Complication Of Typhoid Fever Research Articles

Colonoscopic findings and management of patients with outbreak typhoid fever presenting with lower gastrointestinal bleeding

Lower gastrointestinal bleeding (LGIB) along with intestinal perforation is a well-known complication of typhoid fever. Reports of colonoscopic appearance and intervention of typhoid perforation involve only few cases. This series reports the colonoscopic findings and the role of colonoscopic hemostatic interventions in controlling the bleeding ileocolonic lesions. During the typhoid fever outbreak in Sulaymaniyah City in Iraqi Kurdistan Region, we received 52 patients with LGIB manifesting as fresh bleeding per rectum or melena. We performed total colonoscopy with ileal intubation for all cases. The findings were recorded and endoscopic hemostatic intervention with adrenaline-saline injection and argon plasma coagulation was applied to actively bleeding lesion. These patients were young, 11-30 years of age, with female preponderance. Blood culture was positive in 50 %. Colonoscopic findings were mostly located in the ileocecal region, although other areas of the colon were involved in many cases. Twenty-four percent of the cases required endoscopic hemostatic intervention by adrenaline injection with argon plasma coagulation which was effective in all patients except one who died in spite of surgical intervention in addition of endoscopic hemostasis. Dual endoscopic hemostatic intervention can be a safe and effective management option for patients with LGIB due to typhoid fever.

Enteric fever in Children at Dhulikhel Hospital

Introduction: Typhoid fever is one of the most common public health problems in Nepal. It occurs in all parts of the world where water supplies and sanitation are sub-standard. In Dhulikhel hospital, this is one of the top acute febrile illnesses in inpatient department. The objectives of this study were to evaluate the clinical and laboratory parameters including culture and sensitivity, the response to therapy, and complications of enteric fever among child cases at Dhulikhel Hospital. Materials and Methods: This retrospective study was conducted at Dhulikhel Hospital, Kathmandu University Teaching Hospital from January 2009 to June 2011. Statistical analysis was done with SPSS. Results: There were total of 138 cases of enteric fever admitted. There were 73 (53%) male and 65 (47%) female. Eighty-one percent were above five years of age. The most common clinical presentation was fever (100%) followed by headache and G I symptoms. Hepatomegaly was the most common sign seen among the cases and was seen in 110cases (79.71%). Most of the patients had normal WBC count 100 (72.46%) Widal test was positive in 70 (50.72%) cases and blood culture was positive in 52(37.68%) cases. Nalidixic acid was found to be resistant in 26 (50%) cases. Complications were seen in only 7 (5%) enteric fever cases. Conclusion: Typhoid fever is predominant in school going children in Nepal with slight male predominance. Fever lasting over 3 days followed by headache and GI symptoms are the major presenting symptoms. In making the diagnosis, the isolation of bacteria from blood is the “gold standard”. Nalidixic acid resistant Salmonella typhi is on the increasing trend. Pneumonia was found to be the most common complication among all other complications seen in enteric cases. In Dhulikhel Hospital this is one of the top acute febrile illnesses in inpatient department. DOI: http://dx.doi.org/10.3126/jnps.v32i3.6682 J. Nepal Paediatr. SocVol.32(3) 2012 216-220

Surgical Management of Enteric Perforation by Using Omental Patch : A Prospective Study of 60 Patients

Enteric perforation is a serious complication of typhoid fever. Depending upon the bowel condition, primary closure of perforation is the treatment of choice. Development of fecal fistula is the key apprehension in primary closure. The purpose of this study is to find out the benefit of an omental patch when used over primary closure. It is a small study of 60 patients, which were divided into two groups: Group I - Primary closure with omental patch, and Group II - only primary closure. The outcomes were measured in relation to wound infection, fecal fistula, wound dehiscence, and intra-abdominal abscess. The incidence of complications including fecal fistula and mortality is significantly lower in the group-I patients. Fecal fistula occurs in 13.33% in group II, while in only 3.3% in group I. There was no significant difference in the incidence of wound infection and wound dehiscence. Primary closure with an omental patch is a better option compared with only primary closure in enteric perforation patients. It can be suggested as an alternative method to primary closure only in selective enteric perforation patients.

Journal of Clinical and Diagnostic Research. 2013 Sept, Vol-7(9): 1946-1948 1946 1946 DOI: 10.7860/JCDR/2013/6632.3366 Original Article

Typhoid fever is an important public health problem in developing countries. Intestinal perforation is one of the leading fatal complications of typhoid fever. Typhoid perforation occurs more commonly in terminal ileum. Morbidity and Mortality associated with typhoid perforation are high (9-22%). However this study aims to know whether there are any changes of the same. To analyse the clinical presentation, management, complications, morbidity and mortality associated with typhoid intestinal perforation and assess changing trends in mortality in typhoid intestinal perforation. This is a retrospective observational study. Cases regarding the study have been analyzed by reviewing the patient records. It includes 40 patients who were diagnosed with typhoid intestinal perforation, admitted and treated in the Department of General Surgery from February 2011 to January 2012. A total of 40 patients were considered for the study and their mean age was 35.75 years. 80% of patients were male. Pain abdomen was their main symptom which lasted for an average of 2.95 days. Leukocytosis (11,000 cells/cumm) was present in 57.5% patients. Single perforation was present in 31(77.5%) patients and primary closure was done in 30 of them. Culture sensitivity showed E coli as the main organism. Complications were seen in 42.5% of patients in post-operative period. Early recognition, timely surgical intervention with appropriate surgery and antibiotics, and effective peri-operative care reduces the mortality in typhoid intestinal perforation.

Typhoid intestinal perforation: 24 Perforations in one patient

Intestine perforation is one of the most dreaded and common complication of typhoid fever remarkably so in developing world; it usually leads to diffuse peritonitis, requiring early surgical intervention. Despite various measures such as safe drinking water supply and safe disposal of waste, intestinal perforation from salmonellosis remains the most common emergency surgery performed. The incidence continues to rise, so also the mortality, despite new antibiotics and improvement in surgical technique. More disturbing is that we now see increasing number of ileal perforations and colonic involvement. We hereby present a case report of 35-year-old male with multiple (24) intestinal perforation in the Ileum and Cecum.

A Splenic Abscess which was Caused by Salmonella Typhi in a Non Sickler Patient: A Rare Case Finding

A splenic abscess which is caused by Salmonella typhi is a very rare complication of typhoid fever. We are reporting a case of a 14 year old female who presented with fever and pain in the abdomen. She was treated for fever of unknown origin in a rural hospital and was then admitted to our hospital after 15 days . She complained of fever and pain in the abdomen. On ultrasound, multiple splenic abscesses were seen. A USG guided aspiration was done and the aspirated material was received for culture, which was found to be positive for Salmonella typhi. A blood and stool culture which were done were negative and the Widal test showed a positive result with titres of TO 1:320 and TH 1:320. No predisposing factor was found in our case. Sickling was negative and HIV and HBsAg screening showed negative results. She responded favourably to the antibiotics which were given as per our antibiotic sensitivity report.

Peritonitis secondary to ruptured splenic abscess: A grave complication of typhoid fever

Splenic abscesses are increasingly being identified, possibly due to widespread use of imaging modalities in clinical practice. The commonest clinical features are high grade fever and exclusively localised left upper quadrant abdominal pain. These symptoms are similar to most infectious diseases prevalent in the tropics, making imaging by ultrasonography or computer tomography a necessity in the diagnosis. There are reports from different geographic areas on splenic abscesses associated with typhoid fever. We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever.

Acute transverse myelitis: an unusual complication of typhoid fever

Typhoid fever is associated with a wide spectrum of neurological complications. Acute transverse myelitis is a rare complication with only a few reports in adults and none in children. A 15-year-old boy with typhoid fever is reported who developed acute transverse myelitis in the 3rd week of illness. He was treated with antibiotics and corticosteroids and made a complete recovery.

Guillain-Barré syndrome as a complication of typhoid fever in a child

Guillain-Barré syndrome as a complication of typhoid fever in a child

Enteric fever complicated by multiple splenic abscesses

Enteric fever complicated by splenic abscess is a rare entity in pediatric age group. It is usually a part of disseminated infection. There can be single or multiple abscesses. Single abscess most commonly responds to conservative management with appropriate antibiotics and ultrasound-guided percutaneous drainage of the abscess. However, multiple abscesses require splenectomy. The child presented here had multiple splenic abscesses as a complication of enteric fever. There was no response to conservative management and hence he had to undergo splenectomy. So, in children with enteric fever, it is strong suspicion, which helps in identifying complications early and treating them accordingly. Salvaging the spleen is not possible in case of multiple splenic abscesses.

Typhoid Ileal Perforation: A Review of a Rural District Hospital Experience

Background : Enteric fever is endemic in developing countries and frequently complicates with ileal perforation. Surgical intervention for the perforation is the usual treatment but attendant rate of postoperative complications high. It is unclear what the spec- trum of enteric fever perforations is in rural hospital practice in Kenya, where the diagnosis most often in intraoperative. Objective : To describe the surgical experience of typhoid perforations at a rural district hospital in Kenya. Patient and Methods : This was a retrospective chart review of patients who underwent laparotomies for peritonitis at the Kapenguria District Hospital in Kenya between April 2007 and October 2009. Data abstracted from patient files included demographics, presenting symptom, duration of symptoms, investigations (Widal and/or stool culture), operative management, complications, length of stay, and death. Widal test was indicative when titer was 1:160 for “O” antigen or above. Antimesenteric longitudinal perforation was assumed to be a complication of enteric fever. The data were analyzed using SPSS version 16.0.The results are presented in frequency tables, bar charts and pie charts. Results : Of the 50 files retrieved with diagnosis of peritonitis, 21(42%) were found at operation to have had ileal perforations. Of these 15(71.5%) had resection and primary anastomosis, 2(9.5%) had refreshening and anastomosis (simple anastomosis) and 4 (19%) had ileostomy. Male to female ratio was 4:1, majority were aged 6-15 years (38.1%). Wound infection was 8(38.1%), enterocutaneous fistulae were 7(33.3%), while 7(33.3%) required second laparotomy and 4(19%) were referred due to complications which could not be managed at this level. Mortality was 3(14.3%) and average length of stay was 17days. Conclusion : Morbidity and mortality arising from typhoid ileal perforation is high in this environment making it a major challenge in a resource poor environment. Prevention by use of protocols is highly recommended

Superior Sagittal Sinus Thrombosis Complicating Typhoid Fever in a Teenager

Cerebral venous sinus (sinovenous) thrombosis (CSVT) is a rare life-threatening disorder in childhood that is often misdiagnosed. CSVT encompasses cavernous sinus thrombosis, lateral sinus thrombosis, and superior sagittal sinus thrombosis (SSST). We present an adolescent girl who was well until two weeks earlier when she had a throbbing frontal headache and fever with chills; she later had dyspnoea, jaundice, melena stool, multiple seizures, nuchal rigidity, and monoparesis of the right lower limb a day before admission. Urine test for Salmonella typhi Vi antigen was positive, and Widal reaction was significant. Serial cranial computerized tomography scans revealed an expanding hypodense lesion in the parafalcine region consistent with SSST or a parasagittal abscess. Inadvertent left parietal limited craniectomy confirmed SSST. She recovered completely with subsequent conservative management. Beyond neuropsychiatric complications of Typhoid fever, CSVT should be highly considered when focal neurologic deficits are present.

Comments on sudden death due to polyarteritis nodosa

In this letter, I would like to comment on the excellent case report, Sudden death due to polyarteritis nodosa by Shields et al. [1]. In the aforementioned paper, the authors present a very interesting case of sudden and unexpected cardiac death due to polyarteritis nodosa (PAN) in a 32-year-old male. In the text, the authors wrote that polyartesritis nodosa was ‘‘Initially described in 1866...’’ [1]. While it is true that the first complete classic description of the syndrome of polyarteritis nodosa was made by Kussmaul and Maier in 1866 [2], this pathologic entity had previously been macroscopically described by Karel Rokitansky in 1852 [2–4]. As a resident of the same city where Karel Rokitansky (1804–1878) was born, I would like to briefly remind readers herein of his contribution to modern anatomical and forensic pathology and his first description of polyarteritis nodosa. Karel Rokitansky was born on 19 February 1804 in Hradec Kralove in the Austrian Empire (now the presentday Czech Republic). He studied medicine in Prague and Vienna, graduating from the latter in 1828. He became an assistant professor in the Department of Pathology to Professor Johann Wagner at the Vienna Medical School, and thereafter spent all his professional life in Vienna. After Wagner’s death, he became associate professor (1834) and then full professor of pathology (1844). Rokitansky performed his first autopsy in 1827, and when he retired 48 years later, it was said that he himself, or an assistant directed by him, had undertaken an incredible number of 60,000 autopsies (more than 25,000 medico legal dissections). He published over 400 scientific papers and 20 books. His fundamental monograph, ‘‘Handbook of Pathologic Anatomy’’ was published in three volumes from 1842 to 1846. Another one of his greatest works was his last one, ‘‘Defects in the Septum of the Heart’’. Several notable contributions to the field included his observations on congenital heart diseases, bacterial endocarditis, lobar and lobular pneumonia, emphysema, pulmonary complications of typhoid fever, multiple sclerosis, lardaceous disease of the spleen, liver and kidney (i.e. amyloidosis), goitre, spondylolisthetic deformity of the pelvis, and many others. Rokitansky studied the pathogenesis of atherosclerosis [5] and his work includes the humoral disease theory of dyscrasias (the doctrine of bodily fluids and how they are mixed in the body). Rokitansky was the first to describe superior mesenteric artery syndrome causing vascular compression of the duodenum. Massive hepatic necrosis was recognized by Rokitansky as ‘‘acute yellow atrophy of the liver’’ including associated clinical signs of fulminant liver failure. Rokitansky was the first to notice obstruction of hepatic veins by a blood thrombus in liver cirrhosis, subsequently described by Budd and Chiari [6]. With regard to the commented case report, it is essential to note that the first gross pathologic description of polyarteritis nodosa was made by Karel Rokitansky in 1852. He reported on the presence of aneurysmal lesions in numerous arteries at autopsy in a 23-year-old shoemaker journeyman, who was admitted to the hospital on November 6, 1848, with a 5-day history of bloody diarrhea and fever with abdominal pain, and who subsequently died [3, 4]. At autopsy Rokitansky found aneurysmal formations filled with fibrin thrombi in the arteries of the heart, the liver and P. Hejna (&) Institute of Legal Medicine, Faculty of Medicine in Hradec Kralove, Charles University in Prague, Simkova 870, 500 01 Hradec Kralove, Czech Republic e-mail: hejnap@lfhk.cuni.cz

Omental patch technique for the ileal perforation secondary to typhoid fever

Background/Aim:Enteric perforation is a grave complication of typhoid fever. Laparotomy with primary closure is the treatment of choice depending upon the bowel condition. Fecal fistula formation is the main concern in primary closure and the incidence of this complication dramatically decreases when omentum is used as a patch over primary closure.Materials and Methods:A total of 176 patients underwent laparotomy for enteric perforation and they were divided into two groups randomly; Group I–Primary closure with omental patch and GroupII– –Only primary closure. The outcomes were measured in relation to hospital stay, wound infection, septicemia, fecal fistula, and mortality.Results:The incidence of complications including fecal fistula and mortality is significantly lower in the group I patients. Fecal fistula occurs in 7.7% in group II, while in only 1.1% in group I. The mortality is also lower 3.3% in group II, while 1.1% in group I.Conclusion:Primary closure with omental patch is a better option as compared with only primary closure in enteric perforation patients. It can be recommended as an alternative method to primary closure only in enteric perforation patients.

A case report of typhoid fever masquerading as acute typhoid glomerulonephritis

IJCRI – International Journal of Case Reports and Images, Vol. 2, No. 3, March 2011. ISSN – [0976-3198] ABSTRACT Introduction: Typhoid fever is a common infectious disease worldwide, especially in developing countries. Typhoid fever presenting as nephritis is rare. The common renal complications of typhoid fever are pyelonephritis and cystitis. Patients with typhoid glomerulonephritis may present with acute renal failure, hypertensive encephalopathy or nephritic syndrome. Presence of typhoid nephritis increases mortality to 20-30% in untreated typhoid fever. Case report: We report a case of a 29-year-old patient in this case report who presented with fever, hypertension, pedal oedema, and hematuria. Widal was positive in high titres and blood culture grew Salmonella typhi. His fever, hypertension and oedema resolved on treatment for the infection. Conclusion: Typhoid fever presenting as typhoid glomerulonephritis is a rare occurrence and has to be considered in patients in endemic areas, presenting with nephritis and concomitant fever. High index of suspicion, prompt early diagnosis is beneficial, in preventing morbidity and mortality related to with Salmonella typhi infection.

Typhoid ulcer causing life-threatening bleeding from Dieulafoy's lesion of the ileum in a seven-year-old child: a case report

IntroductionWe describe a case of rare complication of typhoid fever in a seven-year-old child and review the literature with regard to other rare causes of bleeding per rectum. Dieulafoy's lesion is an uncommon but important cause of recurrent gastrointestinal bleeding. Dieulafoy's lesion located extragastrically is rare. We report a case of typhoid ulcer with Dieulafoy's lesion of the ileum causing severe life-threatening bleeding and discuss the management of this extremely uncommon entity.Case presentationAs a complication of typhoid fever, a seven-year-old Kurdish girl from Northern Iraq developed massive fresh bleeding per rectum. During colonoscopy and laparotomy, she was discovered to have multiple bleeding ulcers within the Dieulafoy's lesion in the terminal ileum and ileocecal region.ConclusionAlthough there is no practical way of predicting the occurrence of such rare complications, we emphasize in this case report the wide array of pathologies that can result from typhoid fever.

Typhoid perforation: determinants of outcome in children in Ile-Ife, Nigeria

Background: Ileal perforation can be a fatal complication of typhoid fever in children as its clinical presentation is often atypical. The risk of death from intestinal perforation in typhoid fever is more than four times when compared with patients without perforation. A high index of suspicion therefore, and early intervention are mandatory to reduce morbidities and deaths due to this disease in children. Aim: To highlight the factors that adversely influence treatment outcome following typhoid ileal perforation in a paediatric population and how they could be modified to reduce morbidity and mortality. Methods: This was a retrospective study whereby medical records of children aged 1 to 15 years with typhoid fever admitted to OAUTHC, Ile-Ife, over a 10-year period, 1994-2004. Results: A total of 38 patients, 20 males and 18 females in the ratio 1.1:1, were managed for typhoid perforation during the 10-year study period. Twenty-nine patients (76.3%) survived while 9 (23.7%) died. Of the many factors evaluated, only the duration of time before operation was found to significantly influence treatment outcome adversely (P=0.009), while large single or large multiple perforations (P=0.256), severe peritoneal contamination (P=0.291) and extensive surgery (P=0.089) did not. Conclusion: Typhoid ileal perforation has a poor treatment outcome in children in Ile-Ife, Nigeria. The duration of time before operation was the single most important factor that adversely affected treatment outcome. Therefore, swift preoperative resuscitation and early surgical intervention will enhance overall outcome irrespective of the number of perforations, severity of faecal contamination and extent of surgery. Keywords: Typhoid perforation, Determinants of outcome, Children, Nigeria

Typhoid ileal perforation in children in Benin city

Typhoid ileal perforation is a common complication of typhoid fever, a multi-systemic infection, which is endemic in many developing countries. This study reviews and compares the incidence, morbidity and mortality at the University of Benin Teaching Hospital with other referral centres located in areas with similar socioeconomic and population status. The incidence, morbidity and mortality of typhoid ileal perforation in children treated among Edo People at the University of Benin Teaching Hospital, Nigeria, in the period from 1993 to 2007 were retrospectively studied and compared with centres in localities of similar socioeconomic and population status. Twelve children, all of middle class parents who resided in suburban community with poor water supply and substandard sewage disposal, accounted for 70.6% patients with typhoid ileal perforation managed over 15 years while 29.4% occurred in adults. The children comprised seven males and five females (M/F ratio 1.4:1), aged between five and 13 (average 9) years. This number seen over 15 years in this centre was extremely low when compared with other referral centres; as many as 191 patients were seen over 10 months in one of the centres. The few patients seen were traced to cultural beliefs in Benin City, which influenced proper sewage disposal by the about four million Edo people, especially those living in rural areas. Consequently, no child from the rural area with clean natural water supply or urban areas with pipe born water supply where sewages are disposed of properly had typhoid perforation. Unacceptably high morbidity (100%) and mortality (75%) due to late referrals were recorded in comparison with other centres. Proper sewage disposal may have influenced the low incidence in this centre but early referral is advocated so as to reduce the high associated morbidity and mortality.

Isolated cerebellar ataxia: an early neurological complication of enteric fever

Enteric fever is associated with a variety of clinical presentations and complications. Although central nervous system involvement is not uncommon in enteric fever, acute cerebellar ataxia as a presenting feature is rare. A 7-year-old boy with enteric fever who presented with acute cerebellar ataxia is reported.

Early small bowel perforation and cochleovestibular impairment as rare complications of typhoid fever

Two Indian migrant workers suffering from fever and malaise were admitted to the hospital directly after arrival in the Netherlands. The first patient was 25-year-old man who had fever and rigors on admission. The patient was treated for presumptive typhoid fever with ciprofloxacin. Cefotaxime was added the following day because of the possibility of a nalidixic-acid resistant strain of S. typhi. The clinical course was complicated by a small bowel perforation on the third day of the disease. Blood cultures grew a nalidixic acid resistant strain of Salmonella enterica serovar typhi. The patient recovered completely. The second patient, a 22-year-old man, suffered from fever, malaise and hearing loss. A sensorineural hearing loss with vestibular dysfunction was diagnosed. Cultures of blood and bone marrow aspirate showed a nalidixic acid resistant strain of S. typhi. Treatment with ciprofloxacin and ceftazidime improved the hearing loss significantly. The clinical features of typhoid fever are heterogeneous and rare complications may occur. The emergence of multidrug and nalidixic acid resistance may complicate further the treatment of this serious systemic infection.