(microscopy, culture and guaiac test), serum biochemical analyses, including urea, ... treatment, convalescent stool and urine samples were cultured daily for 3 ...
Chapter 8
Risk Factors Predicting Complication in Blood Culture-proven Typhoid Fever in Adults
Mohammad Khan 1, Yacoob Coovadia 1, Catherine Conolly,
2
and Adriaan Willem
Sturm 1
1
Department of Medical Microbiology, University of Natal Medical School and the 2
Medical Research Council, Durban, South Africa
Scandinavian Journal of Infectious Diseases 2000; 32:201-205.
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To create a prognostic model for complication of blood culture - proven typhoid fever in adults (≥ 15 years old), a retrospective cohort was assembled through review of the medical records of the hospitalized patients treated for typhoid fever over a 3-year period ending January 1995. Of the 59 patients included, 21 (35.6%) developed various complications of typhoid fever. No patient included died. Four baseline variables (abdominal pain, systolic blood pressure 17µmol/l (normal = 0- 17 µ mol/l) 4 0 3.2 2.2-4.8 0.01 ESR (Westergren) >20 mm/h (normal = 0-20 mm/h) 6 8 1.3 0.6-2.7 0.54 Positive guaiac test in stool 8 0 3.9 2.4-6.3 0.0001 Serum creatinine >115µmol/ld (normal =53-115 µmol/l) 3 0 3.1 2.1-4.6 0.04 Treatment with ampicillin 12 26 0.7 0.4-1.5 0.56 Treatment with chloramphenicol 9 12 1.4 0.7-2.7 0.56 Total 21(100) 38(100) a b All known at the time of admission. RR = relative risk. See text for definition. cIn peripheral blood.d Associated with proteinuria , 1+ to 2+ by dipstix ( normal = trace), urinary sedimentation with red blood cell casts, 2-3 /low power field (normal = 0/ low power field) and granular casts, 2-4/high power field(normal=occasional).
Table 3. Prognostic staging system Prognostic Admission Patients(n) stage predictor variables(n)a I(Low) II (Intermediate) III (High)
0 1 ≥2
25 21 13
Predicted probability of complication, (95% CI) b 0.02(0.002-0.15) 0.38(0.22-0.58) 0.95(0.69-0.99)
Patients with complications n(%) 0(0.0) 9(42.9) 12(92.3)
a
Abdominal pain, systolic blood pressure 160 IU/l (normal = 10 - 42 IU/l), and γ-GT level of >80 IU/ (normal = 7 - 64 IU/l).
No other patient included had clinical jaundice and combination of biochemical
abnormalities as noted in patients with TH. At laparotomy, multiple bleeding sites involving terminal ileum were seen in both patients with brisk intestinal bleeding. No patient with acute oliguric renal failure had diarrhoea (i.e. ≥3 liquid stools/day) vomiting, or a systolic blood pressure < 100 mm Hg. Myositis, which involved both thighs, was associated with a serum AST and CPK level of ≥ 320 IU/l and ≥900 IU/l (normal = 22 - 269 IU/l), respectively. No patient had shock (10), myoglobinuria (11), or clinical relapse (12) as described previously. Risk factors of complication are summarized in Table 2. In a logistic model, abdominal pain (odds ratio, 47.5; 95% CI, 3.8 -591.2; P = 0.003), systolic blood pressure
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< 100 mm Hg (odds ratio, 45.8; 95% CI, 3.4 - 616.0; p = 0.004), hypoalbuminaemia
