Serum ALT: LDH ratio in typhoid fever and acute viral hepatitis.

In 100 consecutive children aged below 18 years with confirmed typhoid fever, 29 had moderate hepatitis. Serum alanine amino transferase: lactate dehydrogenase (ALT: LDH) ratios of these 29 children at the time of hospitalization were compared with that of 29 children with acute viral hepatitis. The serum ALT: LDH ratio levels (expressed in multiples of upper limit of normal) was found to be less than 9 in typhoid hepatitis and more than 9 in acute viral hepatitis. Serum ALT: LDH ratio helps to differentiate typhoid hepatitis from acute viral hepatitis.

The diagnostic value of the ELISA-Ty test for the detection of typhoid fever in children.

A study on the reliability of an enzyme linked immunosorbent assay (ELISA) for the detection of typhoid fever, the ELISA-Ty test, was conducted, comprising 44 children suffering from bacteriologically confirmed typhoid fever based on the finding of a positive blood culture for Salmonella typhi, 44 children with fever caused by diseases other than typhoid fever based on the finding of negative culture of blood, urine and stool for S. typhi, and 120 healthy children as controls. This ELISA-Ty test measures the concentration of IgM and of IgG against S. typhi in serum. This test is an indirect ELISA test, based on a method that makes use of a mixture of OMPs (outer membrane proteins) in equal proportion serving as antigen, obtained from different strains of S. typhi which are prevalent locally, peroxidase goat antihuman IgG or IgM (Sigma) as conjugate and orthophenylenediamine (Sigma) as chromogen of the substrate. The result of the test was obtained through the assessment of the end product, using a micro ELISA reader (Behring) at wave length of 490 nm. The data revealed that the mean absorbent values found in children with typhoid fever, for IgM and IgG, were significantly higher (p < 0.05) when compared to those in children with non-typhoid fever as well as to those found in children of the control group. The results of this study confirm that the ELISA-Ty test has a high reliability for the detection of typhoid fever in children, based on the finding of a degree of diagnostic sensitivity as high as 95.45% and 90.91% for respectively IgM and IgG, a diagnostic specificity as high as 93.33% for IgM as well as for IgG, a high diagnostic efficiency (94.32% for IgM and 92.05% for IgG), a high diagnostic positive predictive value of 93.33% for IgM and 93.02% for IgG, high negative predictive values of 95.35% for IgM and 91.11% for IgG for use under clinical as well as under field conditions.

Altos valores de adenosín deaminasa plasmática no asociados a fiebre tifoidea / High plasmatic adenosin deaminase activity not associated to typhoid fever

Valores plasmáticos elevados de ADA han sido asociados a fiebre tifoidea y utilizados para su diagnóstico debido a su bajo costo y rápida lectura. Sin embargo, diferentes registros han señalado un aumento de esta actividad en otras enfermedades lo que puede limitar su precisión diagnóstica. Para confirmar si valores elevados de ADA plasmática están asociados específicamente a fiebre tifoidea, se desarrolló un estudio retrospectivo con los registros de este examen desde un laboratorio hospitalario. Diez pacientes fueron identificados (todos ellos hospitalizados). Seis pacientes padecían fiebre tifoidea y los restantes cuatro tenían otras patologías febriles: leucemia mieloide aguda, dermatomiositis y linfoma no Hodgkin (n=2). Los valores de ADA plasmática fueron similares en ambos grupos pero los pacientes sin fiebre tifoidea se caracterizaron por tener simultáneamente una mayor edad (>35 años) y velocidad de eritrosedimentación (>50 mm/h) (p = 0,004, test de Fisher bilateral). Estos resultados indican que valores plasmáticos elevados de ADA tienen una baja especificidad para el diagnóstico de fiebre tifoidea en pacientes hospitalizados y pueden estar asociados a enfermedades malignas o autoinmunes

Phospholipase A2 is a circulating mediator in typhoid fever.

Circulating proinflammatory mediators have not been found in studies on typhoid fever, although the patients suffer from a systemic disease with characteristic protracted fever. The 14-kDa group II extracellular phospholipase A2 (PLA2) is induced by interleukin-1 and tumor necrosis factor and may mediate some of the effects of these cytokines. Circulating PLA2 concentrations were measured in 12 typhoid fever patients on various days after admission and after recovery. On admission, mean concentrations of PLA2 were elevated (1444 +/- 1560 ng/mL) and decreased gradually and significantly to day 14 (55 +/- 48 ng/mL). patients with complicated disease had significantly higher PLA2 levels on admission. PLA2 was not produced in a lipopolysaccharide-stimulated whole blood culture, indicating that PLA2 originates from other types of cells. These data indicate that PLA2 may be a mediator of disease in protracted inflammatory diseases such as thyroid fever.

Typhoid fever with very high transaminase levels.

Typhoid fever is endemic in developing countries and may cause very different clinical findings. Although hepatic involvement and abnormal liver function tests may be seen in 50% of the patients, intravascular hemolysis and renal involvement are rare. In this report, a 10-year-old patient with enteric fever presenting with hepatitis, severe intravascular hemolysis and glomerulonephritis is presented. To see all of these findings together in a patient with typhoid fever is very rare and may cause diagnostic difficulties.

Adenosine deaminase activity in typhoid fever.

Serum adenosine deaminase (ADA) activity was determined in 41 patients of typhoid fever and 15 normal controls. The mean ADA activity was significantly raised in typhoid fever patients as compared to controls (p < 0.001). The peak enzymatic activity was observed in the first week of illness. Complicated patients had lower mean ADA activity at diagnosis as compared to uncomplicated group and they showed a rise in enzyme level during defervescence, repeated in a few cases. A significant correlation between serum ADA activity and lymphocyte percentage was found (r = 0.4245, p < 0.001). It is concluded that ADA activity in typhoid fever patients not only indicates immunity but also has a prognostic value.

Lymphocytic adenosine deaminase activity in typhoid fevers.

Lymphocyte adenosine deaminase (L-ADA) activity, a measure of lymphocyte activity, was estimated in 10 healthy controls and 30 patients with typhoid fever (20 uncomplicated and 10 complicated) at the time of admission, at onset of complications and weekly until recovery. Mean L-ADA activity in healthy controls was 20.49 +/- 3.62 mU/10(6) cells. In uncomplicated patients L-ADA activity was 36.33 +/- 5.09 mU/10(6) cells at time of admission, which is significantly raised as compared to controls. It remained high at the height of the fever and at defervescence. In complicated patients L-ADA activity was significantly low at admission (15.33 +/- 2.35 mU/10(6) cells) and fell further with development of complications (7.86 +/- 4.07 mU/10(6) cells). At defervescence L-ADA activity increased significantly above the control activity (31.24 +/- 5.37). Serial L-ADA activity can be of prognostic significance. A cut-off value of 24 mU/10(6) cells is suggested to predict prognosis and severity of disease. Activity below this indicates a probability of a severe, prolonged course and may help in instituting early and energetic treatment.

The liver in typhoid fever: always affected, not just a complication.

The course of liver involvement during the first three weeks of typhoid fever was studied in 20 patients. Previous studies of liver involvement in typhoid fever have not considered the time course of changes. In this study, hepatomegaly was found during the 2nd or 3rd wk more often than in the 1st wk (36% vs. 11%), whereas jaundice was detectable in 9% of patients after the 1st wk, but never before. Alkaline phosphatase, AST, and ALT were raised in 100%, 100%, and 91% of cases, respectively, during the 2nd and 3rd wk but during the 1st wk, only 11%, 89%, and 56% had mild increases. This study shows that, although the clinical picture of hepatitis is unusual, liver involvement is invariably present after the 1st wk, and should not be considered as a complication, but as a feature of the disease.

Adenosina deaminasa sérica como ayuda diagnóstica en fiebre tifoidea: estudio preliminar / Seric adenosine deaminase as diagnostic help in thyphoid fever: preliminary study

Como ayuda diagnóstica de fiebre tifoidea se estudió, por la técnica de Giusti, la actividad de la enzima adenosina deaminasa en el suero de 132 pacientes ingresados al Hospital Gmo. Grant Benavente, de Concepción, entre marzo de 1988 y abril de 1989. Los pacientes fueron 93 niños separados en tres grupos: control (52), síndrome febril (15), fiebre tifoidea (26); y 39 adultos separados en dos grupos: control (34), fiebre tifoidea (5). Los promedios obtenidos fueron: niños grupo control 26,8ñ7,8; síndrome febril 31,0ñ9,9 y fiebre tifoidea 120,6ñ34,5 U/L 37-C; y en adultos, grupo control: 18,6ñ7,6; y fiebre tifoidea: 117,0ñ16,4 U/L 37-C. Los valores encontrados son significativamente mayores (p<0,0001) en los pacientes con fiebre tifoidea tanto en niños como en adultos, en relación a sus respectivos grupos controles. El test muestra una sensibilidad de 96,8% y una especificidad de 100%, al considerar como valor límite 60U/L 37-C. El bajo costo, el no ser alterado por la terapia antibiótica, la rapidez de la determinación (2 horas) y su alto rendimiento, indicarían la importancia de la determinación de la actividad de la enzima ADA en la ayuda diagnóstica de fiebre tifoidea

Selectively increased adenosine deaminase levels in T cells during typhoid fever.

ADA and PNP levels were measured in T-enriched and T-depleted subpopulations of peripheral mononuclear cells from patients with typhoid fever. ADA activity was significantly increased in T-enriched, but normal in T-depleted preparations of typhoid patients. Elevated levels of ADA in T cells were observed from the initial phase up to 30 days from the onset of the disease. Unlike ADA changes, PNP modifications were transitory, and affected both T-enriched and T-depleted subpopulations. The usefulness of ADA determination in T cells to detect and follow up T-cell activation during typhoid fever is suggested.

Depression of erythrocyte glucose-6-phosphate dehydrogenase (G6PD) activity in enteric fever.

Ninety adult Indian typhoid and paratyphoid fever (enteric fever, EF) patients and 91 controls were tested for glucose-6-phosphate dehydrogenase (G6PD) deficiency using the fluorescent spot test (FST) and the quantitative methaemoglobin reduction test ( QMRT ). There was a threefold higher incidence of G6PD deficiency in North Indian EF patients (10.6%) than in controls (3.6%) (P = 0.15) which may be attributable to the greater morbidity of the G6PD-deficient EF patients; six of nine had haemolytic anaemia. A transient depression of mean erythrocyte G6PD activity was observed in a subgroup of 49 non-deficient EF patients in whom the spectrophotometric G6PD assay was done. It did not appear to be related to reticulocyte count, chloramphenicol therapy, or differences in leucocyte contamination of the haemolysate used for the G6PD assay. If this depression of G6PD activity occurs in deficient patients as well, it may help to explain the haemolysis seen in them during EF. Of the three tests used, the QMRT and the spectrophotometric assay clearly identified G6PD deficiency in males during haemolysis, whereas the FST was unreliable in this situation.

Transient, acquired glucose-6-phosphate dehydrogenase deficiency in Thai children with typhoid fever.

Seventy nine children with typhoid fever were studied, 45 were males and 34 were females. There were 9 out of 45 males patients (20%) who had definite G-6-PD deficiency of whom 3 had acute intravascular hemolysis. The rest of the patients had transient low enzyme activity during the first few weeks of their illness, with reticulocytopenia. Their G-6-PD activities rose up to normal level later in the course of the disease while the reticulocytes were also increased. This study demonstrated that even in normal G-6-PD subjects, typhoid fever can cause transient, acquired low G-6-PD level due to bone marrow suppression. It was suggested from this study that quantitative G-6-PD assay was more useful and sensitive than the screening method and that long term follow up is needed in the case that had unexplained low G-6-PD activity.

Increased lymphocyte adenosine deaminase in typhoid fever.

Adenosine deaminase in the peripheral lymphocytes (L-ADA) was determined in 27 patients with typhoid fever and in 15 normal controls. Increased values of enzymatic activity were found in the typhoid fever patients compared with the controls. The increase was prolonged and not correlated to treatment. L-ADA levels could be related to the immune response.