| Background: Typhoid fever, a food-borne disease caused by salmonella
species, is a worldwide prevalent disease. In endemic areas, children are at
highest risk owing to weaning from passively acquired maternal antibody
and lack of acquired immunity. Several studies have been done to clarify the
pathogenesis and underlying immune aspects of typhoid fever. Objective:
Study the changes of some proinflammatory cytokines in plasma of children
with typhoid fever. Study design: Thirty consecutive children admitted to
Zagazig Fever Hospital with proven diagnosis of typhoid fever were
included in the study. They were 20 males and 10 females, of ages ranging
from 3 to 13 years. In addition, 10 age and sex matched healthy children
served as a control group. A verbal consent was obtained from parent(s) of
each child before inclusion to the study. All children were subjected to
history taking, clinical examination, and routine investigations (CBC, ESR,
CRP, Widal test and stool culture), as well as determination of serum
interleukin-6 (IL-6) and tumor necrosis factor receptor-1 (TNF-R1), before
and 5 days after start of treatment (for patients). Results: Twenty patients
(66.7%) were responsive to therapy and 10 patients (33.3%) were resistant.
Toxic look, constipation, high fever, splenomegaly, increased CRP and ESR
were significantly presented in patients who displayed resistance to drug
therapy. Both IL-6 and TNF-R1 plasma levels were significantly higher in
patients than in control children, and in resistant cases than in responsive
cases (before and 5 days after treatment). ESR and S. typhi H agglutination
titre correlated significantly with plasma levels of IL-6 and TNF-R1,
whereas S. typhi O agglutination titre and total leucocytic count did not.
Conclusion: patients with typhoid fever resistant to combined therapy with
chloramphenicol and co-trimoxazole have higher plasma levels of IL-6 and
TNF-R1. Toxic look, constipation and splenomegaly may be considered as
indicators of drug resistance. |