Clinicopathological Profile of Salmonella Typhi and Paratyphi Infections Presenting as Fever of Unknown Origin in a Tropical Country.

Abstract

BackgroundEnteric fever, a common infection in the tropics and endemic to India, often manifests as an acute febrile illness. However, presentation as fever of unknown origin (FUO) is not uncommon in tropical countries.MethodsWe aim to describe the clinical, laboratory and pathological features of patients hospitalized with fever of unknown origin and diagnosed as enteric fever. All culture proven cases of enteric fever were analyzed retrospectively over a period of three years from January 2011 to December 2013.ResultsSeven of 88 (8%) cases with enteric fever presented as FUO. Abdominal pain was the most common symptom besides fever. Relative bradycardia and splenomegaly were uncommon. Thrombocytopenia was the most common haematological abnormality while leucopenia was rare. Transaminase elevation was almost universal. S. Typhi and S. Paratyphi A were isolated from six cases and one case respectively. Yield of organisms from blood culture was superior to that of bone marrow aspirate. Multiple granulomas were identified in 4 out of 6 (67%) of the bone marrows studied, including that due to S. Paratyphi A and histiocytic hemophagocytosis was noted in two cases.ConclusionFUO is a relatively common manifestation of enteric fever in the tropics. Clinical and laboratory features may be atypical in such cases, including absence of relative bradycardia, leucopenia, and presence of thrombocytopenia, bicytopenia or pancytopenia. In addition, in endemic countries, enteric fever should be considered as a differential diagnosis, next to tuberculosis, in the evaluation of bone marrow granulomas in cases with FUO and culture correlation should be mandatory.

Clinical and microbiological profile of enteric fever in a tertiary care hospital

“…Blood culture was done in 80 patients, 6 were growing S. typhi; 28 were growing S. paratyphi A; 44 were no growth; 2 were growing skin commensals;Blood culture was not done in 41 cases. In the study by Iqbal, N., et al [13] diagnosis of enteric fever was established in allseven cases within a median duration of 6 days ofhospitalization. Blood culture grew S. Typhi in four cases (57%) and S.Paratyphi A in one case (14%).…”

Eosinopenia in Patients With Typhoid Fever: A Case-Control Study

“…Although considered a key feature of typhoid, leukopenia is only present in 25% of the cases [7]. Differential leukocyte counts show consistent eosinopenia (80%) in several studies [8][9][10]. This gives a new dimension to the diagnostic approach in developing countries where results with a quicker yield are favored.…”

Profil Manifestasi Klinis Dan Laboratorium Pasien Demam Tifoid Di Rs Pku Bantul

“…6,7 Pada kasus demam tifoid, demam dilaporkan pada >75% kasus dan nyeri perut hanya dilaporkan pada 30-40% kasus. 8,9 Penelitian yang dilakukan di Ethiopia menunjukkan manifestasi klinis demam tifoid yang ditemukan masih berupa demam -stepladder‖, anoreksia, lidah kotor, diare, badikardia relatif, neutropenia, dan hematomegali. 6 Penelitian lain di Jakarta menunjukkan gejala predominan demam tifoid adalah nyeri kepala, nyeri epigastric, nausea, anoreksia, bersamaan dengan demam sore hari.…”

“…Gangguan pasien mengalami demam (96,9%), diare (66,9%), muntah (33,5%), dan sakit perut (30,2%). 8 Penelitian lain yang dilakukan di Lebanon selama dua tahun observasi menunjukkan gejala yang paling umum muncul adalah demam (100%), sakit kepala (56,5%), sakit perut (46,4%), diare (40,6%) dan muntah (39,1%). 24 Farmakiotis et al (2013) menemukan hal yang sama pada observasi lima tahun di Jacobi Medical Center, USA.…”

“…Prevalensinya bervariasi secara substansial antara studi. Beberapa penelitian di Asia melaporkan prevalensi trombositopenia sebesar 4,6-15% 8 .…”