Study on ultrasound observations in children with typhoid fever in a tertiary care hospital

Zubair Ahamed Md., Gangadhar B. Belavadi


Background: Enteric fever continues to be endemic in poor countries globally, although it has been eradicated from the developed nations due to their well-organized sanitation and protected water supply. The five Fs most concerned with spread of typhoid disease are fingers, food, fomites, flies, and feces. Enteric fever is predominantly caused by Salmonella typhi and next in frequency is Salmonella paratyphi. Very less literature is available on radiological manifestations of typhoid fever in children on the basis of age difference in India. Hence, a study was conducted to observe the radiological findings and to correlate with laboratory manifestations in typhoid fever. Objectives of the study was to observe the ultrasound abdomen changes in Typhoid fever at rural area.

Methods: The current study was conducted at Department of pediatrics of Narayana Medical College Hospital, Nellore, Andhra Pradesh state in a period of one year. All patients presenting with fever having positive for Widal test were included. In total 50 patients were included and divided into 2 age groups, <5 years and >5years. The laboratory results and abdominal ultrasound were conducted in the two groups and compared.

Results: Total 20 patients in <5 years age and 30 patients in >5 years were enrolled. Male to female ratio was 2:1 in both groups. Common laboratory findings showed 32 patients (64%) with Anemia, elevated liver enzymes in 40 patients (80%), and elevated ESR in 42 patients (84%). 45 patients have Splenomegaly and hepatomegaly with normal parenchymal echotexture. Gallbladder sludge and biliary sludge was seen in 6 patients. Thickened gall bladder in 34 patients (68%) was observed. Bowel wall thickening seen in 32 patients (64%). mesenteric lymphadenopathy in 36 patients (68%) observed. All were recovered by treatment.

Conclusions: On ultrasound, splenomegaly, hepatomegaly, and thick-walled gallbladder were observed in most of the childrens with typhoid fever. Therefore, ultrasound can also be used as supportive diagnose along with laboratory parameters due to it is a non-invasive and economical tool of diagnosing typhoid.


Anemia, Splenomegaly, Typhoid fever, Ultrasound

Full Text:



Gupta A. Multi drug resistant typhoid fever in children: epidiomology and therapeutic approach. Pediatr Infect Dis J. 1994;13:134-40.

Stormaon MO, McIntyre PB, Morris J, Fasher B. Typhoid fever in children: diagnosis and therapeutic difficulties. Pediatr Infect Dis J. 1997;16:713-14.

Crump JA, Luby SP, Mintz ED. The global burden of typhoid fever. Bull World Health Org. 2004;82:346-53.

Typhoid fever (fact sheet N149) Geneva: World Health Organisation; 1997.

Koul PB, Murali MV, Sharma PP, Ghai OP, Ramchandran VG, Talwar V. Multi drug resistant Salmonella typhi infection: clinical profile and therapy. Indian Pediatr. 1991 Apr;28(4):357-61.

Mishra S, Patwari AK, Anand VK, Pillai PK, Aneja S, Chandra J, et al. A clinical profile of multidrug resistant typhoid fever. Indian Pediatr. 1991 Oct;28(10):1171-4.

Weinstein DL, O’Neill BL, Hone DM, Metcalf ES. Differential early interactions between Salmonella enterica serovar Typhi and two other pathogenic Salmonella serovars with intestinal epithelial cells. Infect Immun. 1998;66:2310-8.

Merrell DS, Falkow S. Frontal and stealth attack strategies in microbial pathogenesis. Nature. 2004;430:250-6.

Puylaert JBCM, Kristjánsdóttir S, Golterman KL, de Jong GM, Knecht NM. Typhoid fever: diagnosis by using sonography. Am J Roentgenol. 1989;153:745-6.

Mateen MA, Saleem S, Rao PC, Reddy PS, Reddy DN. Ultrasound in the diagnosis of typhoid fever. Indian J Pediatr. 2006;73:681-5.

Voedisch S, Koenecke C, David S. Mesenteric lymph nodes confine dendritic cell-mediated dissemination of Salmonella enterica serovar Typhimurium and limit systemic disease in mice. Infect Immun. 2009;77:3170-80.

Arora R, Gupta A, Joshi N, Kataria V, Lall P, Anand A. Multidrug resistant typhoid fever: study of an outbreak in Calcutta. Cough. 1992;39:37-8.

Arif N, Khan AA, Iqbal Z. Hepatic involvement with typhoid fever: A report of nine paitents. J Pak Med Assoc. 1990;40:4-9.

Calva JJ, Palacios GR. Salmonella hepatitis: Detection of Salmonella antigens in the liver of patients with typhoid fever. J Infect Dis. 1986;154:373-4.

Khosla SN, Singh R, Singh GP, Trehan VK. The spectrum of hepatic injury in enteric fever. Am J Gastroenterol. 1988;4:413-6.

Tomaraei SN, Singhi S. Hepatobiliary complications of enteric fever. Indian Peadr. 1993;30:721-4.

Morgenstern R, Hayes PC. The liver in typhoid: Always affected, not just a complication. Am J Gastroentrol. 1991;86:12335-9.

Giltin N. Bacterial and systemic infections. In: Schiff’s editor. Disease of the liver. 8th edition. Lippincott William and Wilkin; 1999:1549-1558.

Yaramis A, Yildirim I, Katar S, Ozbek MN, Yalcin I, Tas MA, et al. Clinical and laboratory presentation of typhoid fever. Inter Pediatr. 2001;16(4):227-31.

Rasoolinejad M, Esmailpoor NB, Mogbel BA. Salmonella Hepatitis (analysis of hepatic involvement in 107 patients with typhoid fever). Acta Medica Iranica. 2003;4:161-3.

Mirsadraee M, Shirdel A, Roknee F. Typhoid myopathi or typhoid hepatitis: A matter of debate. Ind J Med Microb. 2007;25:351-3.

Bhutta ZA. Current concepts in the diagnosis and treatment of typhoid fever. BMJ. 2006;333:78-82.

Malik AS. Complication of bacteriologically confirmed Typhoid fever in children. J Trop Ped. 2002;48:102-8.