Case Report: Typhoid Fever Complicated by Ileal Perforation in an Urban Slum of Dhaka, Bangladesh

Abstract

Intestinal perforation is one of the most dangerous complications of typhoid fever and demands urgent hospitalization, diagnosis, and surgical management to reduce morbidity and prevent mortality. Here, we report a case of typhoidal intestinal perforation in a 19 year-old young man detected by passive surveillance during a cluster-randomized trial with Vi-tetanus toxoid conjugate vaccine (Typhoid Vaccine Acceleration Consortium: TyVAC) in an urban slum area in Mirpur, Dhaka, Bangladesh. The patient presented with a high-grade fever, lower abdominal pain, and vomiting and was admitted to a healthcare facility. Physical examination and preoperative investigations of the patient suggested a presumptive diagnosis of intestinal perforation, and the patient was transferred to a tertiary-level hospital for surgical management. A positive blood culture, intraoperative findings, and histopathology of an intestinal biopsy confirmed ileal perforation due to typhoid fever. This case report highlights the need for prompt diagnosis and appropriate pre- and postoperative management of patients who appear with the symptoms of typhoidal intestinal perforation. This report further demonstrates the importance of systematic surveillance and proper evaluation to determine the true incidence rate of typhoid fever and intestinal perforation in Bangladesh.

Prevalence, Anatomic-pathologic Findings, and Associated Factors of Nontraumatic Ileal Perforations Among Patients with Gut Perforation: A Multicenter Cross-sectional Study

“…In contrast to the ndings of Khanam et al, (13) in Bangladesh, the median distance between the perforations and the ileocecal junction was 41.9 cm (range, 20-180 cm). This may be due to racial differences and the large sample size due to the high population density in rural settings.…”

“…However, Shyamkumargupta et al in India observed that approximately 73% of respondents had perforations < 0.5 cm in size (3,9). In Bangladesh, Khanam et al, (13), in a similar report, the size of the perforations was variable, with a median diameter of 5.0 mm and a range of 1-25 mm.…”

“…Currently, there is no single diagnostic modality that can accurately identify the site of ileal perforation, as most cases are identi ed intraoperatively (12). However, identi cation of the etiological agent has changed over time from simple stool analysis, IgM, blood culture, and more recent methods, such as polymerase chain reaction (PCR) and histology of ulcer edge biopsy (10), in which histology is more sensitive and speci c to etiologic agents than is the former (13). Most cases of nontraumatic ileal perforation are reportedly caused by infectious agents according to many studies in low-income countries.…”

Typhoid Ileal Perforation: Comparative Study of Ileostomy Versus Primary Repair and associated Morbidity and Mortality

“…Pakistan, India, and other tropical countries suffer from Typhoid fever, an endemic disease. 4,5 Even though surgery is considered a definite treatment, the choice of the exact surgical procedure remains controversial. Different authors have recommended numerous operative procedures in their studies, the most suggested being: i) simple primary repair of perforation; ii) repair of perforation with an intertransverse colostomy; iii) primary ileostomy; iv) single layer repair with an omental patch; v) resection and anastomosis.…”

Acute febrile illness among outpatients seeking health care in Bangladeshi hospitals prior to the COVID-19 pandemic

“…They reported Rickettsia (37%) and dengue (9.6%) as the predominant causes of AFI in their study, along with very few cases of Coxiella, Leptospira, Bartonella, and chikungunya virus infections. Other than malaria in endemic zones, most single pathogen studies of acute febrile illness investigated enteric fever [21][22][23][24][25][26][27][28] and dengue [29][30][31][32][33][34][35][36][37] as these are common diseases in Bangladesh.…”