Diagnostic and differential diagnostic value of clinical and laboratory findings in enteric fever

ABSTRACTDIAGNOSTIC AND DIFFERENTIAL DIAGNOSTIC VALUE OFCLINICAL AND LABORATORY FINDINGS IN ENTERIC FEVERDr. Ceren KUVANDIKResidency ThesisInfectious Disesase and Clinical BacteriologySupervisor: Assoc. Prof. Dr. Mustafa NAMIDURUNovember 2006, 65 pagesEnteric fever is an important health problem for our country and region. Inthis study, diagnostic and differential diagnostic value of physical examinationand laboratory findings of enteric fever were investigated in which earlydiagnosis and treatment is important in order to prevent the possiblecomplications, to decrease the treatment cost and hospitalization period. In thisretrospective study that we made, 60 cases of enteric fever in which pathogenwere isolated in blood cultures which were treated in Infectious Disease andClinical Microbiology Department of Gaziantep University Faculty of Medicineand as a control group 58 patients who were not diagnosed as enteric feverwere taken for data analysis.Parametric data of case and control group were compared with Student?st-test analysis, nonparametric data were compared with chi-square test.Findings of physical examination like hepatomegaly (p=0.032), splenomegaly(p=0.005), fever-pulse discordance (p=0.001), roseols (p=0.022), rusty tongue (p=0.036) andincrease in `O? aglutination (p<0.001) and AST value (p=0.034), laboratory findings likeabsence of leucocytosis (p<0.001), trombocytopenia (p<0.001), eosinopenia (p=0.001),were compared with control group and the difference were statisticallysignificant. Hepatomegaly (p=0.000), splenomegaly (p=0.002), rusty tongue (p=0.003),fever pulse discordance (p=0.000), leucocyte count (p=0.000) and % eosinophils(p=0.030) value, by using logistic regression analysis were found as independentrisk factors to diagnose enteric fever. These independent risk factors increasedthe possibility of diagnosis of enteric fever in a patient with fever; 6.3 times withhepatomegaly, 4.5 times with splenomegaly, 3.7 times with rusty tongue, 10.2times with fever pulse discordance, 0.7 times with leucocyte count lower than4300 /mm3, 0.6 times with eosinophil count lower than 1%.The diagnostic valueof findings which were found as significant by using multilogistic regressionanalysis were investigated if all of them were present in one case. According toresults of statisitical analysis in a patient in physical examination ifsplenomegaly, roseol, pulse fever discordance were present, in Gruber-Widalaglutination test 1/200 `O? aglutination positivity and leucocyte count lower than4300 mm3 led to 55.8% possibility of enteric fever and 14.3 % possibility ofmisdiagnosis.Consequently diagnosis of enteric fever is possible with determination offrequently observed physical examination and laboratory findings whereas thisdiagnosing procedure is not sensitive and specific unlike isolation andidentification from culture.Key Words: Enteric fever, Diagnosis methods, Clinical signs, Laboratuaryfindings.