Hemorragia pulmonar y síndrome de dificultad respiratoria aguda como complicaciones inusuales de la fiebre tifoidea / Pulmonary haemorrhage and acute respiratory distress syndrome as unusual complications of typhoid fever

La hemorragia pulmonar y el síndrome de dificultad respiratoria aguda son complicaciones infrecuentes de la fiebre tifoidea, y la endotoxemia producto de la sepsis es un factor causal común. Se describe a un paciente de sexo masculino, indio, joven, inmunocompetente, con hemorragia pulmonar, síndrome de dificultad respiratoria aguda y choque séptico en el curso de la fiebre tifoidea, con hemocultivos negativos y cepa de Salmonella typhi, aislada en coprocultivo, resistente a la ciprofloxacina. El paciente tuvo una respuesta satisfactoria al tratamiento convencional para el daño pulmonar con ventilación mecánica, el antibiótico por sensibilidad del antibiograma y la administración de hemoderivados.

Prevalencia de complicaciones en casos confirmados de fiebre tifoidea ingresados en el Hospital Nacional de Niños Benjamín Bloom durante el periodo de 2009 ­ 2012 / Prevalence of complications in confirmed cases of typhoid fever admitted to the Benjamín Bloom National Children's Hospital during the period 2009 ­ 2012

La Fiebre tifoidea es una enfermedad infecciosa de transmisión fecohídrica, cuyo agente etiológico bacteriano, pertenece al género Salmonella, ser. Typhi, S. ser. Paratyphis A, S. ser. Paratyphis B (Schottmuelleri) y S. ser.Paratyphis C (Hirschfeldii). Según la Organización Mundial de la Salud se produce unos 21 millones de caso por año en el mundo, de los cuales entre el 1- 4% presentan complicaciones médico ­ quirúrgicas importantes y en algunos casos suelen ser fatales. El presente trabajo nace como una guía de estudio que se realizó con el objetivo principal de determinar la Prevalencia de las complicaciones en casos confirmados de fiebre tifoidea ingresados en el Hospital Nacional De Niños Benjamín Bloom durante el periodo de 2009 a 2012. Se realizó un estudio descriptivo, retrospectivo y transversal a través de la revisión de expedientes clínicos de los pacientes que cumplieron con los criterios de inclusión previamente aprobado por el comité de ética del Hospital de Niños Benjamín Bloom. Entre los años 2009 a 2012 egresaron 87 pacientes con diagnóstico de fiebre tifoidea de los cuales solo 47 cumplen con los criterios de inclusión del estudio. El 38.2% (18) de los pacientes estudiados presentaron una o más complicaciones durante los años 2009 a 2012. La aparición de complicaciones fue tan temprano como a la 1a semana y tardía como los 2 meses, además, se reportó un paciente fallecido que representa el 4.54% de los pacientes complicados por la enfermedad y el 2.1%de los pacientes estudiados. La edad escolar (de 5 a 10 años) es la más afectada sin predilección de género y el diagnóstico clínico es el primer método utilizado ayudado por el hemocultivo como prueba diagnóstica más utilizada

Challenges in measuring complications and death due to invasive Salmonella infections.

Despite the highest burden of Typhoid fever in children globally, exact estimates of morbidity and mortality are lacking due to scarcity of published data. Despite a high prevalence and a socioeconomic burden in developing countries, published data with morbidity and mortality figures are limited especially Africa and South American regions. Data from the community is insufficient and most case fatality estimates are extrapolations from hospital based studies that do not cover all geographical regions, and include cases which may or not be culture confirmed, MDR resistant or sensitive cases, or from mixed populations of age (adults and children). Complications of typhoid such as intestinal perforation, bone marrow suppression, and encephalopathy are dependent on MDR/Fluoroquinolone resistant Salmonella infection, comorbidities such as malnutrition, and health-care access. Data is again insufficient to estimate the true burden of Typhoid Fever in different regions and groups of populations. Although there has been a rapid decline in cases in developed countries with the advent of improved sanitization, timely and easy access to health care and laboratories, this is still not the case in the developing countries where Typhoid deaths are still occurring. The way forward is to develop rapid and cost effective point of care diagnostic tests, put in place validated clinical algorithms for suspected clinical cases, and design prospective, and community based studies in different groups, implement maintenance of electronic health records in large public sector hospitals and regions to identify populations that will benefit most from the implementation of vaccine. Policies on public health education and typhoid vaccine may help to reduce morbidity and mortality due to the disease.

Salmonella typhi liver abscess overlying a metastatic melanoma.

Pyogenic liver abscesses caused by Salmonella enterica serotype Typhi, although rare, can occur especially in patients with pre-existing hepatobiliary disease, hepatocellular carcinoma, and metastatic liver tumors. We present a case of Salmonella liver abscesses complicating metastatic melanoma in a 24-year-old alcoholic male.

[Reappearance of severe typhoid forms following a case of massive gastrointestinal haemorrhaging]. / Reaparición de formas graves de tifoidea: a propósito de un caso de sangrado masivo gastrointestinal.

A case of a patient is reported who was admitted with massive intestinal haemorrhaging after 10 days of medical discomfort, characterized by persistent fever, headache and abdominal pain. The patient did not respond to medical treatment: antibiotics, blood transfusions and fluid replacement and required emergency surgical intervention. Intestinal resection with primary anastomosis was performed, controlling the bleeding. Following the testing of blood cultures and histopathological study infection by the S. tiphy bacteria was recorded by testing. In Latin America this strain of typhoid fever was common until the beginning of the 90's, before the cholera epidemic and has rarely been seen in the past 15 years.

Reaparición de formas graves de tifoidea: a propósito de un caso de sangrado masivo gastrointestinal / Reappearance of serious forms of typhoid: about a case of gastrointestinal massive bled

Reportamos el caso de un paciente que fue admitido por presentar un cuadro de enterorragia masiva luego de 10 días de evolución, caracterizado por fiebre persistente, cefalea global y dolor abdominal, el cual no respondió al tratamiento médico con antibióticos, transfusiones y resucitación con fluidos, requiriendo intervención quirúrgica de emergencia. Se realizó una resección intestinal con anastomosis primaria, controlando así el sangrado. Se documentó la infección con S. tiphy en los hemocultivos y en la histopatología. En América Latina esta complicación de fiebre tifoidea fue común hasta inicios de la década del 90, antes de la epidemia del cólera. Este tipo de complicación ha sido raramente vista en los últimos 15 años.

A case of a patient is reported who was admitted with massive intestinal haemorrhaging after 10 days of medical discomfort, characterized by persistent fever, headache and abdominal pain. The patient did not respond to medical treatment: antibiotics, blood transfusions and fluid replacement and required emergency surgical intervention. Intestinal resection with primary anastomosis was performed, controlling the bleeding. Following the testing of blood cultures and histopathological study infection by theS.tiphy bacteria was recorded by testing. In Latin America this strain of typhoid fever was common until the beginning of the 90´s, before the cholera epidemic and has rarely been seen in the past 15 years.

[Morbidity and mortality risk factors in patients with ileal typhoid perforation]. / Factores de riesgo de morbilidad y mortalidad en pacientes con perforación tífica ileal.

OBJECTIVES: To determine the risk factors, morbidity and mortality rates and the types of postoperative complications in patients undergoing surgery for ileal typhoid perforation. MATERIAL AND METHODS: This retrospective study evaluated 126 patients with anatomohistological diagnosis of ileal typhoid perforation treated at the Belen Hospital, Trujillo, Peru between 1966 and 2000. RESULTS: The average age of the total series was of 21.39 + 13.4 years (range 1 to 57 years); of which, 97 (76.98%) were male and 29 (23.02%) women (proportion M:F, 3.3:1). By means of univariate analysis, the morbidity was related with the absence of previous medical treatment (p = 0.035). The mortality was associated to time of perforation exceeding 48 hours (p = 00001); digestive hemorrhages (p = 0.003), leukocyte count (p = 0.021) fecaloid peritoneal secretion (p = 0.007) number of perforations (p = 0.001) and the surgical technique, that presented major mortality was the resection and ileostomy (48.3%; p = 0.001). The group of patients that presented post-surgical complications was 80.16%, of which 19.8% of them died. The most frequent complications were wound infections (67.3%) and sepsis (27.7%). In the multivariate analysis two parameters were evidenced in relation to morbidity: previous medical treatment (p < 0.05; OR = 2.9) and number of perforations (p = 0.01; OR = 6.4). With regard to mortality the significant statistical parameters were: low digestive hemorrhages (p = 0.02; OR = 11.4) leukocyte count (p < 0.008; OR = 7.9) type of operation (p = 0.03; OR = 1.8) peritoneal secretion (p < 0.04; OR = 3.02) and number of perforations (p = 0.008; OR = 4.6). CONCLUSIONS: The risk factors identified in the present series can be useful to elaborate a risk scale to predict a small, moderate or greater probability of complications and postoperative mortality.

Hepatic dysfunction in typhoid fever during pregnancy.

We described the hepatic dysfunction found in 10 cases out of 32 women with typhoid fever during pregnancy. This was associated with late diagnosis and maternal and perinatal complications.

[Complications in typhoid fever: description of an anusual case and its bearing on diagnosis and control]. / Complicações na febre tifóide: relato de um caso atípico e considerações sobre suas implicações no diagnóstico e no controle.

A case of typhoid fever with colestatic hepatitis is described, with diagnosis made by stool culture. Examination for malaria, leptospirosis and viral hepatitis were all negatives. These results and the rapid response of the patient to treatment with ciprofloxacin confirmed the diagnosis of typhoid fever and indicate the importance of considering typhoid fever in cases of fever with jaundice.

Manifestación inusual de fiebre tifoidea: presentación de un caso y revisión de literatura / Unusual manifestation of typhoid fever: case presentation and review

RESUMEN. Presentamos el caso de un paciente masculino de 16 años de edad, con historia de fiebre no cuantificada con escalofríos y diaforesis de 1 semana de evolución; 4 días de presentar alteración de el estado de la conciencia, caracterizado por habla incoherente, desorientación en tiempo y espacio con período de mutismo, además 2 días de evacuaciones diarréicas tres veces al día amarillas, fétidas sin moco ni sangre. Se realizó hemocultivo donde se aisló salmonella entérica serotipo typhi, por lo que se manejó con Ceftriaxone por 7 días con evolución satisfactoria. Se destacan las manifestaciones clínicas neurológicas con las que debutó este caso

Complicações na febre tifóide: relato de um caso atípico e considerações sobre suas implicações no diagnóstico e no controle / Complications in typhoid fever: description of an anusual case and its bearing on diagnosis and control

Apresenta-se um caso de febre tifóide que cursou com hepatite colestática cujo diagnóstico foi dado pela coprocultura. A negativação das provas para hepatites virais, malária e leptospirose, e a pronta resposta ao tratamento com ciprofloxacina corroboraram o diagnóstico de febre tifóide. Nas áreas endêmicas, essa hipótese deve ser lembrada diante das icterícias febris.

A case of typhoid fever with colestatic hepatitis is described, with diagnosis made by stool culture. Examination for malaria, leptospirosis and viral hepatitis were all negatives. These results and the rapid response of the patient to treatment with ciprofloxacin confirmed the diagnosis of typhoid fever and indicate the importance of considering typhoid fever in cases of fever with jaundice.

Colecistitis aguda alitiásica en el curso de la fiebre tifoidea en niños / Acalculous acute cholecystitis during the course of typhoid fever in children

Objetivo: Determinar el tratamiento de la colecistitis aguda alitiásica durante el curso de la fiebre tifoidea en niños. Material y métodos: Se realizó un estudio retrospectivo de 10 pacientes que presentaron colecistitis aguda alitiásica durante el curso de la fiebre tifoidea, entre junio de 1992 a mayo de 1997, en el Instituto de Salud del Niño. Resultados: Seis pacientes fueron de sexo masculino y cuatro de sexo femenino, cuyas edades fluctuaron entre los 2 años y 6 meses hasta los 15 años de edad. La colecistitis se presentó mayormente en la primera semana del curso de la fiebre tifoidea. La sintomatología fue caracterizada por presentar fiebre, dolor abdominal, diarrea, vómitos, ictericia y masa palpable. A cuatro pacientes se les realizó colecistostomía, 3 pacientes colecistectomía y 3 no fueron operados; 2 de ellos recibieron tratamiento médico con seguimiento a través de ultrasonografía. Los 10 pacientes recibieron cloramfenicol por 14 días. La complicación postoperatoria se presentó en 2 pacientes, uno obstrucción intestinal por adherencias y otro absceso residual. Conclusión: la colecistitis aguda es una entidad poco común en niños, y su complicación en el curso de la fiebre tifoidea es rara. La decisión quirúrgica es mandatoria en casi todos los pacientes, por el riesgo de que el paciente se convierta en un portador sano y/o por la posibilidad de perforación vesicula. En aquellos pacientes que no se realiza tratamiento quirúrgico se recomienda manejo médico con seguimiento a través de ultrasonografía hasta la resolución de la enfermedad.

[Acalculous acute cholecystitis during the course of typhoid fever in children]. / Colecistitis aguda alitiásica en el curso de la fiebre tifoidea en niños.

OBJECTIVES: Determine the treatment of the acalculous acute cholecystitis during the course of typhoid fever in children. MATERIAL AND METHODS: It was carried out a retrospective study in 10 patients with acalculous cholecystitis in the course of typhoid fever, from June 1992 to May 1997, in the Children's Institute of Health. RESULTS: Six patients were male and four women, whose ages fluctuated among the 2 years 6 months old to 15 years old. Cholecystitis was presented mostly in the first weeks of the illness. Characteristic findings were fever, abdominal pain, diarrhea, vomits, jaundice and palpable mass. We have performed cholecystostomy in four patients, cholecystectomy in 3 patients and three patients were not operated, two then received medical treatment and were follow-up with ultrasonography and one patient got lost in the control. The 10 patients received chloramphenicol for 14 days. As post operative complication, a patient presented an intestinal obstruction for adherences and another patient presented an intraabdominal abscess. CONCLUSION: Acute cholecystitis is not a common entity in children, and rare complication in the course of the typhoid fever. The surgical decision is primary in almost all the patients, for the risk of vesicular perforation and the possibility they become healthy carriers. Those patients who were not able to have a surgical treatment, were recommended to have medical treatment and ultrasonographic follow-up.

[Management of typhoid perforation of the small bowel: a case series in Western French Guiana]. / Conduite à tenir face aux perforations du grêle d'origine typhique: à propos d'une série observée dans l'Ouest Guyanais.

The purpose of this retrospective study of a five-year period in western French Guiana is to report our experience in the management of small bowel perforation due to Salmonella typhi and to underline the main diagnostic and therapeutic pitfalls. Even if clinical and laboratory findings were compatible, final diagnosis was reserved until confirmation by postoperative bacteriological findings. In patients without advanced peritonitis, excellent results can be achieved by excision of the edges of the lesion followed by direct suture in cases involving single perforations and by segmental resection followed by end-to-end anastomosis in cases involving multiple perforations. However these techniques cannot be extended to patients presenting severe peritonitis who must be treated by bowel diversion.