Presentation Of Enteric Fever Research Articles

Enteric Fever Presenting With Right Iliac Fossa Pain Misdiagnosed as Acute Appendicitis: A Diagnostic Pitfall

Enteric Fever Presenting With Right Iliac Fossa Pain Misdiagnosed as Acute Appendicitis: A Diagnostic Pitfall

CLINICAL PROFILE OF TYPHOID FEVER IN CHILDREN

Background: The present study describes the clinical presentation of enteric fever at a tertiary care centre.
 Methods: The study was a hospital based prospective observational study conducted on children of age 2 -18 years who presented with fever of 5 days or more with clinical signs and symptoms suggestive of typhoid fever and positive Widal test or Typhidot tests were included in the study. The demographic and clinical features of the patients were described.
 Results: All the children presented with fever as the main complaint (100%). Commonest sign noticed was toxic look (84%) followed by coated tongue (79%) and splenomegaly (61%). Hepatomegaly was also noted in 34% of cases.
 Conclusion: This study was undertaken to observe the clinical profile of typhoid fever in children admitted in a tertiary care hospital. Typhoid fever remains to be as an endemic disease in this locality. All the signs and symptoms of the disease are nonspecific common with other acute febrile illnesses; a definitive diagnosis of the disease is required for treatment and to prevent transmission.
 Keywords: Enteric fever, Splenomegaly, Toxic look

Clinical profile of typhoid fever in children at a tertiary care hospital: a cross sectional study

Background: In endemic areas such as India, traditional signs and symptoms in enteric fever are not often observed. Unusual presentations lead to diagnostic dilemma and may delay the diagnosis of typhoid fever. The present study describes the clinical presentation of enteric fever at a tertiary care centre in Aurangabad district of Maharashtra.Methods: The study was a hospital based prospective observational study done in paediatric ward of MGM Medical College, Aurangabad over a period of 18 month starting from 1st November 2013 to 31st April 2015. The parents of the children were informed about the research and its objectives, and written informed consent was obtained from them. Prior approval was taken from institutional ethics committee. Children of age 2 -18 years who presented with fever of 5 days or more with clinical signs and symptoms suggestive of typhoid fever and positive Widal test or Typhidot tests were included in the study. The demographic and clinical features of the patients were described.Results: Total of 99 patients were included in the study. Majority of the children were between 2 - 7 year age group (45.4%). Out of 99 children, 57 were males and 42 were females. Majority of the cases were from urban areas accounting for 75%, which included urban slums. Drinking water source was tap water in 80% cases and bore well water in 20% cases. Only 36.4% of children had fever of less than one-week duration. 58.6% of the cases had fever of more than one week but less than two weeks. Continuous fever was noticed in majority of children (55.55%). All the children presented with fever as the main complaint (100%). Loss of appetite and headache were the next common complaints reported by 59.6% cases. Commonest sign noticed was toxic look (83.8%) followed by coated tongue (74.7%) and splenomegaly (61.6%). Hepatomegaly was also noted in 39.4% of cases.Conclusions: Clinical presentation in the study subjects was similar to available reports from literature.

Clinical profile of enteric fever in tertiary care hospital of Kashmir

Background: Enteric fever is common cause of pyrexia in children and its diagnosis poses several problems, the diagnosis most often remains either as an unsubstantiated clinical impression or a serological diagnosis and occasionally confirmed by blood culture. Typhoid fever is a commonly encountered systemic disease caused by the gram-negative bacteria Salmonella enterica serovar typhi. It is a major public health problem in India. The incidence of enteric fever can be regarded as an index of sanitary measure practiced in our country. Aim of our study was to know the clinical profile, hematological features of clinically and serologically suspected typhoid cases, antibiotic pattern in use, the time to defervescence with the treatment received and over all hospital stay days.Methods: This was a retrospective record file review of all admitted children for pyrexia under evaluation who were clinically suspected as cases of enteric fever and serologically proven by significant titres of O and H antigen and few were culture proven cases of enteric fever carried out at a tertiary care children hospital in Kashmir valley over the period January 2012 to January 2016.Results: During this period, a total of 129 children with typhoid fever were admitted to Pediatric ward. Of the 129 children, 69 (53.5%) were boys and 60 (46.5%) were girls. The age range of the study population was 1 year to 15 years. The predominant symptoms of typhoid fever were fever 123 (95.3%), anorexia/weakness 58 (45.0%), abdominal pain 53 (41.1%), pallor 47 (36.4%), coated tongue 42 (32.6%), headache 30 (23.3%) and gastrointestinal symptoms/ dysentry 9 (7.0%). Diarrhea 25 (19.4%) was more common than constipation 5 (3.9%) in this study. Hepatomegaly 26 (20.2%) and splenomegaly 67 (51.9%), lymphadenopathy 24 (19.4%) and seizure in 5 cases (3.9%) were other major physical findings. Typhoid complications were seen in the form of jaundice (deranged LFTs) 25 (19.4%), abdominal distention 20 (15.5%) and tenderness 14 (10.9%), encephalopathy 5 (3.9%), shock 3 (2.3%) and UTI 4 (3.1%). Blood culture was positive in 36 (27.9%), 20 (15.5%) percent of the isolates were Salmonella typhi, while 16 (12.4%) were Salmonella paratyphi A. low yield was attributed to oral antibiotics received outside hospital setting. Ceftriaxone was used to treat all the patients diagnosed with enteric fever. Oral Azithromycin was added to treatment regime in those patients who were persistently febrile after 6 days. Those patients who were discharged before 14 days, therapy was completed with oral cefixime. The mean duration of hospital stay was 9.6 days for uncomplicated cases. Leukopenia was seen in majority of the patients with mean cell count of 6492.7cubic/mm. The mean time to defervescence in patients who received prior antibiotics was 4 days while that in those who did not receive prior antibiotics was 5 days.Conclusions: Atypical presentations are seen in typhoid fever patients so we need to be cautious about it, clinical symptoms and signs can vary with different regional studies, may be attributed to use of empirical oral antibiotic that alter the clinical presentation of enteric fever. Low culture positivity is due to prior or ongoing antibiotic treatment outside hospital setting. Leucopenia could be an important marker of typhoid. Ceftriaxone is important available cephalosporin for sensitive cases. Combination treatment was used to treat persistently febrile child.

Acute acalculous cholecystitis and Gall Bladder perforation: An unusual presentation of enteric fever (typhoid)

Abstract Enteric fever is a common infection that has continued to be a public health problem in many developing countries. Surgical complications of enteric fever constitute a significant cause of morbidity and mortality, most common being intestinal perforation. Gall bladder perforation (GBP) is an unusual presentation of enteric fever following acalculous cholecystitis. It is particularly very rare in adoloscents. GBP is a common complication of acute calculous cholecystitis, commonly seen in adults and elderly. GBP following acalculous cholecystitis has high mortality as compared to calculous cholecystitis. We report a case of an adoloscent male who presented with peritonitis without evidence of intestinal perforation and was diagnosed to have acute acalculous cholecystitis and localized GBP due to enteric fever.

Unusual presentation of enteric fever in an 11-year-old female child

Abstract Enteric fever is a very common preventable disease seen in the Indian population. This disease is known to cause a variety of complications involving every system. We report a case of enteric fever that presented at the start as acute gastritis and then went on to develop acute pancreatitis, which is a rare complication of enteric fever, along with capillary leak syndrome in the acute phase mimicking dengue shock syndrome. This unusual presentation has not been reported in Indian or foreign literature.

Enteric fever presenting as catatonia and parkinsonism : An unusual presentation

Enteric fever presenting as catatonia and parkinsonism : An unusual presentation

Mysterious Looks of Typhoid Fever: A New Experience

Enteric fever (typhoid or paratyphoid) is a common infectious disease worldwide, especially in developing countries like Bangladesh. Typhoid fever caused by the gram negative bacterium Salmonella typhi that may have a wide spectrum of clinical presentations. We report a case of a 17 year old previously healthy college boy who presented with fever, abdominal pain and shortness of breath later on who was eventually diagnosed as having typhoid fever complicated by acute pancreatitis, hepatitis and severe pulmonary hypertension. Enteric fever presenting as acute pancreatitis and pulmonary hypertension is a rare entity and must be considered in endemic areas like Bangladesh, in patients presenting with fever and concomitant severe abdominal pain and shortness of breath, as any delay in timely institution of treatment can prove fatal. There are very few case reports in the world which have depicted this unusual association.Bangladesh Crit Care J March 2015; 3 (1): 36-38

A Rare Complication of Enteric Fever - Case Report

Enteric fever is a common infectious disease worldwide, especially in developing countries like India. We report a case of a 27 year old patient who presented with fever and abdominal pain and was eventually diagnosed as having enteric fever complicated by acute pancreatitis. Enteric fever presenting as acute pancreatitis is a rare entity and must be considered in endemic areas like India, in patients presenting with fever and concomitant severe abdominal pain as any delay in timely institution of treatment can prove fatal. There are very few case reports which have depicted this unusual association. Keywords: Acute Pancreatitis, Enteric Fever, Typhoid, Abdominal pain

Enteric Fever Presenting as Acute Ataxia

Enteric Fever Presenting as Acute Ataxia

Enteric Fever Presenting as Secondary Hemophagocytic Lymphohistiocytosis

Sir, Hemophagocytosis is the pathologic finding of aggressive, but non-malignant proliferation of macrophages and histiocytes [1]. Hemophagocytic Lymphohistiocytosis (HLH) has been associated with a variety of infections and malignancies [2, 3]. However, its association with enteric fever is uncommon. We describe a case of enteric fever with an uncommon complication of secondary HLH (sHLH), responding completely with antibiotic treatment alone. A 10-y-old boy presented with complaints of fever for 5 d and altered consciousness for one day. His younger sibling was admitted to a hospital for the past 10 d as a case of enteric fever. Examination revealed severe pallor, petechie over body, hepatomegaly (5 cm below right costal margin), splenomegaly (3 cm in splenic axis), altered sensorium (E3M1V2) and meningeal signs. Initial diagnosis of meningoencephalitis was kept. Investigations revealed pancytopenia (Hb 6.9 g%, TLC 800/μL, ANC 384/μL, MCV 86.3 fL, platelets010×10/ μL, DLC 0 N48L48E0M4, and normocytic normochromic RBCs). Rest of the investigations, including lumbar puncture were normal. In view of pancytopenia, bone marrow examination was performed which showed features of hemophagocytosis (Fig. 1). His serum triglycerides (265 mg/dl) and serum ferritin (1,791 ng/ml) were high. Thus the diagnosis was established as infection associated hemophagocytosis (IAHS). A widal test done on the seventh day of fever showed positive titres (TO >1:320, TH >1:320) rising from baseline tires (TO <1:40, TH <1:40) done at day two, done from outside. Repeat blood culture and bone marrow cultures were sterile. The patient was managed as a case of enteric fever with encephalopathy and secondary HLH. He received multiple transfusion supports and ceftriaxone for fourteen days. He became asymptomatic by fifth day of antibacterial therapy, his blood counts normalised and he was discharged after completion of antibiotic therapy. Association of sHLH with enteric fever has only been reported in a few cases till date in the English literature [4, 5]. Fatality rate of 50% is present in children with sHLH. The treatment includes etoposide, dexamethasone, and cyclosporine. However our case report stresses the fact that management of underlying infection in cases presenting with severe forms of HLH with enteric fever may obviate the need of intensive treatment. Cytopenias are known in enteric fever due to marrow suppression. However, hemophagocytosis is described as an uncommon extra-intestinal complication of enteric fever [4].

An Unusual Presentation of Enteric Fever

An Unusual Presentation of Enteric Fever

Shock: A presentation of enteric fever

Shock: A presentation of enteric fever

Enteric (Typhoid) Fever in Travelers

The incidence of enteric (typhoid) fever in travelers is estimated to be approximately 3-30 cases per 100,000 travelers to developing countries. Recently, it is become clear that travelers who are visiting friends and relatives, especially travelers to the Indian subcontinent, seem to be the most vulnerable to enteric fever and require special attention for prevention. Recent concerns are the increasing incidence of paratyphoid fever in Asia, which is not covered by available typhoid vaccines, and the emergence of infections caused by antibiotic-resistant strains (including strains resistant to fluoroquinolones). Typhoid vaccination is recommended for most travelers to moderate- to high-risk countries. Because of the nonspecific clinical presentation of enteric fever, a high index of suspicion is important in febrile travelers who have traveled to areas of endemicity.

Typhoid Fever Presenting as Acute Psychosis.

Enteric fever presenting with atypical manifestations is challenging even to astute clinicians and is not a new occurrence in the tropics. Various authors have highlighted the protean manifestations of this common tropical infection [1, 2, 3]. The emergence of multi-drug resistant strains of Salmonella typhi and the HIV pandemic have altered the spectrum of the disease and made the treatment difficult due to multiple drug resistance. The classical pattern of presentation of continuous fever with “step ladder” rise and relative bradycardia is not common. Though neuropsychiatric complications are reported in as much as 45–76% of patients during every stage of typhoid fever [4, 5, 6, 7, 8], the chance of misdiagnosis or delayed diagnosis of the primary illness is still quite common. Most of such cases are considered to be a part of the “Typhoid toxaemia”, where patients develop delirium and confusion during the initial stages of the disease along with high fever, and generally subsides within 1–2 days of defervescence [8].