• Vol. 41 No. 7, 281–286
  • 15 July 2012

Computed Tomography Features in Enteric Fever

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ABSTRACT

Introduction: Enteric fever is a common infection in endemic areas; however, there are few reports describing the computed tomography (CT) manifestations of enteric fever. We aim to describe and illustrate CT findings in enteric fever in this study.

Materials and Methods: A retrospective search of medical records in our institute for patients with positive blood cultures for Salmonella typhi, and Salmonella paratyphi organisms yielded 39 cases. Among these patients, 12 had undergone a CT study of the abdomen. The CT images, laboratory and clinical findings of these 12 patients were reviewed.

Results: The most common clinical presentation was fever (100%). Typical features of gastroenteritis were present in only over half of the patients. Liver function tests were abnormal in all patients. The most common abdominal manifestations on CT were the presence of mesenteric lymphadenopathy and splenomegaly (75%). Other features were circumferential small bowel wall thickening (58.3%) and free intraperitoneal fluid (50%). Three patients were found to have complications; one with bleeding from terminal ileal ulceration, another with an ileal perforation and the third with renal abscess formation.

Conclusion: CT is useful in evaluating enteric fever in patients with severe forms of presentation, a longer clinical course or less specific symptoms. Although the imaging features overlap with other abdominal infections, when combined with clinical features, travel history to endemic areas and presence of transaminitis, the diagnosis of enteric fever should be considered. CT in particular, is useful for the detection of complications such as perforation, bleeding and abscess formation.


Enteric fever is a potentially fatal multi-systemic febrile disease caused by Salmonella.  Salmonella are gram-negative, rod-shaped facultative intracellular anaerobic bacteria with more than 2500 serotypes that cause a broad spectrum of clinical manifestations. Clinically, Salmonella can be divided into 2 distinct categories. The first group being the non-typhoidal species that cause a majority of salmonella infections (non-typhoidal salmonellosis) with S. enteritidis and S. typhimurium being the most frequently isolated serotypes. The second group is the typhoidal species including S. Typhi and S. Paratyphi serotypes A, B and C responsible for enteric fever (also known as typhoid fever). In contrast to the non-typhoidal species, the typhoidal species are restricted only to human hosts.5 Worldwide, there are an estimated 22 million cases of enteric fever with the highest incidence in Asia. A high incidence of enteric fever correlates with poor sanitation and lack of access to clean drinking water. However, increasing global travel and movement of population has increased the risk of Salmonella infections, in addition to food contamination.

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