Laboratory findings can provide an early diagnosis of coexistent rheumatic heart disease and typhoid. A boy 12 years of age was hospitalized because penicillin and sulfonamide compounds failed to control a week-long episode of fever, chills, headache, nausea, and nonproductive cough. He had had rheumatic heart disease (with aortic stenosis and mitral insufficiency) four years before the admission; at the time of admission he had a fever and slow pulse rate. The cardiac state was unchanged as compared to previous examination. Absence of anemia and absence of elevated sedimentation rate and leukocyte count cast doubt on presence of either active rheumatic fover or subacute bacterial endocarditis. A gram-negative bacillus was found in the blood culture. The agglutination reaction was positive for typhoid O agglutinins. The patient was treated for and cured typhoid with a total of 33.5 Gm. of chloramphenicol over a period of 18 days. No sequelae developed within the subsequent four years.
Sobol H. RHEUMATIC ENDOCARDITIS COMPLICATED BY TYPHOID. JAMA. 1959;169(17):1998–2000. doi:10.1001/jama.1959.03000340030008
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