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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Typhoid fever is a febrile illness caused by Salmonella typhi. The usual symptoms include fever, malaise, and compromise of the gut such as diarrhea and abdominal pain. Occasionally, an extraintestinal involvement can be seen and it may be accompanied by severe complications like bowel perforation or massive hemorrhage. The general manifestations are always present in the extraintestinal compromise, and can be preponderant. However, nonintestinal involvement without the general symptoms that this case reports is so rare that no related records can be found in the MEDLINE database.
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PMID:Primary Psoas Abscess Due to Salmonella typhi. 1110 18

Two hundred and forty eight cases of proved typhoid ileal perforation were admitted and treated in three phases in the department of surgery during 1966-1998. Of these, 71% patients belonged to second and third decades of life. Male female ratio was 4:1. Abdominal pain (100%) fever (95%) and constipation (87%) were the main presenting symptoms. Abdominal guarding and rigidity (84%) were the principal physical signs. Plain radiograph of abdomen showed evidence of pneumoperitoneum in 57% of cases. The Widal test was positive for S. typhi in 74% of cases. Blood and bone marrow culture were positive for S. typhi in 9% and 30% respectively. Histology of the excised edges of perforation confirmed typhoid pathology in 62% of specimens. Many of the patients were treated conservatively in the first phase. In phase two and three vigorous resuscitation and early surgery was resorted to. Simple closure in two layers and wedge resection were the treatment of choice in most of the cases. Bypass, ileostomy and resection were done on few occasions. Chloramphenicol was the only drug used in the first phase. Other broad spectrum antibiotics were added to chloramphenicol with metranidazole in the second phase. Ciprofloxacin and metronidazole were the drugs of choice in the third phase. The mortality rate showed a dramatic improvement from 47.2% (first phase) to 17.7% (second phase) and as low as 7% in the last phase. The lag period (advent of symptoms to time of admission to hospital) showed definite correlation with mortality. Septicemia, wound infection, dehiscence, enterocutaneous fistula were the principal postoperative complications.
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PMID:Changing trends in outcome of typhoid ileal perforations over three decades in Pondicherry. 1168 Nov 12

A prospective study of 102 children with bacteriologically confirmed typhoid fever, admitted to Hospital Universiti Sains Malaysia over 5 years was conducted. The average age at presentation was 91.3 (range 6 - 159) months. Fever (900%), abdominal pain (56%) and diarrhoea (44%) were common symptoms. Findings included: hepatomegaly (85.3%), splenomegaly (27.5%), anaemia (31%), leukopenia (15%). thrombocytopenia (26%), positive Widal (62.5%) and Typhidot test (96%). Patients were treated with ampicillin (n = 54) or chloramphenicol (n = 49) and 1/3 developed complications like hepatitis (n = 19), bone marrow suppression (n = 8) and paralytic ileus (n = 7). A patient with splenomegaly, thrombocytopenia or leukopenia was at higher risk of developing complications.
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PMID:Typhoid fever in Malaysian children. 1201 69

Blood cultures of children treated at King Chulalongkorn Memorial Hospital from 1986 to 2000 were retrospectively reviewed and 19 specimens were positive for Salmonella typhi. Of 14 patients whose medical records were available, the age range was between 2 years and 15 years with a male to female ratio of 1.8:1. Major presentations were prolonged fever with a mean duration of 7 days and gastrointestinal manifestations including abdominal pain (71%), hepatomegaly (64%), anorexia (57%), vomiting (57%), and diarrhea (50%). Most cases had normal hematocrit values with white blood cell counts of 5,000-9,000 cells/mm3 and the percentage of neutrophils was 60-89. Complications were abnormal urine sediments (3) including a case of typhoid nephritis, severe enteritis (2) and acute hemolysis (1). Most isolates were susceptible to cotrimoxazole, ampicillin and ceftriaxone by the disk diffusion susceptibility test. Defervescence was seen within 3-14 days after antibiotic therapy. There was no mortality.
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PMID:Typhoid fever in children: experience in King Chulalongkorn Memorial Hospital. 1267 60

Culture and serology were performed on blood and serum samples collected at or shortly after admission from 473 patients presented with suspected clinical typhoid. Clinical symptoms at first presentation including confusion, hepatomegaly, splenomegaly, abdominal pain, anemia, and gastrointestinal bleeding were non-specific as they were observed even more often in non-typhoid patients. Culture confirmed the diagnosis in 65.3% of the patients with typhoid fever as the final diagnosis. The sensitivity (58%) and specificity (98.1%) of a rapid dipstick assay for the detection of S. typhi-specific immunoglobulin M were somewhat lower than those of culture but higher than those of the Widal test. The dipstick assay thus may well be used in the serodiagnosis of typhoid in situation where culture facilities are not available. Combination of test results of dipstick and culture improved sensitivity to 82.5%. In laboratories that perform blood culture the dipstick assay may be used as a rapid screening tests to facilitate a rapid diagnosis. Sensitivity of the dipstick assay strongly increased with duration of illness and was higher for culture positive than for culture negative patients. Duration of illness, and different pathogen and host factors including dose of infection, pathogenicity and antigenicity, and prior antibiotic use are likely to influence the immune response, therefore the result of the dipstick assay. Duration of illness and presence of S. typhi in the blood are major factors that determine severity of disease.
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PMID:Antibody response in typhoid fever in endemic Indonesia and the relevance of serology and culture to diagnosis. 1275 21

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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PMID:Current trends in typhoid Fever. 1286 57

Vaccines against Salmonella enterica serotype Typhi are used for prophylaxis of international travelers and have potential use as counterbioterrorism agents. The Vaccine Adverse Event Reporting System (VAERS) cannot usually establish causal relationships between vaccines and reported adverse events without further research but has successfully detected unrecognized side effects of vaccine. We reviewed reports to VAERS for US-licensed typhoid fever vaccines for the period of July 1990 through June 2002. We received 321 reports for parenteral Vi capsular polysaccharide vaccine and 345 reports for live, oral, attenuated Ty21a vaccine, with 7.5% and 5.5%, respectively, describing death, hospitalization, permanent disability, or life-threatening illness. Unexpected frequently reported symptoms included dizziness and pruritus for Vi vaccine and fatigue and myalgia for Ty21a vaccine. Gastroenteritis-like illness after receipt of Ty21a vaccine and abdominal pain after receipt of Vi vaccine, which are previously recognized events, occasionally required hospitalization. Nonfatal anaphylaxis was reported after both vaccines. VAERS reports do not indicate any unexpected serious side effects that compromise these vaccines' use for travelers' prophylaxis.
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PMID:Postmarketing safety surveillance for typhoid fever vaccines from the Vaccine Adverse Event Reporting System, July 1990 through June 2002. 1499 18

Typhoid fever, a systemic disease caused by Salmonella typhi, is classically characterized by fever and abdominal symptoms. Although now considered uncommon, it seems to have re-emerged in Taiwan in recent years. We conducted a retrospective study of the clinical characteristics and microbiologic findings in 24 confirmed cases of typhoid fever treated over a 7-year period at a medical center in northern Taiwan. There were 11 males and 13 females, including 15 adults (over 18 years in age) and 9 children. Their mean age was 24.7 years (range, 9 months to 58 years). Twelve patients had recently returned from abroad, mostly from Southeast Asia. The most common complaints were fever (24/24), diarrhea (18/24), abdominal pain (10/24), and cough (10/24). The average duration of fever before diagnosis was 14.1 days, with a maximum of 30 days. Relative bradycardia was noted in 6 patients. Leukopenia was noted in 2 patients. S. typhi was isolated from blood culture in 20 cases, from stool culture in 3 cases, and from bone marrow culture in 1 case. Widal test was only positive initially in 7/18 cases. Fever of unknown origin was the most common initial diagnosis. Typhoid or enteric fever was impressed initially in only 2 cases. Almost all isolates of S. typhi were susceptible to antibiotics currently used for typhoid fever, with only 1 isolate resistant to chloramphenicol. All patients survived after antibiotic treatment. Only 1 patient developed recurrence after a 10-day course of ceftriaxone. In conclusion, the diagnosis of typhoid fever is often challenging due to non-specific symptoms and lack of an immediate confirmatory test. It is important to include this disease in the differential diagnosis of febrile patients with abdominal symptoms.
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PMID:Changing characteristics of typhoid fever in Taiwan. 1518 93

In September 2000, an outbreak of typhoid fever was reported in a rural village of Central Myanmar. The authors investigated the outbreak in the affected village. A suspected case was a person suffering from fever with either constipation, abdominal pain, diarrhoea/bloody diarrhoea. A probable case was a suspected case who had positive result on the diazo urine test or widal test. Based on probable cases, the authors conducted a case-control study comparing history of contact with the cases, water source, and personal hygiene. Control was a person living in the village was not ill and having a negative result for diazo urine test. Among 49 suspected cases, 33 were probable. Attack rate was 1.2%. Three cases had a positive culture for Salmonella typhi and were not drug resistant. The following risk factors were identified: drinking unboiled river water (adjusted OR 12.5, 95%CI 2.8-75.3), history of contact with other patients before the illness (adjusted OR 22, 95%CI 3.5-76.2), no hand washing with soap after defecation (adjusted OR 0.15, 95% CI 0.03-0.81). Environmental investigation result showed that most of the households had unsanitary latrine and some latrines were constructed near the edge of a river. The outbreak subsided quickly after intervention.
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PMID:Typhoid fever outbreak in Madaya Township, Mandalay Division, Myanmar, September 2000. 1521 77

We report a case of multiple colonic perforations in a 5-year-old boy due to typhoid fever. The main objective is to present the occurrence of this complication and discuss the management. The patient was admitted with nine days history of high-grade fever and abdominal pain. On examination, he was very sick looking child with acute abdomen. After initial workup and resuscitation, laparotomy was performed which revealed multiple colonic perforations with feacal peritonitis. The case revealed that one must not forget to inspect entire intestine including colon, as there may be perforations present in the large bowel.
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PMID:Colonic perforations in enteric fever. 1545 59


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