Intestinal perforation resulting from typhoid VRT752271 clinical trial fever has been reported to be more prevalent in people with low socio-economic status [15]. This observation is reflected in our study where most of patients had either primary or no formal education and more than

eighty percent of them were unemployed. The majority of patients in the present study came from the rural areas located a considerable distance from Mwanza City and more than three CYT387 in vivo quarter of them had no identifiable health insurance. Similar observation was reported by others [15, 37]. This observation has an implication on accessibility to health care facilities and awareness of the disease. The clinical presentation of typhoid intestinal perforation in our patients is not different from those in other geographical areas [6, 15, 26, 27, 38] with fever and abdominal pain being common to all the patients. In our study, perforation occurred early in the course of the disease and this has been recognized by others [28, 29, 31, 36]. Patients who perforate during the first two weeks of the illness appear to have a better prognosis [36]. It has been observed that compromised nutritional status could possibly play a role in the poor prognosis

of the patient who has been ill for more than 2 weeks and then develops a perforation [39], but this observation is yet to be proved. Typhoid intestinal perforation generally WZB117 ic50 occurs in 2nd to 3 rd week of illness, this is because of mechanism of perforation in Peyer’s patches of terminal ileum [12] but in developing countries cases are reported early within first week of illness [30], reason behind this observation is not clear but it is speculated to be due to low immune power, change

in virulence of bacteria, hypersensitivity to Peyer’s patches and ileal contents of bacteria. This observation is reflected in our study where more than fifty percent of patients developed perforation within 1-2 weeks of the illness. The mechanism Erastin of intestinal perforation in typhoid fever is hyperplasia and necrosis of Peyer’s patches of the terminal ileum. The lymphoid aggregates of Peyer’s patches extend from the lamina propria to the sub-mucosa, so that in the presence of hyperplasia the distance from the luminal epithelium to the serosa is bridged by lymphoid tissue. During the course of typhoid fever, S. Typhi is found within mononuclear phagocytes of Peyer’s patches, and in cases with intestinal perforation, both this tissue and surrounding tissues show hemorrhagic areas, most often during the third week of the illness [3]. Tissue damage in Peyer’s patches occurs, resulting in ulceration, bleeding, necrosis, and, in extreme cases, full-thickness perforation. The process leading to tissue damage is probably multifactorial, involving both bacterial factors and host inflammatory response [3, 35].