| 원저 : Salonela typhi 에 의한 급성 간염으 임상적 고찰 ( Clinical Study of the Acute Hepatitis due to Salmonella typhi ) |
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| 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. |
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| ABSTRACT |
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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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