A Case Report of Typhoid Pneumonia

Abstract

The following case is submitted because of the interest in demonstrating an acute bronchitis, and bronchopneumonia of the left upper lobe, which we believe was caused by typhoid bacilli. No effort was made to recover the typhoid bacilli from the sputum so that the case is not definitely proven. However, the patient did go on to develop a typical attack of typhoid fever. Osler describes typhoid pneumonia with asthenic or toxic pneumonia, stating that the local lesions may be slight in extent and the subjective phenomena of the disease absent. The nervous phenomena are usually predominating, which he mentions as delirium, prostration and early weakness. There is frequently jaundice and also diarrhea and meteorism along with abdominal pain. He says that it is difficult to differentiate between toxic or asthenic pneumonia and typhoid fever, which has set in with early localization in the lung. The differentiation can be made only by the Widal and blood cultures. In his description of the morbid anatomy of typhoid fever, he says: “One finds that ‘lobar pneumonia’ may be found early in the disease or it may be a late event. Hypostatic congestion and the condition of the lung spoken of as splenization occur.” In describing the symptoms, he states that cough and bronchitic symptoms are not uncommon at the outset of typhoid fever. He further states that lobar pneumonia is met with at the outset, and speaks of it as the “pneumo-typhus of the Germans.” After an indisposition of a day or so the patient is seized with a chill, high fever and pain in his side, and within forty-eight hours there are signs of consolidation and the evidence of ordinary lobar pneumonia. Intestinal symptoms may or may not occur until towards the end of the first week or later. Crisis does not occur, but by the end of the second week the clinical picture is that of typhoid fever. This description fits quite well with the case we have here pre sented. Secondly, he says that lobar pneumonia forms a serious and by no means infrequent complication of the second and third weeks. Patient, Mr. H., was admitted December 24, 1924. He came in complaining of fever, severe headache, sensation of pressure in the epigastrium. He also had coughing and some transitory pains in his chest. Ten days before admission he had had a severe attack of cramp-like pains in the right epigastrium, lasting only half a day. They did not radiate. Just previous to his admission he had taken a heavy meal, which included a seafood cocktail. The next day he went to bed with a chilly sensation and remained there until the day of admission. He was not jaundiced; had no vomiting or diarrhea. The chilly feeling, headache, pain in the chest, and coughing persisted. Past history is negative except for the usual childhood diseases and left lower lobar pneumonia in the Summer of 1924. Scotchman, 56 years of age, acutely ill.