Clinical and therapeutic aspects of typhoid fever in upper Egypt

الملخص EN

This study included 160 patients suspectedclinically to be typhoid fever.

The patients were classified into two groups:- Group I: Included 93 patients who were culture - positive for salmonella, 53 (56.9%) of them were males and 40 (43.1%) were females.

Group II: Included 67 patients who were culture — negative for salmonella, 44 (65.7%) of them were males and 23 (34.3%) were females.

The clinical signs found in culture positive patients in order of frequency were fever (100%), splenomegaly (92.5%) coated tongue (65.69%), hepatomegaly (47.3%), pallor (16.1%), apathy (8.6%), confusion (3.2%), chest rhonchi (16.11%), abdominal tenderness (5.47%), and costochondritis (1.1%).

Comparing culture positive group with Culture negative group.

The duration of fever was significantly more prolonged in culture positive patients.

Sweating was more frequent in culture +ve patients.

Haematouria was more frequent in culture positive cases.

The mean level of SGPT was significantly higher in culture +ve cases.

The patients with high levels of serum creatinine were significantly more frequent in culture +ve patients.

Among culture positive patients, forty five cases (48.4%) showedHB level < lOg/dl, one third of them had normocytic normochromic anaemia and the other two thirds had microcytic hypochromic anaemia.

Leucopenia was found in 10.8% of culture positive patients while leucocytosis in 9.7% of them.

Lymphocytosis, monocytosis, lymphopenia and eosinophilia were found in (19.4%, 17.2%, 8.6% and 1.1% respectively).

In addition thrombocytopenia was present in 16.1% while thrombocytosis in 1.1% of patients.

Liver function tests in patients revealed raised total bilirubin in 5.37% of cases, hypoalbuminaemia was found in 25.2% of cases.

In addition SGOT, SGPT and ALP were raised in 81.72, 54.8% and49.56% respectively.

Serum urea and creatinine were raised in 4.3% and 8.60% of patients respectively.

Serum chloramphenicol level was estimated in 43 patients of group 1 and 29 patients in group 11 and no significant difference was found in the mean level between the two groups.

Concerning therapy in the two groups, the response to chloramphenicol was significantly higher in group 11 (51.50% Vs.

25.80%) (P =0.001).

The response to antibiotics other than chloramphenicol were similar in the two groups.

The in vitro sensitivity to 11 antibiotics using the disc diffusion method in 93 cases with positive culture forS-typhi was estimated.

The resistance to the conventional antibiotics was high in comparison to the new antibiotics, chloramphenicol 73.1%, co-trimoxazole 63.4% and amoxicillin 72.0%.

The resistance to fluoroquinolones (ofloxacin, norfloxacin and ciprofloxacin) rangedfrom 25% to 30% of cases.

As regard the 3 rd generation cephalosporins (cefotaxime, ceftriaxone and cefoperozone), the resistance ranged from 29% to 44%.

The resistance was also high to the new ampicillin — sulbactam combination 56.98%.

The relation between in vivo and in vitro antibiotic sensitivity in 93 patients with culture — proven typhoid fever was determined.

Among 22 patients who were sensitive to chloramphenicol in vivo, 13 patients were resistant in vitro while 9 patients were sensitive with various grades.

Similarly there was a discrepancy between the in vivo and in vitro sensitivity to co-trimoxazole, amoxicillin and cefotaxime.

However regarding ceftriaxone and ofloxacin the in vitro and in vivo antimicrobial activities were nearly simila