Clinical Study of the Acute Hepatitis due to Salmonella typhi.
- Author:
Sang Woo LEE
1
;
Seung Won SEO
;
Heyng Woong YANG
;
Jae Kyu SEONG
;
Seung Min LEE
;
Byung Seok LEE
;
Nam Jae KIM
;
Heon Young LEE
Author Information
1. Department of Internal medicine, Chung-Nam National University College of Medicine, Taejeon, Korea. leehy@hanbat.chungnam.ac.kr
- Publication Type:Original Article
- Keywords:
Hepatitis/Salmonella hepatitis;
Acute viral hepatitis B
- MeSH:
Anemia;
Anti-Bacterial Agents;
Bilirubin;
Bradycardia;
Cholecystitis, Acute;
Cholecystostomy;
Diarrhea;
Early Diagnosis;
Fever;
Headache;
Hepatitis*;
Hepatomegaly;
Humans;
Hypoalbuminemia;
Hypoproteinemia;
Jaundice;
Leukocytes;
Retrospective Studies;
Salmonella typhi*;
Salmonella*;
Thrombocytopenia
- From:The Korean Journal of Hepatology
2000;6(3):350-359
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND/AIM: It is not easy to differentiate Salmonella from acute viral hepatitis (AVH), especially in the case of jaundice. Therefore we analyzed the differences between Salmonella hepatitis and AVH-B. METHOD: Our study was performed retrospectively on 11 patients with acute hepatitis who had positive blood culture for Salmonella typhi and 11 patients with AVH-B as controls. RESULT: The greater proportion of patients with Salmonella experienced fever, headache, diarrhea, relative bradycardia and hepatomegaly in contrast to the patients with AVH-B (p<0.05). But jaundice was detected more frequently in patients with AVH-B. The laboratory findings that were noted more in Salmonella patients than AVH-B patients were: left shift of leukocyte, anemia, thrombocytopenia, hypoproteinemia, hypoalbuminemia, lower peak levels of aminotransferase and total bilirubin, a trend toward a higher peak level of serum LDH and lower ratio of ALT/LDH expressed as a multiple of the upper limit of normal level on admission (p<0.05). Acute cholecystitis was complicated in 2 patients with Salmonella. One was resolved by cholecystostomy and the other had surgical intervention. The other 9 patients recovered with appropriate administration of antibiotics. CONCLUSION: The clues that raise the possibility of Salmonella over AVH-B include: high fever, headache, diarrhea, relative bradycardia, hepatmegaly, left shift of leukocyte, anemia, thrombocytopenia, hypoproteinemia, hypoalbuminemia, a markedly elevated serum level of LDH and lower ALT/LDH ratio (less than 4) on admission. Of these, ALT/LDH ratio is the best discriminator between Salmonella and AVH-B. Early diagnosis and appropriate administration of antibiotics are necessary for the successful treatment of Salmonella.
