Lower gastrointestinal bleed in a patient with typhoid fever

Zuckerman, Marc J.; Meza, Armando; Ho, Hoi; Menzies, Ian S.; Dudrey, Ellen

doi:10.1111/j.1572-0241.2000.01874.x

Cited by 10 publications

(7 citation statements)

References 6 publications

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“…Recently, colonoscopy was recommended for localizing sites of gastrointestinal bleeding in patients with typhoid fever. However, the colonoscopic characteristics of bleeding ulcers in typhoid fever have not been well established [19] ; so endoscopic examinations may give rise to other possibilities, such as intestinal tuberculosis, Yersinia enterocolitis, amoebiasis, or Crohn's disease, and, when antibiotics or NSIADs are administered, can lead to misdiagnoses of pseudomembranous colitis or antibiotic-induced colitis [20] or even NSAIDs-induced intestinal ulcers. [21] In our case, the patient initially denied her travel history, and confirmed a history of NSAIDs use, and moreover, EGD showed multiple duodenal ulcers.…”

Section: Discussionmentioning

confidence: 99%

Successful endoscopic hemoclipping and conservative management for typhoid fever complicated by massive intestinal bleeding and acute pancreatitis

Cho

2019

Medicine

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Rationale: Massive intestinal bleeding as a complication of typhoid fever has rarely been reported due to the advent of antibiotics. In addition, although several literatures have been issued on the use and success of endoscopic modalities in cases of massive typhoid ulcer bleeding, few have described hemostasis by endoscopic hemoclipping. Patient concerns: We describe a case of a 61-year-old Korean female who presented acute episodes of massive lower gastrointestinal bleeding during admission to local hospital with a provisional diagnosis of acute gastroenteritis. She had returned from a trip to Southeast Asia 3 weeks prior to admission Diagnoses: After the result of blood culture was identified as Salmonella typhi , we could make a diagnosis of typhoid fever complicated by massive intestinal bleeding and acute pancreatitis based on elevated serum lipase and computerized tomography (CT) findings. Interventions: The patient was treated successfully by two repeat colonoscopic hemostasis procedures involving the deployment of hemoclips on ulcers in the terminal ileum and 10-day course of intravenous ciprofloxacin Outcomes: The patient was stable and reported no further episodes of intestinal bleeding or fever during the follow-up time. In addition, acute pancreatitis, which is a rare complication of typhoid fever, resolved without complication on follow-up CT and a laboratory study. Lessons: Considering the risk of procedure-related complications such as perforation of the small intestine wall, which become thin and friable due to ulceration, mechanical hemostasis methods, such as hemoclipping, might be safer than coagulation, when the bleeding spot can be identified and is not multiple, as in our case. In addition, our case demonstrates that S. typhi should be considered in the differential diagnosis of massive lower gastrointestinal hemorrhage, especially in the setting of recent travel in South or Southeast Asia.

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Section: Discussionmentioning

confidence: 99%

Successful endoscopic hemoclipping and conservative management for typhoid fever complicated by massive intestinal bleeding and acute pancreatitis

Cho

2019

Medicine

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“…These complications are related to lymphoid hyperplasia and necrosis, especially in the ileocecal area [43]. Bloody stools occur in 10% of patients, with severe bleeding in 2%; most gastrointestinal bleeding is self-limited.…”

Section: Clinical Manifestationsmentioning

confidence: 99%

Current trends in typhoid fever

Crum

2003

Curr Gastroenterol Rep

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Typhoid fever, a systemic infection caused by Salmonella enterica serotype typhi, remains an important worldwide cause of morbidity and mortality. Endemic cases in the United States are unusual, with most following foreign travel to the Indian subcontinent, Africa, Asia, or Latin America. The classic findings of typhoid fever include rose spots, relative bradycardia, and stepwise fevers, but unfortunately these signs are frequently absent. Gastrointestinal manifestations may include diffuse abdominal pain, bleeding, perforation, cholecystitis, and cholangitis. The diagnosis should be suspected after collection of the appropriate clinical and travel history with confirmation by blood or bone marrow culture. Novel methods are in development to establish the diagnosis when cultures are negative or unavailable. Multidrug resistance has increased worldwide, and decisions on antimicrobial therapy must take such resistance into account. The empiric treatment of choice is a fluoroquinolone drug; ceftriaxone and azithromycin are alternatives. Preventive strategies include good sanitation and food handling practices along with vaccination of selected groups.

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“…Empirical antimicrobial therapy for typhoid fever with a quinolone or third-generation cephalosporin is usually effective [3,5]. Ceftriaxone, a third-generation cephalosporin, is highly effective against S. Typhi and has become the antibiotic of choice in many parts of the world, for the treatment of typhoid fever.…”

Section: Lower Gastrointestinal Bleeding In a Patient With Typhoid Fevermentioning

confidence: 99%

“…tal number of existing cases of a disorder as a proportion of a population (usually per 100,000 people) at a specific time [5]. Unfortunately, this author succumbed to the vernacular and should have employed the less precise but more correct 'rate' or 'percentage'.…”

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confidence: 99%