Carrada BT

Language: Spanish
References: 25
Page: 457
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ABSTRACT

A 29 year-old man was admitted to the hospital because of fatigue, anorexia, malaise, occipital headache, fever and difficulty concentrating. On physical examination he appeared tired and thin. His temperature was 40 &#deg;C. The liver edge was tender and palpated 3 cm below the right costal margin, with diffuse abdominal tenderness. An abdominal computed tomographyc scan showed thickening of the terminal ileum wall and clumped-enlarged mesenteric lymph nodes in the right lower quadrant. Laboratory test: white cells count, 4,600/mm³; aspartate-aminotransferase, 790 U/L; lactate-dehydrogenase, 1,562 U/L. He also had roseola spots distributed on the trunk. Repeated blood cultures were negative. Microscopy of a liver biopsy showed lobular aggregates of Kupffer’s cells (typhoid nodules). Bacterial cultures of the liver’s tissue and roseola spots biopsy were positive for Salmonella typhi. The fecal culture of the patient’s wife was also positive for S. typhi and the molecular typing of the bacterial DNA showed the wife was a silent carrier and main source of the typhoidic infection. Since the isolated Salmonella was sensitive in vitro to fluoroquinolones, this drug was administered and the patient was egressed as cured. This article reviews the natural history and pathogenesis, laboratory diagnosís and chemotherapy of uncomplicated typhoid fever.

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