Scientific Publications
Quantitative bacterial counts in the bone marrow of Vietnamese patients with typhoid fever
Transactions of The Royal Society of Tropical Medicine and Hygiene,, 1-9
Background
Bone marrow culture (BMC) is the reference standard for typhoid fever diagnosis. We studied the additional yield of BMC over blood culture (BC) and the relationship between quantitative BMC counts and severe disease.
Methods
Hospitalised Vietnamese patients with suspected typhoid fever were prospectively investigated with a BC, BMC, faecal culture and quantitative BMC counts.
Results
Salmonella typhi was isolated in 195 of 231 patients: from BC and BMC in 144 (73.8%), from BMC alone in 33 (16.9%), from BC alone in 12 (6.2%) and from faeces alone in 6 (3.1%). In 167 patients the median extracellular count of S. typhi was 2.5 cfu/mL (interquartile range [IQR] 010) and the intracellular count was 10.5 cfu/mL (IQR 242) with a ratio of 1.3 bacteria/cell (IQR 0.62.5). The median count of intracellular bacteria in 24 patients with severe disease was 46 bacteria/cell (IQR 9105) compared with 6.5 bacteria/cell (IQR 234) in 143 with non-severe disease (p=0.005). The intracellular BMC count was negatively correlated with the peripheral white cell count and positively correlated with hepatomegaly, splenomegaly, aspartate transaminase, a positive BC and the fever clearance time following treatment with azithromycin, ofloxacin or a combination of the two.
Conclusions
BMC gave a moderate additional yield over BC. Intracellular BMC counts may reflect the bacterial load in typhoid fever.
Transactions of The Royal Society of Tropical Medicine and Hygiene,, 1-9
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