Parasitic infections presenting as prolonged fevers

Over 2 successive years, out of 187 cases of fevers of undetermined origin [FUO], 30 [16%] cases proved to be of parasitic origin. 10 within normal subjects were taken as controls. Complete blood picture, repeated stool examination, rectal snip by transparency technique, ELISA for specific IgM antibodies for S. mansoni, indirect hemagglutination test for S. mansoni, Fasciola, hydatid, amoebic liver abscess and toxoplasmosis, indirect fluorescent antibody test for toxoplasmosis and abdominal ultrasonography were performed whenever indicated. Cases comprised 8 [26%] acute S. mansoni, 7 [24%] acute fascioliasis, 3 [10%] hydatid cyst, 8 [26%] amoebic liver abscess, 2 [7%] toxoplasmosis and 2 [7%] malaria cases. The clinical picture of acute S. mansoni and acute fascioliasis were similar in the form of prolonged fever, diarrhea, hepatomegaly and leucocytosis with high eosinophilia. Serology [ELISA and IHAT] was essential in differentiating them. Abdominal ultrasonography is an easy, sensitive cheap, noninvasive technique aiding in the diagnosis of amoebic liver abscess, liver hydatid cysts and fascioliasis, but serology was essential in their differentiation

Fatal complications of acute enteric fevers

Eighty eight patients presenting with fatal typhoid complications were studied in Abbassia and Embaba fever hospitals during a 4 years period [1987 - 1991]. Criterion of inclusion in the study was either positive. blood culture in 70 [80%] cases or postmortem gross appearance of typhoid fever in 18 [20%] cases. Positive blood culture cases included 54 [77%] S. typhi and 16 [23%] S. paratyphi A. Seven [10%] cases were resistant in vitro to chloramphenicol. Postmortem examination performed in 18 [20%].cases revealed typical typhoid ulcers in ileum, jejunum and large intestine. The main clinical picture of 31 toxic, 22 encephalitic or meningeal irritating, 15 gastroenteritic, 9 pneumonic, 8 perforated and 3 haemorrhagic enteric fever cases were discussed. The tetrad of fever, toxic look, bronchitic Chest, tumid tympanitic abdomen and splenomegaly was a good sign for suggestion of typhoid diagnosis

Rapid diagnosis of non-prolonged febrile illnesses necessitating fever hospital admission

Two hundred and seventy patients were studied during a 2 years period in Abbassia and Embaba fever hospitals. The duration of illness before admission was less than 20 days. Suggestive clinical symptoms and/or signs of each disease were stressed. Rapid laboratory investigations include slide typhoid agglutination test [98%] in enteric fevers, slide malta agglutination test [86%] in brucellosis, urine culture [100%] in urinary tract infection, gram stain of C.S.F. in bacterial meningitis [80%], encephalitis [0%] and meningeal irritation [0%], high vaginal swab culture [100%] in puerperal fevers, echocardiogram [100%] in infective endocarditis, high E.S.R. [100%] and positive C.R.P [71%] and/or high A.S.O [86%] in rheumatic fever, counterimmunoelectrophoresis [86%] in amoebic liver abscess, chest X-ray in pneumonia [100%], pulmonary tuberculosis [100%] and pleural effusion [100%], ultrasound of lymph nodes [100%] in tuberculous. lymphadenitis. Erysipelas and tetanus were diagnosed on clinical grounds only

Acute enteric fever presenting as acute viral hepatitis

Fifteen cases of acute enteric fever presenting by jaundice and 10 acute enteric fever cases as controls were studied. Careful history,thorough clinical examination, complete blood picture, blood culture, widal agglutination test and liver function tests were performed for cases and controls. There was a significant increase in the incidence of nausea and/or vomiting, yellow sclerotics, dark colouration of urine and hepatomegaly in cases when compared to controls, The duration of fever in the cases after the appearance of interus ranged from 5-7 [mean 5.87 +/- 0.83] days. Serum bilirubin ranged between 2-4 [mean 2.97 +/- 0.67] rag% and serum glutamic pyruvic transaminase ranged between 32-50 [mean 40.33 +/- 6.04] iu. It is concluded from this study that one of the changing pattern of acute enteric fever is its presentation with jaundice. Differentiation from acute viral hepatitis is discussed