Original Articles
Vol. 7 (2015): Review Series, Original Articles, Case Reports
https://doi.org/10.4084/mjhid.2015.021

CLINICOPATHOLOGICAL PROFILE OF SALMONELLA TYPHI AND PARATYPHI INFECTIONS PRESENTING AS FEVER OF UNKNOWN ORIGIN IN A TROPICAL COUNTRY.

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Received: December 8, 2014
Accepted: February 7, 2015
Published: February 17, 2015
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Salmonella Typhi, Salmonella Paratyphi, FUO, granulomas, bone marrow, cultures
infectious disease, haematology

Authors

Nayyar Iqbal
Pondicherry Institute of Medical Sciences, India.
Aneesh Basheer
basheeraneesh@gmail.com
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.

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Original articles

Supporting Agencies

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Nayyar Iqbal, Pondicherry Institute of Medical Sciences
Assistant Professor of medicine
Aneesh Basheer, Pondicherry Institute of Medical Sciences
Assistant Professor of Medicine
Sudhagar Mookkappan, Pondicherry Institute of Medical Sciences
Assistant Professor of Medicine
Anita Ramdas, Pondicherry Institute of Medical Sciences
Professor of Pathology
Renu G'Boy Varghese, Pondicherry Institute of Medical Sciences
Professor of Pathology
Somanath Padhi, Pondicherry Institute of Medical Sciences
Associate Professor of Pathology
Bhairappa Shrimanth, Pondicherry Institute of Medical Sciences
Professor of Medicine
Saranya Chidambaram, Pondicherry Institute of Medical Sciences
Junior resident
Anandhalakshmi S, Pondicherry Institute of Medical Sciences
Associate Professor of Microbiology
Reba Kanungo, Pondicherry Institute of Medical Sciences
Ptofessor of Microbiology

How to Cite



“CLINICOPATHOLOGICAL PROFILE OF SALMONELLA TYPHI AND PARATYPHI INFECTIONS PRESENTING AS FEVER OF UNKNOWN ORIGIN IN A TROPICAL COUNTRY”. (2015) Mediterranean Journal of Hematology and Infectious Diseases, 7(1), p. e2015021. doi:10.4084/mjhid.2015.021.