Korean J Hepatol > Volume 6(3); 2000 > Article
The Korean Journal of Hepatology 2000;6(3): 350-359.
원저 : Salonela typhi 에 의한 급성 간염으 임상적 고찰 ( Clinical Study of the Acute Hepatitis due to Salmonella typhi )
Clinical Study of the Acute Hepatitis due to Salmonella typhi
Sang Woo Lee,Seung Won Seo,Heyng Woong Yang,Jae Kyu Seong,Seung Min Lee,Byung Seok Lee,Nam Jae Kim,Heon Young Lee
Department of Internal medicine, Chung-Nam National University College of Medicine, Taejeon, Korea.
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 aminotrans ferase 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. Conclus ion: The clues that raise the poss ibility 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 diagnos is and appropriate administration of antibiotics are necessary for the successful treatment of Salmonella.
KeyWords: Hepatitis / Salmonella hepatitis , Acute viral hepatitis B

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