Salmonella enterica serovar Typhi and gallbladder cancer: a case-control study and meta-analysis
Pooling more than a thousand cases, people with signs of past or chronic typhoid infection were four to five times more likely to have gallbladder cancer, though the bacterium itself was not recovered from the Chilean patients studied.
Overview
In Chile, where typhoid was endemic until the 1990s, 39 gallbladder cancer cases, 40 gallstone controls and 39 population controls were tested for Salmonella Typhi Vi antibodies, with culture and quantitative PCR on available bile, stone, tissue and stool. Cases were more likely to have high Vi titres (odds ratio 4.0, 95 percent CI 0.9 to 18.3), but S. Typhi was not recovered from any sample. A meta-analysis combining these with previous studies (over 1,000 cases) gave a summary relative risk of 4.6 (3.1 to 6.8) for anti-Vi antibodies and 5.0 (2.7 to 9.3) for bile or stool culture. The mechanism remains to be established.
- Meta-analysis summary relative risk 4.6 (95 percent CI 3.1 to 6.8) for anti-Vi antibodies and 5.0 (2.7 to 9.3) for bile or stool culture.
- Chilean case-control odds ratio 4.0 (0.9 to 18.3) for high Vi titre; no S. Typhi recovered from samples.
Typhoid carriage is one of the few modifiable risk factors for gallbladder cancer. In the UK it is rare, but it matters for people who grew up where typhoid is endemic and for the question of whether chronic carriers should be offered cholecystectomy.
- Small Chilean sample; the association rests mainly on the meta-analysis.
- Serology cannot distinguish past infection from chronic carriage.
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