Hemophagocytosis accompanying typhoid fever

Fame, Thomas M.; Engelhard, Dan; Riley, Harris D.

doi:10.1097/00006454-198605000-00018

Cited by 19 publications

(11 citation statements)

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“…Serovar Typhi is concentrated in lymphoid tissues. Early histopathological descriptions of the inflammatory processes in Peyer's patches, mesenteric lymph nodes, liver, and spleen from human autopsy material (12) are reminiscent of the histiocytic proliferation and granuloma formation described more recently in the bone marrow of patients with typhoid fever (4,10,11,17). Bone marrow aspirates are known to yield a higher rate of positive cultures in typhoid than peripheral blood (5,7).…”

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confidence: 98%

Quantitation of Bacteria in Bone Marrow from Patients with Typhoid Fever: Relationship between Counts and Clinical Features

et al. 2001

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Enteric fever is the only bacterial infection of humans for which bone marrow examination is routinely recommended. A prospective study of the concentrations of bacteria in the bone marrow and their relationship to clinical features was conducted with 120 Vietnamese patients with suspected enteric fever, of whom 89 had confirmed typhoid fever. Ninety-three percent of the Salmonella enterica serovar Typhi samples isolated were resistant to ampicillin, chloramphenicol, and co-trimoxazole. For 81 patients with uncomplicated typhoid and satisfactory bone marrow aspirates, the number of serovar Typhi CFU in bone marrow aspirates was a median value of 9 (interquartile range [IQR], 1 to 85; range, 0.1 to 1,580) compared to 0.3 (IQR, 0.1 to 10; range, 0.1 to 399) CFU/ml in simultaneously sampled blood. The ratio of individual blood counts to bone marrow counts was 10 (IQR, 2.3 to 97.5). The number of bacteria in blood but not bone marrow was correlated inversely with the duration of preceding fever. Thus, with increasing duration of illness the ratio of bone marrow-to-blood bacterial concentrations increased; the median ratio was 4.8 (IQR, 1 to 27.5) during the first week compared with 158 (IQR, 60 to 397) during the third week. After lysing the host cells, the median ratio of viable bone marrow to blood increased, reflecting the higher concentration of intracellular serovar Typhi in the bone marrow. Effective antibiotic pretreatment had a significantly greater effect in reducing blood counts compared to bone marrow counts (P < 0.001). Thus, bacteria in the bone marrow of typhoid patients are less affected by antibiotic treatment than bacteria in the blood. The numbers of bacteria in bone marrow correlated negatively with the white blood cell (R ‫؍‬ ؊0.3, P ‫؍‬ 0.006) and platelet counts (R ‫؍‬ ؊0.32, P ‫؍‬ 0.01) and positively with fever clearance time after treatment (R ‫؍‬ 0.4, P < 0.001). The bacterial load in bone marrow therefore may reflect the clinical course of the infection, and high levels may suppress neutrophil proliferation.

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confidence: 98%

Quantitation of Bacteria in Bone Marrow from Patients with Typhoid Fever: Relationship between Counts and Clinical Features

et al. 2001

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“…Further, it is possible that these illnesses may, in turn, trigger MAS. It may also be noted that some of these infectious disorders can themselves cause infectionassociated hemophagocytosis (IAHS) [13][14][15][16]. In a developing country setup, differentiating MAS in association with SOJIA from other reactive hemophagocytosis like IAHS is important, because treatment of the two conditions is along different lines.…”

Section: Discussionmentioning

confidence: 99%

Macrophage activation syndrome in children with systemic onset juvenile idiopathic arthritis: clinical experience from northwest India

et al. 2011

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The objective of this study is to describe the clinical and laboratory features of macrophage activation syndrome (MAS) in systemic onset juvenile idiopathic arthritis (SOJIA) at a tertiary care center in northwest India. Review of medical records of all children with SOJIA admitted during the period January 1995-December 2008 in Pediatric Allergy and Immunology Unit, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, was done. Six patients (5 boys and 1 girl) with SOJIA and MAS were identified. Mean age at time of disease onset was 6.5 years. MAS was the presenting manifestation of SOJIA in 4 patients. Clinical manifestations included fever (6/6), clinical shock (6/6), encephalopathy (5/6), generalized lymphadenopathy (4/6), hepatosplenomegaly (3/6), jaundice and abdominal tenderness (3/6), cardiac involvement (3/6), and meningeal irritation (2/6). Laboratory findings at onset of MAS included decreasing total leukocyte and platelet counts, coagulopathy, elevated transaminases, hyponatremia, and lipid abnormalities. Hemophagocytosis was demonstrable in the bone marrow in 4 patients and in the lymph node in 1. For treatment, we used intravenous methylprednisolone (4/6), oral prednisolone (2/6), and intravenous immunoglobulin (2/6). Outcome was favorable in all patients except one who died of rapidly progressive disease. This paper describes the experience of JIA-related macrophage activation syndrome in a tertiary Indian center. We have shown that MAS can be the early presenting manifestation of evolving SOJIA. Early diagnosis and aggressive management can have a significant impact on the mortality associated with this syndrome. We stress on the role of glucocorticoids in the management of this condition and believe that glucocorticoids have a far more important role in the management of this condition than what has been previously reported.

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“…Hemophagocytic lymphohistiocytosis may be primary (familial) or may develop secondary to many infectious agents. Salmonella-related HLH has been reported considerably rarely (5,6). Here, a 13-year old girl who developed both acute glomerulonephritis and hemophagocytic lymphohistiocytosis in relation with Salmonella spp.…”

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confidence: 92%

“…In addition to diarrhea, it may lead to extraintestinal infections including enteric fever, sepsis and rarely aseptic meningitis, hepatitis, cholecystitis, acute abdomen, intestinal perforation, pneumonia, psychosis and ataxia (1,(6)(7)(8). Fever, headache, abdominal pain and gastrointestinal complaints including loss of appetite, nausea, vomiting and constipation are observed in the first weeks of thyphoid fever related with Salmonella typhi, whereas bradycardia, hepatomegaly, splenomegaly and abdominal tenderness develop in the second week.…”

mentioning

confidence: 99%

Salmonella Glomerulonephritis and Haemophagocytic Lymphohistiocytosis in an adolescent

Kır¹,

Aydoğan²,

Bengoa³

et al. 2016

Turk Pediatri Ars

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Hemophagocytosis accompanying typhoid fever

Cited by 19 publications

References 0 publications

Quantitation of Bacteria in Bone Marrow from Patients with Typhoid Fever: Relationship between Counts and Clinical Features

Quantitation of Bacteria in Bone Marrow from Patients with Typhoid Fever: Relationship between Counts and Clinical Features

Macrophage activation syndrome in children with systemic onset juvenile idiopathic arthritis: clinical experience from northwest India

Salmonella Glomerulonephritis and Haemophagocytic Lymphohistiocytosis in an adolescent

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