Ahmed A, Ahmed B
Department of Surgery, Centre Hopitalier Regional de Hombo, Anjouan, Comoros Islands.
Ann Afr Med. 2010 Jul-Sep;9(3):135-40. doi: 10.4103/1596-3519.68361.
While typhoid fever is common in our environment, presentation with jaundice is unusual. The aim of this study has been to determine the clinical and laboratory features that allow early diagnosis of typhoid fever in patients that present with jaundice and differentiate it from other common causes of fever and jaundice in the tropics.
This prospective study was conducted between May 1997 and October 1998 at Center Hopitalier Regional de Hombo Anjuoan, Comoros Islands. Patients with clinical and laboratory evidence of typhoid fever were included. Viral or toxic hepatitis, chronic liver disease, sickle cell disease and other causes of jaundice were excluded by clinical examination and appropriate investigations. Serial evaluation of liver function test and abdominal ultrasound were done. Patients were resuscitated with fluids and electrolytes and treated with appropriate antibiotics. Liver involvement was determined using clinical and laboratory parameters.
Of the 254 patients with confirmed diagnosis of typhoid fever, 31 (12.2%) presented with jaundice. Their mean age was 24.6+/-9.2SD years. Fever preceded the appearance of jaundice by 8-27 days. In 27 (87.1%) patients, there was hepatosplenomegaly. Serum bilirubin ranged 38-165 micromol/l with mean of 117+/-14SD. Conjugated bilirubin ranged 31-150 micromol/l with mean of 95+/-8SD. Serum aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase were raised with mean values of 180, 105 and 136 IU, respectively. Six (19.4%) patients died compared to 12.1% of non-icteric patients.
Typhoid patients may present with varying degrees of jaundice and fever that may be confused with viral, malarial or amebic hepatitis, diseases that are common in the tropics. Physical examination and simple biochemical tests would identify the typhoid patients who should be treated with appropriate antibiotics even before the results of blood culture are available.
虽然伤寒热在我们所处环境中很常见，但伴有黄疸的情况并不常见。本研究的目的是确定在出现黄疸的患者中能够早期诊断伤寒热的临床和实验室特征，并将其与热带地区发热和黄疸的其他常见病因区分开来。
这项前瞻性研究于1997年5月至1998年10月在科摩罗群岛安朱安岛洪博地区中心医院进行。纳入具有伤寒热临床和实验室证据的患者。通过临床检查和适当的检查排除病毒性或中毒性肝炎、慢性肝病、镰状细胞病及其他黄疸病因。进行肝功能试验和腹部超声的系列评估。患者接受液体和电解质复苏，并使用适当的抗生素进行治疗。使用临床和实验室参数确定肝脏受累情况。
在确诊为伤寒热的254例患者中，31例（12.2%）出现黄疸。他们的平均年龄为24.6±9.2标准差岁。发热比黄疸出现早8 - 27天。27例（87.1%）患者有肝脾肿大。血清胆红素范围为38 - 165微摩尔/升，平均为117±14标准差。结合胆红素范围为31 - 150微摩尔/升，平均为95±8标准差。血清天冬氨酸转氨酶、丙氨酸转氨酶和碱性磷酸酶升高，平均值分别为180、105和136国际单位。6例（19.4%）患者死亡，而非黄疸患者的死亡率为12.1%。
伤寒患者可能出现不同程度的黄疸和发热，这可能与热带地区常见的病毒性、疟疾性或阿米巴性肝炎相混淆。体格检查和简单的生化检查能够识别出即使在血培养结果出来之前也应使用适当抗生素治疗的伤寒患者。
