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Njarekkattuvalappil SK, Thomas M, Kapil A, Saigal K, Ray P, Anandan S, Nagaraj S, Shastri J, Perumal SPB, Jinka DR, Thankaraj S, Ismavel V, Zachariah P, Singh A, Gupta M, Ebenezer SE, Thomas MS, Ghosh D, Kataria K, Senger M, Balasubramanian S, Kang G, John J. Ileal Perforation and Enteric Fever: Implications for Burden of Disease Estimation. J Infect Dis 2021; 224:S522-S528. [PMID: 35238354 PMCID: PMC8914860 DOI: 10.1093/infdis/jiab258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Ileal perforation occurs in about 1% of enteric fevers as a complication, with a case fatality risk (CFR) of 20%–30% in the early 1990s that decreased to 15.4% in 2011 in South East Asia. We report nontraumatic ileal perforations and its associated CFR from a 2-year prospective enteric fever surveillance across India.
Methods
The Surveillance for Enteric Fever in India (SEFI) project established a multitiered surveillance system for enteric fever between December 2017 and March 2020. Nontraumatic ileal perforations were surveilled at 8 tertiary care and 6 secondary care hospitals and classified according to etiology.
Results
Of the 158 nontraumatic ileal perforation cases identified,126 were consented and enrolled. Enteric fever (34.7%), tuberculosis (19.0%), malignancy (5.8%), and perforation of Meckel diverticulum (4.9%) were the common etiology. In those with enteric fever ileal perforation, the CFR was 7.1%.
Conclusions
Enteric fever remains the most common cause of nontraumatic ileal perforation in India, followed by tuberculosis. Better modalities of establishing etiology are required to classify the illness, and frame management guidelines and preventive measures. CFR data are critical for comprehensive disease burden estimation and policymaking.
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Affiliation(s)
| | - Maria Thomas
- Christian Medical College and Hospital, Ludhiana, India
| | - Arti Kapil
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Pallab Ray
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Jayanthi Shastri
- Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, India
| | | | | | - Shajin Thankaraj
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Assam, India
| | - Vijayanand Ismavel
- Makunda Christian Leprosy and General Hospital, Bazaricherra, Assam, India
| | | | - Ashita Singh
- Chinchpada Christian Hospital, Maharashtra, India
| | - Madhu Gupta
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Dhruva Ghosh
- Christian Medical College and Hospital, Ludhiana, India
| | - Kamal Kataria
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Jacob John
- Christian Medical College, Vellore, India
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Dudaka A, Sundaramurthi S, Vijayakumar C, Elamurugan TP, Jagdish S. Coinfection of Typhoid Fever With Tuberculosis: A Challenge to Surgical Management. Cureus 2020; 12:e8540. [PMID: 32670677 PMCID: PMC7357349 DOI: 10.7759/cureus.8540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Ileal perforation is one of the most dreaded complications of abdominal tuberculosis. It is more common in immunodeficient patients, where ulcerative type of intestinal tuberculosis predominates. Various factors play role in the outcome of these patients, such as age and comorbid illness, though the lag period (advent of symptoms to time of admission to hospital) correlated directly to the mortality in these patients. Herein we present a 28-year-old male who had a coinfection of typhoid fever along with intestinal tuberculosis. The patient presented with abdominal pain and fever for one-week duration. On examination, he had diffuse tenderness of his abdomen with guarding. X-ray revealed free air under diaphragm. The patient underwent limited resection of terminal ileum and cecum with end ileostomy for ileal perforation. The patient’s serum Widal test was positive and blood culture grew Salmonella Typhi, and the patient was started on intravenous (IV) antibiotics based on culture and sensitivity. The patient’s general condition worsened after two weeks with bile leak from the surgical site. The patient succumbed to severe sepsis. Postoperative histopathology of the resected ileo-cecal segment showed features of ileo-cecal tuberculosis. As typhoid is a common cause of ileal perforation in the developing countries, the co-existence of typhoid fever in this patient lead to the delay in the diagnosis and appropriate management of tubercular ileal perforation. Knowledge about various causes of typhoid perforation is essential for treating surgeons.
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Affiliation(s)
- Anusha Dudaka
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | | | - Chellappa Vijayakumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - T P Elamurugan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
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