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Hepatic dysfunction in paediatric typhoidal salmonellosis
1Department of Paediatrics, Aga Khan University and Hospital, Karachi, Pakistan.
Insights
Typhoid can cause significant liver problems in children, with 22% showing impaired liver function. This hepatic dysfunction in pediatric typhoid patients is linked to increased toxicity and mortality.
Area of Science:
- Pediatric Infectious Diseases
- Hepatology
- Clinical Microbiology
Background:
- Hepatic dysfunction is documented in adult typhoid cases.
- Significant hepatic functional impairment in children with typhoid is rarely reported.
Purpose of the Study:
- To investigate the prevalence and clinical significance of hepatic dysfunction in children diagnosed with typhoid fever.
Main Methods:
- Retrospective analysis of 435 children with culture-proven typhoid.
- Clinical examination for hepatomegaly and right hypochondrial tenderness.
- Liver function tests (LFTs) performed on a subset of patients.
Main Results:
- Hepatomegaly observed in 29% of children.
- Significant hepatic dysfunction identified in 22% of children undergoing LFTs.
- Children with hepatic dysfunction exhibited higher toxicity and mortality rates (p<0.001, p<0.002).
- Two cases of fatal fulminant hepatic failure were recorded.
Conclusions:
- Hepatic dysfunction is a notable complication in pediatric typhoid.
- Impaired liver function in pediatric typhoid is associated with poorer outcomes.
- Further research into the mechanisms and management of typhoid-related liver injury in children is warranted.
Abstract:
Although hepatic dysfunction has been described among adults with typhoid, there are few reports of significant hepatic functional impairment in children with typhoid. Of 435 children with culture-proven typhoid seen at the Aga Khan University Hospital, hepatomegaly was noted in 125 (29%) and isolated right hypochondrial tenderness in three (7%). Liver function tests performed on 156 of these children were normal in 121 (78%) and showed significant hepatic dysfunction in 35 (22%). Patients with significant hepatic dysfunction were more toxic (p less than 0.001) at presentation and had higher mortality (p less than 0.002) than those with normal liver function. Two children presented with a picture of fulminant hepatic failure with fatal outcome.