Document Detail

Jaundice in typhoid patients: differentiation from other common causes of fever and jaundice in the tropics.
MedLine Citation:
PMID:  20710103     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: While typhoid fever is common in our environment, presentation with jaundice is unusual. The aim of this study has been to determine the clinical and laboratory features that allow early diagnosis of typhoid fever in patients that present with jaundice and differentiate it from other common causes of fever and jaundice in the tropics. MATERIALS AND METHODS: This prospective study was conducted between May 1997 and October 1998 at Center Hopitalier Regional de Hombo Anjuoan, Comoros Islands. Patients with clinical and laboratory evidence of typhoid fever were included. Viral or toxic hepatitis, chronic liver disease, sickle cell disease and other causes of jaundice were excluded by clinical examination and appropriate investigations. Serial evaluation of liver function test and abdominal ultrasound were done. Patients were resuscitated with fluids and electrolytes and treated with appropriate antibiotics. Liver involvement was determined using clinical and laboratory parameters. RESULTS: Of the 254 patients with confirmed diagnosis of typhoid fever, 31 (12.2%) presented with jaundice. Their mean age was 24.6+/-9.2SD years. Fever preceded the appearance of jaundice by 8-27 days. In 27 (87.1%) patients, there was hepatosplenomegaly. Serum bilirubin ranged 38-165 micromol/l with mean of 117+/-14SD. Conjugated bilirubin ranged 31-150 micromol/l with mean of 95+/-8SD. Serum aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase were raised with mean values of 180, 105 and 136 IU, respectively. Six (19.4%) patients died compared to 12.1% of non-icteric patients. CONCLUSION: Typhoid patients may present with varying degrees of jaundice and fever that may be confused with viral, malarial or amebic hepatitis, diseases that are common in the tropics. Physical examination and simple biochemical tests would identify the typhoid patients who should be treated with appropriate antibiotics even before the results of blood culture are available.
A Ahmed; B Ahmed
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of African medicine     Volume:  9     ISSN:  0975-5764     ISO Abbreviation:  Ann Afr Med     Publication Date:    2010 Jul-Sep
Date Detail:
Created Date:  2010-08-16     Completed Date:  2010-09-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101231417     Medline TA:  Ann Afr Med     Country:  Nigeria    
Other Details:
Languages:  eng     Pagination:  135-40     Citation Subset:  IM    
Department of Surgery, Centre Hopitalier Regional de Hombo, Anjouan, Comoros Islands.
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MeSH Terms
Alanine Transaminase / blood
Alkaline Phosphatase / blood
Anti-Bacterial Agents / therapeutic use
Aspartate Aminotransferases / blood
Bilirubin / blood
Diagnosis, Differential
Jaundice / blood,  diagnosis,  etiology*
Liver Function Tests
Middle Aged
Prospective Studies
Typhoid Fever / complications*,  diagnosis*,  drug therapy
Young Adult
Reg. No./Substance:
0/Anti-Bacterial Agents; 635-65-4/Bilirubin; EC Aminotransferases; EC Transaminase; EC Phosphatase

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