Shahid Jamal, Azhar Mubarik, Nadira Mamoon, Muhammad Luqman.
Fatal enteric fever - A study of 54 autopsies
Pak J Pathol Oct - Dec 2001;12(4):4-9.
Armed Forces Institute of Pathology and Army Medical College, Rawalpindi

Fifty fatal cases of enteric fever, autopsied at different military hospitals of the country were reviewed at histopathology department of Armed Forces Institute of Pathology,Rawalpindi (Pakistan). Ages varied between 18 to 35 years (average 23.3 years). The cause of death in 28 cases (56%) was toxaemia, whereas 22 cases (44%) died of intestinal perforation or haemorrhage. The patients dying of toxaemia presented with fever, vomiting, pain abdomen and loose motions, with average duration of 9.4 days. Leucopenia was not present in >50% cases and Widal titer was within normal limits in 42% cases. Fifty three percent patients were not diagnosed as enteric fever and therefore were not treated accordingly. Autopsy of these cases revealed ileal ulceration in 71.4% cases with hepatomegaly and typhoid nodules in 50% cases. Spleen was involved in 53.5% and kidneys in 28.5% cases which might have contributed to a fatal outcome, along with bronchopneumonia (21.4%) and myocarditis (7.1%). In the patients dying of perforation or haemorrhage the average duration of illness was prolonged, being 25.12 and 18.4 days `respectively. In conclusion; the enteric fever might not be suspected clinically and widal test can be normal even in fatal cases. Being a multisystem disease, gastrointestinal system is mostly involved but patients may die due to toxaemia, without perforation or haemorrhage.

Category: Internal Medicine
Keywords: Enteric Fever. Typhoid Fever. Autopsy. DIC. Disseminated Intravascular Coagulation.

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