Typhoid intestinal perforation in developing countries: Still unavoidable deaths?

Contini, Sandro

doi:10.3748/wjg.v23.i11.1925

Cited by 44 publications

(49 citation statements)

References 64 publications

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“…Typhi in humans is not related initially to gastrointestinal symptoms, but it is characterized by fever, bacteremia, and hepato-splenomegaly. In the absence of appropriate treatment, it can lead to intestinal hemorrhage or perforation ( 4 , 5 ). Importantly, some patients become asymptomatic carriers and harbor the bacteria in gallbladder ( 6 – 8 ).…”

Section: Introductionmentioning

confidence: 99%

Interleukin-10 Production by T and B Cells Is a Key Factor to Promote Systemic Salmonella enterica Serovar Typhimurium Infection in Mice

et al. 2017

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Salmonella enterica serovar Typhimurium (S. Typhimurium) is a Gram-negative bacterium that produces disease in numerous hosts. In mice, oral inoculation is followed by intestinal colonization and subsequent systemic dissemination, which leads to severe pathogenesis without the activation of an efficient anti-Salmonella immune response. This feature suggests that the infection caused by S. Typhimurium may promote the production of anti-inflammatory molecules by the host that prevent efficient T cell activation and bacterial clearance. In this study, we describe the contribution of immune cells producing the anti-inflammatory cytokine interleukin-10 (IL-10) to the systemic infection caused by S. Typhimurium in mice. We observed that the production of IL-10 was required by S. Typhimurium to cause a systemic disease, since mice lacking IL-10 (IL-10−/−) were significantly more resistant to die after an infection as compared to wild-type (WT) mice. IL-10−/− mice had reduced bacterial loads in internal organs and increased levels of pro-inflammatory cytokines in serum at 5 days of infection. Importantly, WT mice showed high bacterial loads in tissues and no increase of cytokines in serum after 5 days of S. Typhimurium infection, except for IL-10. In WT mice, we observed a peak of il-10 messenger RNA production in ileum, spleen, and liver after 5 days of infection. Importantly, the adoptive transfer of T or B cells from WT mice restored the susceptibility of IL-10−/− mice to systemic S. Typhimurium infection, suggesting that the generation of regulatory cells in vivo is required to sustain a systemic infection by S. Typhimurium. These findings support the notion that IL-10 production from lymphoid cells is a key process in the infective cycle of S. Typhimurium in mice due to generation of a tolerogenic immune response that prevents bacterial clearance and supports systemic dissemination.

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Section: Introductionmentioning

confidence: 99%

Interleukin-10 Production by T and B Cells Is a Key Factor to Promote Systemic Salmonella enterica Serovar Typhimurium Infection in Mice

et al. 2017

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“…The reported complications in our study were dominated by ileal perforations (71.2%). Ileal perforation is the most common complication of typhoid fever in the medical literature [16]. Between 15% and 30% of cases of typhoid fever will progress to ileal perforation [17].…”

Section: Discussionmentioning

confidence: 99%

“…Between 15% and 30% of cases of typhoid fever will progress to ileal perforation [17]. The preponderance of ileal complications is related to the richness of the reticuloendothelial system in the terminal intestine [16]. Indeed, during typhoid fever, Salmonella typhi preferentially colonizes the Peyer's patches of the terminal ileum and causes necrosis and perforation.…”

Section: Discussionmentioning

confidence: 99%

Complications of typhoid fever in digestive surgery: a descriptive study based on 295 cases in a sub Saharan environment

Ouédraogo

Ouangré

Zida

et al. 2019

Preprint

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Background: Typhoid fever is endemic in sub-Saharan Africa. Inadequate management often leads to complications, which are mainly surgical. Surgical complications are fraught with heavy mortality. Objective: To describe the surgical and digestive complications of typhoid fever in the Surgical Department of Tenkodogo Regional Hospital in Central-Eastern Burkina Faso. Methods: This was a descriptive study performed in the digestive surgery department of Tenkodogo Regional Hospital. It covered the period from January 2014 to December 2018. The records of all patients who were admitted for a surgical complication of typhoid fever were included. Results: Two hundred and ninety-five patients were treated for a surgical complication of typhoid fever. There were 184 male patients (62.4%) and 111 female patients. Their average age was 15.7 years. The reported complications were peritonitis by ileal perforation with 212 cases (71.2%), acute cholecystitis with 45 cases (13.8%), primary biliary peritonitis with 23 cases (6.8%) and liver abscess with 15 cases (5.1%). Patients were operated on by laparotomy and laparoscopy under general anaesthesia. The ileal perforations were treated according to 3 surgical procedures: excision-suture of the perforation, resection-anastomosis at the same time and ileostomy with restoration of the digestive continuity after 3 weeks. In cases of acute cholecystitis or biliary peritonitis, a cholecystectomy was proposed. The liver abscesses were drained by laparotomy or by puncture. Antibiotic therapy was associated with surgical treatment. The average length of stay of patients was 9 days. Twenty-eight patients died, which represents 9.5% mortality. Conclusion: The surgical complications of typhoid fever are responsible for heavy mortality in digestive surgery.

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“…2 The most serious complication is typhoid intestinal perforation (TIP), observed in 0.8-39%, with a striking rate difference between high-income and low-middleincome countries. 3 Perforation results in super infection of the peritoneal cavity with gut flora leading to a full-blown peritonitis, with severe peritoneal contamination being associated with a poor prognosis and high mortality. 4 The reasons for the high mortality are multifactorial.…”

Section: Introductionmentioning

confidence: 99%

Our experience with enteric ileal perforation: a retrospective study at a tertiary care centre in northern India

Agrawal¹,

Imbisat²

2019

Int Surg J

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Background: Typhoid fever is one of major causes of intestinal perforation in India and is one of the common surgical emergencies for which intervention is required. The study aims to evaluate the clinical presentation, operative findings, outcome of surgical procedures, postoperative complications and associated mortality among the patients managed for typhoid ileal perforation in a tertiary care hospital.Methods: This was a retrospective study evaluating the patients who were operated for typhoid ileal perforation peritonitis in FH Medical College, Agra, UP, India between April 2017 and September 2019. Diagnosis of typhoid ileal perforation was made with the combination of clinical presentation, laboratory investigations, radiological results and per-operative findings.Results: In the present study, 57 patients were managed for typhoid ileal perforation. Majority of the patients were young. In our study 40 patients (70.18%) were male and 17 patients (29.82%) were female. All patients presented with pain in abdomen and abdominal distension. However there was no history of fever in 19.3% of patients. Free gas under the right diaphragm was present in 60% of patients. Exploratory laparotomy was done in all the patients and multiple perforations were found in 59.65% of patients. Ileostomy was made in 75% of patients. Most common post-operative complication was wound infection (85.96%) and mortality was 12.28%.Conclusions: Perforation peritonitis is an alarming complication of typhoid fever which needs urgent and aggressive management. Mortality rate is high (12.28%) and may be attributed to delayed presentation.

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Typhoid intestinal perforation in developing countries: Still unavoidable deaths?

Cited by 44 publications

References 64 publications

Interleukin-10 Production by T and B Cells Is a Key Factor to Promote Systemic Salmonella enterica Serovar Typhimurium Infection in Mice

Interleukin-10 Production by T and B Cells Is a Key Factor to Promote Systemic Salmonella enterica Serovar Typhimurium Infection in Mice

Complications of typhoid fever in digestive surgery: a descriptive study based on 295 cases in a sub Saharan environment

Our experience with enteric ileal perforation: a retrospective study at a tertiary care centre in northern India

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