Clinical Study of the Acute Hepatitis due to Salmonella typhi

Lee, Sang Woo; Seo, Seung Won; Yang, Heyng Woong; Seong, Jae Kyu; Lee, Seung Min; Lee, Byung Seok; Kim, Nam Jae; Lee, Heon Young

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 aminotransferase 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.
CONCLUSION
The clues that raise the possibility 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 diagnosis and appropriate administration of antibiotics are necessary for the successful treatment of Salmonella.