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Correlation of clinical and hematologic profiles with bone marrow responses in typhoid fever
J James1, T K Dutta, S Jayanthi
1Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Abstract:
Thirty-six adult patients with typhoid fever were studied. Severe, moderate, and mild typhoid fevers were observed in 17 (47.2%), 17 (47.2%), and two (5.6%) patients, respectively. Twenty-eight (77.8%) had either isolated anemia (i.e., anemia unaccompanied by other blood component cytopenias) or mixed cytopenias. Three patients (8.3%) had pancytopenia. Sixteen patients (44.5%) had either total or partial bone marrow suppression. In five (31.3%) with partial suppression, the effect of bone marrow suppression was not reflected in peripheral blood. Sixteen (48.5%) of 33 had peripheral blood cytopenias that were not accompanied by concurrent bone marrow suppression, suggesting a peripheral mechanism responsible for the blood dyscrasia in those cases. No patient had evidence of disseminated intravascular coagulopathy. There was no correlation between clinical severity of disease and bone marrow changes. Bone marrow/peripheral blood changes did not influence the outcome of the disease, since all the patients recovered fully after treatment.
Insights
Typhoid fever commonly causes anemia and other blood cell count changes (cytopenias) in adults. These blood dyscrasias often stem from peripheral mechanisms rather than bone marrow suppression, with all patients recovering fully.
Area of Science:
- Hematology
- Infectious Diseases
- Internal Medicine
Background:
- Typhoid fever, a systemic infection caused by Salmonella Typhi, can lead to various hematological abnormalities.
- Understanding the mechanisms behind these blood dyscrasias is crucial for patient management.
Purpose of the Study:
- To investigate the hematological changes, including bone marrow and peripheral blood alterations, in adult patients with typhoid fever.
- To determine the correlation between disease severity, bone marrow suppression, peripheral cytopenias, and patient outcomes.
Main Methods:
- Prospective study of 36 adult patients diagnosed with typhoid fever.
- Assessment of peripheral blood counts and bone marrow morphology.
- Correlation analysis between clinical severity, hematological findings, and treatment outcomes.
Main Results:
- Severe or moderate typhoid fever was observed in 94.4% of patients.
- Anemia and/or cytopenias were present in 77.8% of patients.
- Bone marrow suppression (total or partial) occurred in 44.5%, but peripheral cytopenias were often independent of bone marrow changes, suggesting peripheral mechanisms.
- No disseminated intravascular coagulopathy was observed.
- No correlation found between clinical severity and bone marrow changes, nor did these changes impact patient recovery.
Conclusions:
- Typhoid fever frequently induces anemia and cytopenias in adults, often due to peripheral factors rather than direct bone marrow suppression.
- Hematological abnormalities in typhoid fever do not appear to influence the overall positive treatment outcome.