title: A clinical, microbiological, and pathological study of intestinal perforation associated with typhoid fever.
abstract: One of the most serious complications of typhoid fever is intestinal perforation. Of 27 patients admitted to a provincial hospital in the Mekong Delta region of Vietnam who had gastrointestinal perforation secondary to suspected typhoid fever, 67% were male, with a median age of 23 years and a median duration of illness of 10 days. Salmonella enterica subspecies enterica serotype Typhi (S. Typhi) was isolated from 11 (41%) of 27 patients; of 27 patients, only 4 (15%) had positive cultures from gut biopsies. S. Typhi DNA was detected by polymerase chain reaction for all perforation biopsy samples. Detailed histological examination of the gastrointestinal mucosa at the site of perforation in all cases showed a combination of discrete acute and chronic inflammation. Acute inflammation at the serosal surface indicated additional tissue damage after perforation. Immunohistochemical results showed that the predominant infiltrating cell types at the site of perforation were CD68+ leukocytes (macrophages) or CD3+ leukocytes (T lymphocytes).
authors.affiliation: Dong Thap Provincial Hospital, Dong Thap, Ho Chi Minh City, Vietnam.
authors.forename: Quoc Chanh
authors.initials: QC
authors.lastname: Nguyen
authors.forename: Paul
authors.initials: P
authors.lastname: Everest
authors.forename: Tan Khoa
authors.initials: TK
authors.lastname: Tran
authors.forename: Deborah
authors.initials: D
authors.lastname: House
authors.forename: Simon
authors.initials: S
authors.lastname: Murch
authors.forename: Christopher
authors.initials: C
authors.lastname: Parry
authors.forename: Phillippa
authors.initials: P
authors.lastname: Connerton
authors.forename: Van Bay
authors.initials: VB
authors.lastname: Phan
authors.forename: Song Diep
authors.initials: SD
authors.lastname: To
authors.forename: Pietro
authors.initials: P
authors.lastname: Mastroeni
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
authors.forename: T Hien
authors.initials: TH
authors.lastname: Tran
authors.forename: Van Ho
authors.initials: VH
authors.lastname: Vo
authors.forename: Gordon
authors.initials: G
authors.lastname: Dougan
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Farrar
authors.forename: John
authors.initials: J
authors.lastname: Wain
mesh_terms: D000328:Adult; D015373:Bacterial Typing Techniques; D019411:Clinical Laboratory Techniques; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007416:Intestinal Perforation / Q000209:etiology* / Q000382:microbiology; D008297:Male; D016133:Polymerase Chain Reaction; D019779:Salmonella enterica / Q000302:isolation & purification; D012485:Salmonella typhi / Q000235:genetics / Q000302:isolation & purification*; D012698:Serologic Tests; D014435:Typhoid Fever / Q000150:complications* / Q000382:microbiology; D014744:Vietnam