scholarly journals A Reappraisal of Clinical Characteristics of Typhoid Fever

2012 ◽  
Vol 34 (3) ◽  
pp. 80-85 ◽  
Author(s):  
ABM Shahidul Alam ◽  
Sanjana Zaman ◽  
Farhana Chaiti ◽  
Naveen Sheikh ◽  
Gopen Kumar Kundu
Keyword(s):  
Typhoid Fever ◽  
Clinical Presentation ◽  
Current Knowledge ◽  
Clinical Manifestations ◽  
Health Resources ◽  
Signs And Symptoms ◽  
Salmonella Typhi ◽  
Widal Test ◽  
Missed Diagnosis ◽  
The Mean

Background: Recent reports from developing countries show that the clinical presentation, diagnosis and treatment of typhoid have significantly altered often leading to missed diagnosis. The incidence of complications is also reported to be variable. The consequence of missed diagnosis is immense in terms of burden on limited health resources and patients’ suffering. Therefore, its clinical spectrum requires constant reappraisal to update our physicians with current knowledge. This study was carried out to determine the changes in clinical pattern of typhoid fever. Patients & Methods: A total of 106 children, aged up to 14 years, diagnosed primarily as typhoid fever, were included as study population. The diagnostic criteria were either positive blood culture for Salmonella typhi or Salmonella paratyphi or at least a four-fold rise in antibody titre on Widal test. The study included mode of clinical presentations, treatment received before admission, Widal test findings and culture and sensitivity to antibiotics. Results: The mean age of the patients was 5.2 years and males were a little than the females. The mean duration of illness was 11.2±3.3 days. Majority of the patients presented with classical signs and symptoms like step ladder pattern of fever (nearly 70%) coated tongue (69.8%), diarrhoea (49.1%), toxemia (68.9%), relative leucopenia (71.7%), hepatomegaly (55.7%), pain in the right hypochondrium (41.5%) and splennomegaly (18.9%). Very few cases had a typical manifestations. Over 85% of the patients had raised SGPT (>40 IU/L) and 13.8% had detectable jaundice (serum billirubin >3 mg/dl). Widal test demonstrated that about 45% of the patients’ ‘O’ antibody titer increased to 4-fold, 27.4% to 8-fold or more. In case of antibody ‘H’, 35.8% exhibited 4-fold and 39.7% 8-fold or more increase. Of the 103 cases, 68(66%) were positive for Salmonella typhi. Majority of the isolated organisms was sensitive to cefixime, ceftriaxone and gentamycin (83%, 84% and 82% respectively). The second line of sensitivity was obtained to amikacin (64.2%), meropenem (50%), ciprofloxacin (46.2%), imepenem (46.2%) and azithromycin (43.4%). The least sensitive drugs were amoxicillin (28.3%), cotrimoxazole (27.4%) and chloramphenicol (22.6%). Onethird (33.8%) of the patients had multidrug resistant (MDR) strains. However, No significant association was found between multi-drug resistant (MDR) strains and atypical clinical manifestations. Conclusion: Clinical presentation of most typhoid fever still conforms with the classic pattern. High fever, anorexia, coated tongue, diarrhoea, relative leucopenia and hepatosplenomegaly are still common manifestations of typhoid fever. So, majority of the patients could be treated blindly based on clinical diagnosis. However, treatment should be given with first line of drugs like cefexime or ceftriaxone. DOI: http://dx.doi.org/10.3357/bjch.v34i3.10357 BJCH 2010; 34(3): 80-85

scholarly journals Utility of A Single Widal Test in The Diagnosis of Typhoid Fever

2012 ◽  
Vol 35 (2) ◽  
pp. 53-58 ◽  
Author(s):  
ABM Shahidul Alam ◽  
Fahim Ahmed Rupam ◽  
Farhana Chaiti
Keyword(s):  
Blood Culture ◽  
Typhoid Fever ◽  
Predictive Value ◽  
Salmonella Typhi ◽  
Definitive Diagnosis ◽  
Blood Cultures ◽  
Widal Test ◽  
Female Ratio ◽  
The Mean ◽  
Agglutinin Titer

Background & objectives: The clinical diagnosis of typhoid fever is difficult, as the presenting symptoms are often diverse and similar to those observed with other febrile illnesses. The definitive diagnosis of typhoid fever requires the isolation of Salmonella typhi or paratyphi from the patient concerned. Since patients often receive antibiotics prior to a confirmatory diagnosis, there is uncertainty that bacteria can be isolated from the blood cultures. Besides this, the facilities for blood culture are not always available or feasible. All these limitations have made Widal test the most utilized diagnostic test for typhoid fever. Many studies have produced data which had cast serious doubts on the value of the Widal Test and thus reappraisal of the role of a single Widal test is needed.Methods & materials: This study was carried out to determine the changes in clinical pattern of enteric fever. A total of 153 children, aged 0 to 14 years, diagnosed as typhoid fever (either positive blood culture for Salmonella typhi or paratyphi) were induced in the study. Of them, 86 children were with a definitive diagnosis of typhoid or paratyphoid fever as indicated by the isolation of S. typhi or S. paratyphi from the blood and 17 had negative blood culture but were clinically suspected of having typhoid fever. The control group was comprised of 50 children with non-typhoidal fevers The Widal test was carried out using rapid slide agglutination method and its accuracy was assessed by comparing the findings with that obtained through blood culture.Result: The mean age of the patients was 5.2 ± 2.8 years and the youngest and oldest patients were 0.7 and 14 years respectively and male to female ratio was roughly 1:1. Nearly one-quarter (24.6%) of the patients had been suffering from the disease for >10 days and the mean duration of illness was 8.2 ± 3.3 days. Widal Test result showed that an ‘O’ agglutinin titer of cut-off value e”1:40 gave a sensitivity of 87.2%, a specificity of 47.1%, a positive predictive value (PPV) of 89.2% and a negative predictive value (NPV) of 42.1%. The sensitivity and NPV decreased with the increase in titer levels and were 56.9% and 31.5% at cut-off value of e” 1:320, while the specificity and PPV increased with the increase in titer levels from 47.1% and 89.2% respectively at a titer of e”1:40 to 100% at a titer of e” 1:320. The ‘titer behaved in the same way as did the ‘O’ agglutinin titer. Similarly when H’ agglutinin was used the sensitivity and NPV decreased from 65% and 31.7% at a titer of e”1:40 to only 25% and 20% respectively at a titer of > 1:320, while specificity and PPV increased from 76.4% and 81.1% at >1:40 to 94.1% and 95.6% respectively at e” 1:320. When either ‘O’ or ‘H’ antibody titer of e”1:160 was used, a good sensitivity (71%), specificity (70.6%) and PPV (92.4%) resulted, though NPV decreased to 32.4%.Conclusion: The Widal test can be of diagnostic value when blood cultures are not available nor practically feasible.DOI: http://dx.doi.org/10.3329/bjch.v35i2.10377  Bangladesh J Child Health 2011; Vol 35 (2): 53-58

scholarly journals CLINICAL PROFILE OF TYPHOID FEVER IN CHILDREN

2021 ◽  
Vol 5 (12) ◽  
Author(s):  
Poonam Meena ◽  
Satish Meena ◽  
Ashok Meena ◽  
Kailash Meena
Keyword(s):  
Typhoid Fever ◽  
Prospective Study ◽  
Enteric Fever ◽  
Clinical Presentation ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Definitive Diagnosis ◽  
Clinical Profile ◽  
Widal Test ◽  
Clinical Signs And Symptoms

Background: The present study describes the clinical presentation of typhoid fever. Methods: The study was a hospital based prospective study. 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. Results: Commonest sign noticed was toxic look (88.00%) followed by coated tongue (79.00%) and splenomegaly (63.00%). Hepatomegaly was also noted in 35.00% of cases. Conclusion: 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

scholarly journals TYPHOID FEVER

2007 ◽  
Vol 14 (04) ◽  
pp. 620-626
Author(s):  
MAQSOOD AHMAD ◽  
Badar Bashir ◽  
MUHAMMAD SAEED AKHTAR ◽  
Muhammad Irfan ◽  
MUHAMMAD AMER ADIL ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Salmonella Typhi ◽  
Blood Cultures ◽  
Efficacy And Safety ◽  
Widal Test ◽  
Male Patients ◽  
The Mean ◽  
Almost All ◽  
Study Setting ◽  
Symptoms And Signs

Objectives: To find out the efficacy and safety of Levofloxacinin patients suffering from typhoid fever. Design: Non-comparative and prospective study. Setting: Medical Units ofAllied & DHQ Hospital (PMC) Faisalabad. Period: From May 2002 to July 2004. Material & Methods: All suspectedfebrile patients were examined and provisionally diagnosed to have typhoid fever were admitted for the purpose ofstudy till they were satisfactorily discharged. Results: This clinical study was conducted on 70 patients of Enteric Fever.Fifty-two patients were male and 18 were female. The mean age for male patients in the study sample was 37.58± 8.13while the mean age of females was 21.92± 4.73 years. Fever as a symptom was present in all 70(100%) of thepatients. Anorexia was there in 61(85.5%)patients and abdominal pain in 49(70%) patients. Twenty-seven (38.5%)patients had constipation along with other features. Diarrhea was present in 6 (8.5%) patients. Relative bradycardiawas present in 20(28.5%) patients. Hepatomegaly was there in 31(44.3%) and Splenomegaly in 24(34.3%). Elevatedliver enzymes were found in 29 (41.4%) of the patients and blood cultures positive for Salmonella typhi was seen in19(27.1%) patients. Widal test was positive at dilution of 1:160 in almost all of the cases and at 1:320 dilution in 18%of cases in current study. The success rate of Levofloxacin in our study was 100% in the form of settlement of feverand other symptoms and signs. The side effects were seen in 17(24.2%) patients. Conclusions: In conclusionlevofloxacin is effective in treatment of typhoid fever and its use in this indication is safe.

scholarly journals Clinical manifestations of chronic subdural hematoma in the elderly: Literature Review

2021 ◽  
Author(s):  
Gabriela Ferreira Kalkmann ◽  
Carlos Umberto Pereira ◽  
Francisco de Assis Pereira ◽  
Débora Moura da Paixão Oliveira ◽  
Nicollas Nunes Rabelo
Keyword(s):  
Early Diagnosis ◽  
Literature Review ◽  
Subdural Hematoma ◽  
Elderly Population ◽  
Clinical Presentation ◽  
Clinical Manifestations ◽  
Chronic Subdural Hematoma ◽  
Signs And Symptoms ◽  
The Elderly ◽  
Study Results

Introduction: The clinical manifestations of chronic subdural hematoma (CSDH) are often confused with other medical entities in the elderly, making their early diagnosis difficult or difficult. Early diagnosis is important, since its prognosis is directly associated with the preoperative neurological state, thus resulting in a worse vital and functional prognosis. Objectives: Report through a literature review the clinical manifestations of CSDH in the elderly population. Methods: Literature review, with the search terms: “Signs and Symptoms”, “Chronic Subdural Hematoma”, Aged, Diagnosis and Prognosis. In which PubMed, Lilacs, Scielo, Cochrane and TripDataBase data platforms were used. The inclusion criteria were: original studies published in any language. Articles in which full reading was prevented were excluded. With the application of the inclusion and exclusion criteria, 110 articles were included in the study. Results: Clinical presentation depends on the location, volume of the hematoma, rapid growth, the location of the CSDH, whether unilateral or bilateral, and the clinical conditions of the patient. Because the forms of clinical presentation of CSDH are variable, it is necessary that health professionals linked to the elderly (geriatrician, psychiatrist, general practitioner) have knowledge of this clinical entity. Conclusions: The recognition of classic forms as well as the identification of risk factors in the elderly favors the timely diagnosis and treatment of CSDH in the elderly population.

scholarly journals A Patient with Typhoid Hepatitis

2021 ◽  
Vol 22 (2) ◽  
pp. 154-158
Author(s):  
M Vitanata Arfijanto ◽  
Isty Rindryastuti
Keyword(s):  
Blood Culture ◽  
Typhoid Fever ◽  
Gastrointestinal Symptoms ◽  
Signs And Symptoms ◽  
Hemorrhagic Fever ◽  
Liver Function Tests ◽  
Salmonella Typhi ◽  
Abnormal Liver Function ◽  
Grade Ii ◽  
Ig G

Typhoid hepatitis is typhoid fever accompanied by symptoms of jaundice, hepatomegaly and abnormal liver function tests. The incidence varies between 0.4% -26% of typhoid fever patients. We report a case of a 34-year-old male, presented with fever, epistaxis, gastrointestinal symptoms, thrombocytopenia and elevated AST/ ALT, thus the patient was first diagnosed as dengue hemorrhagic fever grade II. On day 9th the signs and symptoms were persisted, Ig M and Ig G Dengue was negative. Then we evaluated the virus marker for hepatitis and blood culture. The results were negative for HBsAg, anti HCV and Ig M anti HAV, but Salmonella typhi detected on blood culture. The patient was treated with ceftriaxone 1000mg bid iv and get better then discharged from hospital.

scholarly journals Catecholamine-Induced Cardiomyopathy in Pheochromocytoma: How to Manage a Rare Complication in a Rare Disease?

2018 ◽  
Vol 51 (07) ◽  
pp. 458-469 ◽  
Author(s):  
Jenn Rachelle U. Santos ◽  
Alessandra Brofferio ◽  
Bruna Viana ◽  
Karel Pacak
Keyword(s):  
Clinical Presentation ◽  
Rare Complication ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Cardiovascular Responses ◽  
Adrenergic Stimulation ◽  
Venous Compliance ◽  
Therapeutic Algorithm ◽  
Different Types ◽  
Excessive Secretion

AbstractPheochromocytomas and paragangliomas (PHEOs) are rare neuroendocrine tumors. Clinical manifestations include different cardiovascular signs and symptoms, which are related to excessive secretion of catecholamines. Catecholamine-induced cardiomyopathy in PHEO (CICMPP) is a rare but dreaded complication of PHEO. Once patient is diagnosed with this condition, the prognosis is worse and a surgical risk is much higher than expected. This article focuses on how catecholamines affect the heart and the pathophysiologic mechanism of CICMPP. The cardiovascular responses to catecholamine depend mostly on which catecholamine is released as well as the amount of catecholamine that is released. The acute release of norepinephrine and epinephrine from PHEO increases heart rate, systemic vascular resistance, myocardial contractility, and reduces venous compliance. The excessive adrenergic stimulation by catecholamine results in severe vasoconstriction and coronary vasospasm, myocardial ischemia, and subsequently damage, and necrosis. Chronically elevated catecholamine levels lead to significant desensitization of cardiac β-adrenoceptors. The increased levels of the enzyme β-adrenoceptors kinase (βARK) in the heart seems to mediate these biochemical and physiological changes that are consistently correlated with attenuated responsiveness to catecholamine stimulation. Through these mechanisms different types of cardiomyopathy (CMP) can be formed. This review discusses extensively the 3 types of cardiomyopathies that can be present in a PHEO patient. It also provides the clinical presentation and diagnostic and therapeutic algorithm in managing patients with CICMPP.

scholarly journals Gambaran Hasil Uji Widal Berdasarkan Lama Demam pada Pasien Suspek Demam Tifoid

2016 ◽  
Vol 5 (3) ◽  
Author(s):  
Vika Rahma Velina ◽  
Akmal M. Hanif ◽  
Efrida Efrida
Keyword(s):  
Typhoid Fever ◽  
Medical Record ◽  
Salmonella Typhi ◽  
Definitive Diagnosis ◽  
Widal Test ◽  
Descriptive Research ◽  
Antibody Titers ◽  
O Antigens

AbstrakDiagnosis definitif demam tifoid adalah dengan biakan, tetapi pada beberapa daerah sering tidak tersedia fasilitas untuk biakan, maka cara lain untuk membantu menegakkan diagnosis yang praktis dan tersedia di rumah sakit yaitu uji Widal. Tujuan penelitian ini adalah untuk mengetahui gambaran hasil uji Widal pada pasien suspek demam tifoid. Penelitian ini dilakukan di Bagian Rekam Medik  RS Dr. M. Djamil Padang. Jenis penelitian ini adalah retrospektif deskriptif yang telah dilaksanakan dari Juli 2013 sampai Februari 2014. Jumlah sampel yang didapatkan adalah sebanyak 46 orang. Dari 46 sampel didapatkan hasil uji Widal dengan titer antibodi terhadap antigen O 1:80 sebanyak 6,51%, 1:160 sebanyak 73,89%, 1:320 sebanyak 19,54%, dan 1:640 sebanyak 0%. Titer antibodi terhadap antigen H 1:80 sebanyak 4,34%, 1:160 sebanyak 47,80%, 1:320 sebanyak 45,63%, dan 1:640 sebanyak 2,17%. Kesimpulan hasil studi ini ialah 1:160 adalah titer yang tersering ditemukan dengan titer antibodi terhadap antigen O tertinggi yakni 1:320 lebih sering ditemukan pada lama demam dengan rentang 6 – 8 hari sedangkan titer antibodi terhadap antigen H tertinggi yakni 1:640 ditemukan pada lama demam dengan rentang 6 – 8 hari.Kata kunci: demam tifoid, uji Widal, Salmonella typhi AbstractThe definitive diagnosis of typhoid fever is  proven by culture, but in some areas is often no way of culture. There is another examination that has been found to help the diagnosis that is practical and available in hospital which is called Widal test. The objective of this study was to describe the results of Widal test in patients with suspected typhoid fever. This research was conducted at the medical record of Dr. M. Djamil Padang Hospital. This is a descriptive research which was held in July 2013 – February 2014. The number of samples obtained are as many as 46 people.  The 46 samples obtained Widal test, the results was made with titres of antibodies against O antigens 1:80 as much as 6,51%, 1:160 as much as 73,89%, 1:320 as much as 19,54%, and 1:640 as much as  0%. Titers of antibodies against H antigens 1:80 as much as 4,34%, 1:160 as much as 47,80%, 1:320 as much as 45,63%, and 1:640 as much as 2,17%. The conclusion is 1:160 is the most often titres found in patients with suspected typhoid fever with the highest value of antibody titers against the O antigens that is 1:320, is more common in duration of fever with a range of 6-8 days and the highest value of antibody titers against H antigens that is 1:640 has found in duration of fever with range 6-8 days.Keywords: typhoid fever, Widal test, Salmonella typhi

scholarly journals The Optimum Cut-off Value of the Nelwan Score to Diagnose Typhoid Fever in Adults

2021 ◽  
Author(s):  
Erni Juwita Nelwan ◽  
Luh Putu Listya Paramita ◽  
Robert Sinto ◽  
Fransiscus Nikodemus Hosea ◽  
Pringgodigdo Nugroho ◽  
...  
Keyword(s):  
Typhoid Fever ◽  
Clinical Presentation ◽  
Clinical Signs ◽  
Gastrointestinal Symptoms ◽  
Signs And Symptoms ◽  
Diagnostic Value ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Clinical Signs And Symptoms ◽  
Sensitivity Specificity

AbstractIntroductionTyphoid fever can be challenging to diagnose since clinicians often depend merely on clinical presentation. Clinical scores are useful to provide more accurate diagnosis. Variables in Nelwan Score are derived from clinical signs and symptoms of suspected cases for typhoid. Diagnostic value of Nelwan Score based on a cut-off value has never been evaluated.MethodsA cross sectional study was conducted between July 2017 and January 2018 in five hospitals and two Primary Health Centers in Jakarta and Tangerang. The inclusion criteria were patients with 3-14 days of fever and gastrointestinal symptoms between July 2017 and January 2018. Diagnosis are confirmed by blood culture, rectal swab culture, or PCR. Cut-off analysis was performed by using Receiver Operating Characteristic (ROC) curve and diagnostic value was analyzed to generate sensitivity, specificity, predictive value and likelihood ratio.ResultFrom 233 subjects involved, 4.72% of them were confirmed to have typhoid fever. The optimal cut-off value of Nelwan Score is 10 with AUC 71.3%. This cut-off value has sensitivity 81.8%, specificity 60.8%, PPV 9.3%, NPV 98.5%, LR + 2.086, and LR – 0.299.ConclusionNelwan Score with cut-off value of 10 provides a good diagnostic performance as a screening tool for patients with suspected typhoid fever clinical presentation.

scholarly journals Comparison of results obtained by widal agglutination test & polymerase chain reaction among clinically suspected typhoid fever cases

2015 ◽  
Vol 30 (2) ◽  
pp. 46-50
Author(s):  
Shafinaz Khan ◽  
Md Ruhul Amin Miah ◽  
Shammin Haque ◽  
Chowdhury Rafia Naheen
Keyword(s):  
Polymerase Chain Reaction ◽  
Blood Culture ◽  
Typhoid Fever ◽  
False Negative ◽  
Salmonella Typhi ◽  
Widal Test ◽  
Chain Reaction ◽  
Polymerase Chain ◽  
Positive Results ◽  
Prior Antibiotic Treatment

The diagnosis of typhoid fever currently depends on isolation of Salmonella Typhi from blood. The sensitivity of blood culture is very low due to prior antibiotic treatment which is a common practice in Bangladesh. The sensitivity of blood culture also decreases at later stage of the disease. Widal test is the most utilized test in Bangladesh next to blood culture because it is inexpensive, less invasive. But the result of the test is controversial due to false negative & false positive results in some cases.  In this study, a recently introduced polymerase chain reaction-based technique (which has 100% specificity for S. Typhi) was compared with widal test among 80 clinically suspected typhoid fever cases.  Among 80 cases, the respective figures of positivity for PCR & widal test were 70% & 43.75% respectively.  It can be concluded that PCR based technique is more sensitive & much superior to widal for diagnosis of typhoid fever. DOI: http://dx.doi.org/10.3329/bjpp.v30i2.22683 Bangladesh J Physiol Pharmacol 2014; 30(2): 46-50

scholarly journals USE OF WIDAL TEST IN DIAGNOSIS OF TYPHOID FEVER IN NORTH INDIAN POPULATION BY ESTIMATING BASELINE TITER IN CONTROL GROUP

2017 ◽  
Vol 10 (7) ◽  
pp. 251
Author(s):  
Shetty Jeevan
Keyword(s):  
Typhoid Fever ◽  
Healthy Volunteers ◽  
Enteric Fever ◽  
Early Recognition ◽  
Test Group ◽  
Salmonella Typhi ◽  
Control Group ◽  
Age Group ◽  
Widal Test ◽  
Medical College

Objective: This study was undertaken to establish a cutoff significant titer for Widal test using healthy volunteers as control group. Utilizing the baseline titer obtained from the control group, a diagnosis of typhoid fever was made in the test group comprising outpatients and inpatients. Methods: Blood samples were collected from healthy volunteers and patients attending G.S Medical College and Hospital, Pilkhuwa, over a period of 6 months from September 2016 to March 2017. Antibodies to Salmonella typhi (TO, TH) and Paratyphi A (AH) and Paratyphi B (BH) are determined by this tube agglutination test. A total of 124 healthy controls and 303 patients having clinical suspicion of typhoid fever were subjected to Widal test. Results: In healthy control group, titer TO ≥20 was observed in 43 (34.7%), TO ≥40 in 48 (38.7%), TO≥80 in 25 (20.2%), and titer TO ≥160, TO ≥320 was observed in none of the control group. Titer TH ≥40 in 58 (46.8%), AH ≥40 in 7 (5.6%), and BH ≥40 in 13 (10.5%) were observed in the control group. Among the test group, 96 (31.7%) sera were positive out of 303 clinically suspected enteric fever by the Widal test. Among different age group studied, 34 (46.6%) patients belonged to the age group of 11-20 years which formed the highest followed by the age group of 21-30 years (33.3%). Conclusion: Based on the study, a cutoff titer of ≥160 for anti-O and anti-H antibodies and titer of ≥80 for anti-AH and anti-BH antibodies be considered as significant titer in diagnosis of enteric fever in this region. The baseline titer helps in early recognition and treatment of this serious health problem.

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