| [ Summary ] |
Patients with typhoid or paratyphoid fever always have some degree of hepatic involvement. Some patients are initially suspected of having acute viral hepatitis. Several clinical and laboratory findings can help to differentiate typhoid fever from viral hepatitis. These include a history of traveling abroad, symptoms of diarrhea, vital signs including continual high-grade fever and relative bradycardia, and a hematologically left shift of leukocytes, with eosinopenia. Biochemically, the peak levels of serum AST and ALT are lower in patients with typhoid fever than in those with viral hepatitis, and AST levels are higher than ALT levels in most patients with typhoid fever. Usually, LDH and ALP levels are relatively higher than those of AST and ALT in patients with typhoid fever. The histopathological findings show hyperplasia of Kupffer cells, inflammation of portal zones, and focal necrosis within the parenchyma, known as a "typhoid nodule". Diagnosis is established with positive blood or stool cultures for Salmonella typhi/Salmonella paratyphi A. |