Atypical Presentation of Typhoid Fever

Abstract

The classical presentation of typhoid has changed over the years. Atypical presentation of typhoid is now seen in clinical practice. Entericfever can present with atypical manifestations like abdominal lymphadenopathy, acute acalculous cholecystitis, osteomyelitis, splenic abscess and Pneumonia. Jaundice splenic abscess and thrombocytopenia in a febrile patient in the tropics is commonly due to Malaria, Leptospirosis and Dengue. We report a case of typhoid fever presenting with jaundice and thrombocytopenia. A 17 year old male presented to us with history of fever and jaundice. Investigations revealed thrombocytopenia and conjugated hyperbilirubinemia. Blood culture grew Salmonella Typhi. He was treated with ceftriaxone and he improved. A diagnosis of typhoid fever must be considered in a febrile patient with jaundice and thrombocytopenia in the tropics.

A Patient with Typhoid Hepatitis

“…Diagnosis of typhoid hepatitis is a probable case or confirmed case of typhoid fever with meets 3 or more criterias: (a) hepatomegaly, (b) jaundice, (c) biochemical abnormalities, or (d) liver histopathology . 8,12 This patient was confirmed typhoid fever, as well as jaundice, hepatomegaly, increased bilirubin, AST and ALT that met the diagnostic criteria for typhoid hepatitis.…”

“…Hematogenous spreading of organisms or toxins from salmonella can cause systemic involvement that affects all major organs 8 . Liver involvement in typhoid fever was first reported by William Osler in 1899 8,9 . The pathogenesis of typhoid hepatitis is not completely clear, it is thought to be multifactorial, including direct hepatic damage by invading bacteria, endotoxin, or inflammatory processes and or secondary damage due to host immune mechanisms.…”

Sensorineural hearing loss as an atypical presentation of typhoid fever: A case report

“…2 A few cases of typhoid fever manifesting as sensorineural hearing loss have been reported. [3][4][5] The exact mechanism remains unclear, but factors such as host susceptibility, endotoxins, arteritis, and ischaemia may contribute. 6 The primary treatment for sensorineural hearing loss in typhoid is antibiotics; studies on the use of steroids as an adjunctive therapy are limited.…”