Nayyar Iqbal, Aneesh Basheer, Sudhagar Mookkappan, Anita Ramdas, Renu G'Boy Varghese, Somanath Padhi, Bhairappa Shrimanth, Saranya Chidambaram, Anandhalakshmi S, Reba Kanungo
  • Nayyar Iqbal
    Pondicherry Institute of Medical Sciences, India
  • Sudhagar Mookkappan
    Pondicherry Institute of Medical Sciences, India
  • Anita Ramdas
    Pondicherry Institute of Medical Sciences, India
  • Renu G'Boy Varghese
    Pondicherry Institute of Medical Sciences, India
  • Somanath Padhi
    Pondicherry Institute of Medical Sciences, India
  • Bhairappa Shrimanth
    Pondicherry Institute of Medical Sciences, India
  • Saranya Chidambaram
    Pondicherry Institute of Medical Sciences, India
  • Anandhalakshmi S
    Pondicherry Institute of Medical Sciences, India
  • Reba Kanungo
    Pondicherry Institute of Medical Sciences, India


Background: Enteric fever, a common infection in the tropics and endemic to India, often manifests as an acute febrile illness. However, presentation as fever of unknown origin (FUO) is not uncommon in tropical countries.

Methods: We aim to describe the clinical, laboratory and pathological features of cases hospitalized with fever of unknown origin and diagnosed as enteric fever. All culture proven cases of enteric fever were analyzed retrospectively over a period of three years from January 2011 to December 2013.

Results: Seven of 88(8%) cases with enteric fever presented as FUO. Abdominal pain was the most common symptom besides fever. Relative bradycardia and splenomegaly were uncommon. Thrombocytopenia was the most common haematological abnormality, while leucopenia was rare. Transaminase elevation was almost universal. S.Typhi and S.Paratyphi were isolated from six cases and one case respectively.  Yield of organisms from blood culture was superior to that of bone marrow aspirate. Multiple granulomas were identified in 4 out of 6 (67%) of the bone marrows studied, including that due to S. Paratyphi and histiocytic hemophagocytosis was noted in two cases.

Conclusion: FUO is a relatively common manifestation of enteric fever in the tropics. Clinical and laboratory features may be atypical in such cases, including absence of relative bradycardia, leucopenia and presence of thrombocytopenia, bicytopenia or pancytopenia.  Moreover, in endemic countries, enteric fever should be considered as a differential diagnosis, next to tuberculosis, in the evaluation of bone marrow granulomas in cases with FUO and culture correlation should be mandatory.


Salmonella Typhi, Salmonella Paratyphi, FUO, granulomas, bone marrow, cultures

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Published: 2015-02-17 00:00:00
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