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Fulminant hepatic failure with typhoid fever in childhood
1Department of Paediatrics, Aga Khan University and Hospital, Karachi.
Insights
Typhoid fever rarely causes severe liver problems in children. However, when it does, it is linked to increased mortality and can lead to fatal liver failure.
Area of Science:
- Pediatrics
- Hepatology
- Infectious Diseases
Background:
- Hepatic dysfunction is documented in adult typhoid cases.
- Limited data exists on significant liver impairment in pediatric typhoid patients.
Observation:
- A study analyzed 355 children with culture-proven typhoid.
- Hepatomegaly and right hypochondrial tenderness were observed in 33% and 8.5% of cases, respectively.
- Liver function tests (LFTs) were mostly normal.
Findings:
- Significant hepatic dysfunction occurred in only 7.3% of pediatric typhoid cases.
- Children with typhoid and hepatic dysfunction exhibited higher mortality rates (P < 0.001).
- Two cases presented with fatal fulminant hepatic failure.
Implications:
- While uncommon, severe hepatic dysfunction in pediatric typhoid is a critical indicator of poor prognosis.
- Highlights the need for vigilant monitoring of liver function in children with typhoid.
- Underscores the potential for severe hepatic complications in pediatric typhoid, necessitating prompt and appropriate medical intervention.
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 355 children with culture proven typhoid seen at the Aga Khan University Hospital, hepatomegaly was noted in 118 (33%) and isolated right hypochondrial tenderness in 30 (8.5%). The liver function tests were normal in 78% and 47% of these children respectively and significant hepatic dysfunction was seen only in 26 (7.3%). However, children with typhoid and significant hepatic dysfunction had higher mortality (P less than 0.001) and two patients presented with a picture of fulminant hepatic failure with fatal outcome.