Typhoid fever – clinical and endoscopic aspects*

 

A. Murinello, A. Morbey, J. Figueira Coelho, P. Mendonça, A. C. Pires, V. Magalhães Ramalho, N. Carrilho Ribeiro, A. Lázaro, H. Peres, J. Netta **

 

 

Resumo

A febre tifóide é uma infecção intestinal causada pela Salmonella typhi, manifestada por quadro septicémico, ocorrendo incidência elevada de casos em regiões com deficientes condições sanitárias, através do consumo de água e alimentos contaminados por fezes de indivíduos doentes ou portadores assintomáticos. Em países desenvolvidos os casos verificados são geralmente “importados”. A observação endoscópica das ulcerações da ileocolite tífica tem sido raramente descrita, não havendo referências prévias em Portugal da documentação colonoscópica das ulcerações tíficas. Baseados num caso clínico, os autores fazem uma revisão sobre febre tifóide, no que concerne à patogenia, histopatologia, quadro clínico, aspectos endoscópicos das ulcerações, e terapêutica antibiótica aconselhada nos casos de estirpes de Salmonella typhi sensíveis ou resistentes a vários grupos de antibióticos.

 

 

Summary

Typhoid fever is an enteric disease due to Salmonella typhi, presenting as a septicaemic illness, affecting an elevated number of people living in regions with poor sanitary conditions,  acquired through the ingestion of water and food contaminated by feces of acutely ill patients or chronic carriers of the microorganism. In developed countries the disease is usually “imported”. Colonoscopic demonstration of ulcerations of typhoid ileocolitis is scarcely referred in medical literature, and there are no previous references to endoscopic aspects of typhoid ileocolitis in Portugal. Based on this, the authors review typhoid fever as far as are pathogeny, pathology, clinical picture and colonoscopic aspects are concerned as well as therapy recommended for susceptible and resistant strains of Salmonella typhi.

 

 

Texto Completo disponível apenas em PDF

Full text only available in PDF format

 

 

Bibliografia

 

1. Richens J, Parry C. Typhoid and paratyphoid fever. In: Warrel DA, Cox TM, Firth JD, Benz Z, Jr EJ, eds. Oxford Textbook of Medicine. 4th ed. Oxford: Oxford University Press; 2003. p. 503-507.        [ Links ]

2. Christie AB. Typhoid and paratyphoid fevers. In: Christie AB, ed. Infectious Diseases: Epidemiology and Clinical Practice. 3rd ed. Edinburgh: Churchill Livingstone; 1980. p. 47-102.

3. Gillespie SH. Salmonella infections. In: Cook GC, Zumla A, eds. Manson’s Tropical Diseases. 21rst ed. London: WB Saunders/Elsevier; 2003. p. 937-949.

4. Hornick RB, Greiseman SE, Woodward TE, et al. Typhoid fever:  pathogenesis and immunological control. New Engl J Med 1970;283: 686-91.

5. Bhan MK, Bahl R, Sazawal S, Sinha A, Kumar R, Mahalanabis D, et al. Association between Helicobacter pylori infection and increased risk of typhoid fever. J Infect Dis 2002; 186: 1857-60.

6. Gillespie SH. Salmonella. In: Emerson AM, Hawkey PM, Gillespie SH, eds. Principles and Practice of Clinical Bacteriology. 1rst ed. Chichester: Wiley; 1997. p. 399-412.

7. Epstein JE, Hoffman SL. Typhoid fever. In: Guerrant RL, Walker  DH, Weller PF, eds. Tropical Infectious Diseases: Principles, Pathogensand Practice. 2nd ed. Philadelphia: Churchill Livingstone/Elsevier; 2006. p. 220-240.

8. Netter FH. Typhoid fever. In: Oppenheimer E, ed. The Ciba Collection of Medical Illustrations – Part II, vol 3 – Digestive System. New York: Ciba Pharmaceutical Co.; 1962. p. 149-151.

9. Hepps K, Sutton FM, Goodcame RW. Multiple left-sided colon ulcers due to typhoid fever. Gastrointestinal Endoscopy 1991; 37:479-80.

10. Sood A, Midha V, Sood N. Massive hemorrhage from colonic ulcers in typhoid fever. Indian J Gastroenterol 2001; 20:80.

11. Herrán L, Flores A, De Benedetti ME, de los Rios R, Gotuzzo E. Reaparicíon de formas graves de tifóide: a propósito de un caso de sangrado masivo gastrointestinal. Rev Gastroenterol Peru 2007;27: 62-67 (spanish).

12. Uddin N, Vihan MA, Tasneem Z. Colonic perforations in enteric fever. J Coll Physicians Surg Pak 2004; 14: 634-5.

13. Kasamaki S, Sato T, Ochiar T, Shijo H, Kudo K, Suda S. A case of typhoid ulcers followed up with colonoscopy. Digestive Endoscopy 2000; 12: 196-8.

14. Lee JH, Kim JJ, Jung JH, Lee S-Y, Bae MH, Kim Y-H, et al. Colonoscopic manifestations of typhoid fever with lower gastrointestinal bleeding. Dig Liv Dis 2004; 36: 141-6.

15. Smith JH. Typhoid fever. In: Binford CH, Connor DH, eds. Pathology of Tropical and Extraordinary Diseases. Vol 1. 1rst ed. Washington: Armed Forces Institute of Pathology; 1976. p. 123-129.

16. Reyes E, Hernandez J, Gonzalez A. Typhoid colitis with massive lower gastrointestinal bleeding. Dis Colon Rectum 1986; 29: 511-4.

17. Kume K, Kubo K, Murata I, Yoshikawa I, Nakamura H, Hata H, et al. Endoscopic diagnosis in typhoid fever. Endoscopy 2000; 32: S31.

18. Kang JY. Endoscopic diagnosis of ileal ulceration in typhoid fever. Gastrointestinal Endoscopy 1988; 34: 442-3.

19. Wong S-Y, Fook-Hong Ng, Know K-H, Chow K-C. Skip colonic ulceration in typhoid ileocolitis. J Gastroenterol 1999; 34: 700-01.

20. Zuckerman M, Meza AD, Ho H, Menzies IS, Dudrey EF. Lower gastrointestinal bleed in a patient with typhoid fever. Am J Gastroenterol 2000; 95: 843-5.

21. Garg PK, Bathia V, Tandon RK. Endoscopic therapy is effective for bleeding ileal ulcer. Gastrointestinal Endoscopy 2003; 57: 797-9.

22. Mock CN, Amatral J, Kisser LE. Improvement in survival from typhoid ileal perforation. Results of 221 operative cases. Ann Surg 1992; 215: 244-9.

23. Adeniran JO, Taiwo JO, Abdur-Rahman LO. Salmonella intestinal perforation: (27 perforations in one patient, 14 perforations in another). Are the goal posts changing? J Indian Assoc Pediatr Surg 2005; 10: 248-51.

24. Hornick RB, Greisman S. On the pathogenesis of typhoid fever. Arch Int Med 1978; 138: 357-9.

25. Connor BA, Schwartz E. Typhoid and paratyphoid fever in travelers. The Lancet Infectious Diseases 2005; 5: 623-8.

26. Bastos CO. Febre Tifóide. In: Veronesi R, ed. Doenças Infecciosas e Parasitárias. 6ª ed. Rio de Janeiro: Guanabara Koogan; 1976. p. 406-417 (portuguese).

27. Pegues DA, Ohl ME, Miller SI. Salmonella species, including Salmonella typhi. In: Mandell GL, Bennet JE, Dolin R, eds. Mandell, Douglas, Bennet’s Principles and Practice of Infectious Diseases. 6th ed. Philadelphia: Elsevier/Churchill Livingstone; 2000. p. 2636-2650.

28. Bhutta ZA, Mansurali N. Rapid serologic diagnosis of pediatric typhoid fever in an endemic area: a prospective comparative evaluation of two dot-enzyme immunoassays and the Widal test. Am J Trop Med Hyg 1999; 61: 654-7.

29. Chandlhay R, Laxmi BV, Nisar N, et al. Standardisation of polymerase chain reaction for the detection of Salmonella typhi in typhoid fever. J Clin Pathol 1997; 50: 437-9.

30. Mirza SH, Beeching NJ, Hart CA. Multi-drug resistant typhoid: a global problem. J Med Microbiol 1996; 44: 317-9.

31. Gupta A. Multi-drug-resistant typhoid fever in children: epidemiology and therapeutic approach. Pediatr Infect Dis J 1994; 13: 134-40.

32. Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ. Typhoid fever. New Engl J Med. 2002; 347: 1770-82.

33. Parry CM, Wain J, Chin NT, et al. Quinolone-resistant Salmonella typhi in Vietnam. Lancet 1998; 351-3.

34. Mermin JH, Villar R, Carpenter J, et al. A massive epidemic of multi-drug resistant typhoid fever in Tajikistan associated with consumption of municipal water. J Infect Dis 1999; 17: 1416-22.

35. Murdoch DA, Banatvala NA, Bone A, et al. Epidemic ciprofloxacin resistant Salmonella typhi in Tajikistan. Lancet 1998; 351: 339.

36. French RW, Nakhla I, Sultan Y, et al. Azythromycin versus ceftriaxone for the treatment of uncomplicated typhoid fever in children. Clin Infect Dis 2000; 31: 1134-8.

37. Alam MN, Hag SA, Das KK, et al. Efficacy of ciprofloxacin in enteric fever: comparison of treatment duration in sensitive and multi-drug resistant Salmonella. Am J Trop Med Hyg 1995; 53: 306-11.

38. Butler T, Islam A, Kabir I, Jones PK. Patterns of morbidity and mortality in typhoid fever dependent on age and gender: review of 552 hospitalized patients with diarrhea. Rev Infect Dis 1991; 13: 85-90.

39. McGowan JE, Chesney PJ, Crossley KB, et al. Guidelines for the use of glucocorticosteroids in the management of selected infections. J Infect Dis 1992; 165: 1-13.

40. Hoshimo Y, Masuda G, Negfishi M, Ajisana A, Imamura A, Hachimori K, et al. Clinical and bacteriological profiles of patients with typhoid fever treated during 1975-1998 in the Tokyo Metropolitan Komagome Hospital. Microbiol Immunol 2000; 44: 577-83.

 

 

* Apresentado em forma de Poster no XIII International Congress for Infectious Diseases, Junho 2008 – Kuala Lumpur, Malaysia

 

** Units of Internal Medicine, Gastroenterology, Radiology, Clinical Pathology, Histopathology, Hospital Curry Cabral, Lisbon, Portugal.

 

Recebido para publicação: 23/08/2007

Aceite para publicação: 31/03/2008