A study of the Biochemical and Haematological parameters in Patients of Typhoid Fever

Many studies have indicated several biochemical and/ or haematological parameters that are involved in developing the risk of typhoid fever such as hepatic dysfunction, central nervous system complications, cardiovascular complications, leucopenia and neutrophils leukocytosis. The aim of this study was to evaluate the relation between biochemical and haematological parameters. Total 47 subjects were studied, 19 healthy individuals and 28 typhoid patients (aged 15-60 years old). Levels of Monocyte, Lymphocytes, total White Blood Cells (WBC), Haemoglobin concentration (Hb), Packed Cell Volume (PCV), Platelet count (PLT), Red Blood Cells (RBC), Uric acid, total Serum Bilirubin (TSB) , Blood Urea (B.Urea) and serum enzyme activity: Aspartate transaminase (AST), Alanine transaminase (ALT), Alkaline phosphatase (ALP) and Creatine Kinase (CK). Results showed that ALT, AST, ALP, TSB, S.Uric acid, B.Urea and RBC were higher in patients compared with control while CK, Hb, PCV, WBC, Monocyte, Lymphocyte and PLT were lower in patients compared with control. Conclusion: correlation between haematological and biochemical parameters could be afford and thereby serves as indications for more reliable and diagnosis aid of the infection with typhoid fever which could changes the necessary antibiotic therapy .


Introduction
Typhoid fever is widely recognized as a major public health problem in developing countries.
Incidence of typhoid fever has been established as approximately as 22 million cases with at least 200,000 death occurring annually [1][2][3].Typhoid fever is caused by Salmonella Enteric a Serovar Typhi, a gram-negative bacterium [4].The organism is transmitted by the fecal-oral route; thus the disease is often associated with poor sanitation and hygiene [3,5].Typhoid fever manifests with fever, headache, abdominal pain, gastrointestinal symptom like anorexia, nausea, vomiting, constipation.The common sings like abdominal tenderness may develop [6].
Both clinical entities, myopathy and hepatitis are usually diagnosed by serum enzymes such as Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), alkaline phosphatase (ALP) and Creatine phosphokinase (CK).AST is elevated in myopathy as well as hepatitis, whereas ALT and CK are relatively specific for liver and muscle respectively [7].It is generally accepted that typhoid fever are associated with leucopenia and this is servers as a diagnostic aid [8], the total white blood cell is low and anemia may be involved [9].It has been stated that neutrophils leukocytosis is a feature of complicated typhoid fever and that lymphopenia is associated with typhoid because of typhoid fever, specific mediators released by cells which act on bone marrow to increase proliferation of neutrophils [10].Tissue invasion by microorganism is accompanied by substantial stimulation of neutrophils grounopoesis which account for increase in neutrophils counts in the blood [11].The aim of the present study was to establish a correlation between hematological parameters and serum enzymes levels in typhoid fever.

Materials and Methods
A total of 28 blood samples were collected from patients aged between 15 to 60 years old with a clinical approved of typhoid fever by physicians in Central Tikrit Hospital , sample collocated in the period from march till September 2014 and 19 apparently healthy control individuals.
Blood samples were collected from patients with a clinical suspicion of typhoid fever and screened for the presence of S.typhi infection in Widal test [12].The blood sample was drained on the first day of management at the same time with blood culture sample collection.The

Statistical analysis:
All values were expressed as the Mean ±SD .Data were analyzed using Minitab program vr14 with t-test for comparison of variable.A probability value of p<0.05 was considered to be statically significant.

Results and Discussion
Alteration in some biochemical and in hematological parameters have been investigated and reported in typhoid fever infection [9][10][11][12][13][14][15][16][17][18][19].It is necessary to include hematological and biochemical investigation in the diagnosis of typhoid infection so as to detect early complication associated with acute typhoid infection.This helps to intensively care for the patient and prevent death that may results from such complications.This study examined the effect of typhoid fever on some biochemical and hematological indices.Table (1) shows that significantly high (p ≤ 0.001) in the level of ALT of patients (12.32±1.42U/L)compared with control (6.68±2.87U/L)and in the level of AST for patients (14.91±2.21U/L)compared with control (6±1.15U/L).No significant increase (p > 0.001) was observed in the levels of ALP in patients (47.0±11.0Mmol/L)compared with control (45.6±10.1Mmol/L).Many organs other than gastrointestinal tract may be involved in typhoid fever.Hepatic involvement is one of the earliest reported complications of typhoid fever [14] , hepatic dysfunction detected by clinical and/or biochemical parameters was noticed in as many 64% of typhoid fever cases.Liver enzymes ALT, AST and ALP were used for evaluation of hepatic involvement during typhoid fever [20], the frequency of elevated serum enzyme was 52%, 100% and 22% [21] respectively.
The level of CK for patients (83.0±23.1Mmol/L)compared with control (84.3±18Mmol/L) indicates no significant increase.The incidence of cardiac involvement in typhoid is variable [21][22], Myopathy can cause severe myoglobinuria and elevated CK was found in 60% of typhoid fever patients [21].
Table (1)   Table (2) shows strong correlation in patients between Monocytes and Uric acid (-0.458),PLT and CK, ALT (0.230, 0.452) respectively, RBC and WBC (-0.022) , Uric acid and ALP, AST (-0.095, -0.110) respectively, Uric acid and ALP, ALT (-0.095, -0.110) respectively, B. Urea and CK ( -0.069), finally between ALP and AST (-0.064) compared with control.In conclusion typhoid fever is associated with many complications such as intestinal profanation, paralytic ileus, hepatitis, cholecystitis and peritonitis.Central nervous system complications described are encephalopathy, meningitis, chorea, intracranial hemorrhage, acute renal failure and glomerulonephritis.Cardiovascular complications include myocarditis and peripheral circulatory failure.Hematological complication include disseminated intravascular coagulation and bone marrow suppression [4].As a result of these complication, Hematological subcutaneous abscess, subphrenic abscess and cutaneous ulcers and biochemical parameters could be afford correlation and thereby serves as indications for more reliable and diagnosis aid of the infection which could changes the necessary antibiotic therapy [9].