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A clinical, microbiological, and pathological study of intestinal perforation associated with typhoid fever

Quoc Chanh Nguyen1, Paul Everest, Tan Khoa Tran

  • 1Dong Thap Provincial Hospital, Dong Thap, Ho Chi Minh City, Vietnam.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|June 19, 2004
PubMed

Insights

Intestinal perforation is a severe typhoid fever complication. This study found Salmonella Typhi DNA in all perforation biopsies, with inflammation and immune cell infiltration at the site.

Area of Science:

  • Gastroenterology
  • Infectious Diseases
  • Pathology

Background:

  • Intestinal perforation is a critical complication of typhoid fever.
  • Typhoid fever remains a significant public health concern, particularly in endemic regions.

Purpose of the Study:

  • To investigate the microbiological and histological findings in patients with gastrointestinal perforation due to suspected typhoid fever.
  • To identify the causative agent and characterize the inflammatory response at the perforation site.

Main Methods:

  • Analysis of clinical data from 27 patients with gastrointestinal perforation.
  • Isolation of Salmonella enterica subspecies enterica serotype Typhi (S. Typhi) from patient samples.
  • Detection of S. Typhi DNA using polymerase chain reaction (PCR) on biopsy samples.
  • Histological examination and immunohistochemical analysis of gastrointestinal mucosa.

Main Results:

  • S. Typhi was isolated from 41% of patients, and its DNA was detected in all perforation biopsy samples via PCR.
  • Histological examination revealed acute and chronic inflammation at the perforation site, with evidence of serosal damage.
  • Immunohistochemistry identified CD68+ leukocytes (macrophages) and CD3+ leukocytes (T lymphocytes) as the predominant infiltrating cells.

Conclusions:

  • PCR is a sensitive method for detecting S. Typhi in perforation biopsies.
  • The inflammatory response at the perforation site involves both acute and chronic inflammatory cells, including macrophages and T lymphocytes.
  • Understanding the host response is crucial for managing typhoid-related intestinal perforations.

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