wong KH: Evaluation of a new assay for Vi antibody in chronic carriers of Salmonella typhi. J Clin Microbiol 12:22-36, 1980Google Scholar
  15. 15.
    Edelman R, Levine MM: Summary of an international workshop on typhoid fever. Rev Infect Dis 8(3):329-349, 1986Google Scholar
  16. 16.
    Dinbar A, Altmann G, Tulcinsky DB: The treatment of chronic biliary Salmonella carriers. Am J Med 47:236, 1969Google Scholar
  17. 17.
    Singh H, Pandey M, Shukla VK: Salmonella carrier state, chronic bacterial infection and gallbladder carcinogenesis. Eur J Cancer Prev 5:1, 1996Google Scholar
  18. 18.
    El-Zayadi, Ghoneim M, Kabil SM: Bile duct carcinoma in Egypt-possible aetiological factors. Hepato-Gastroenterol 38:337-340, 1991Google Scholar

Copyright information

© Plenum Publishing Corporation 2000

Authors and Affiliations

  • Vijay K. Shukla
    • 1
  • Harbans Singh
    • 1
  • Manoj Pandey
    • 1
  • S.K. Upadhyay
    • 1
  • Gopal Nath
    • 1
  1. 1.Departments of Surgery, Statistics, and Microbiology, Institute of Medical SciencesBanaras Hindu UniversityVaranasiIndia

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