No work has been to prove that lymphopenia occurs.

It is a typical symptom although I do not know any publication about it.

Thanks to Dr. Seedat and Dr.Kuchar for your info.

I am again sharing a couple of studies that points out about the lymphopenia in typhoid fever.

"This paper reviews 191 adult patients with typhoid. The total and differential leucocyte counts done on admission were analysed. In this study leucopenia was found in only 24.6% of patients........ Neutropenia was found in 25% of patients, and none of the patients had an absolute lymphocytosis, whereas 75.8% of patients had true lymphopenia."

http://www.pubfacts.com/detail/1496717/The-white-cell-count-in-typhoid-fever

This is confusing. What could be the real interpretation of this study?

Best Regards, Sidharta

pleaser review the following

Am. J. Trop. Med. Hyg., 82(6), 2010, pp. 1121–1126

The American Society of Tropical Medicine and Hygiene

Imported Enteric Fever: Case Series from the Hospital for

Tropical Diseases, London, United Kingdom

Trupti A. Patel ,* Margaret Armstrong , Stephen D. Morris-Jones , Stephen G. Wright , and Tom Doherty

Hospital for Tropical Diseases, London, United Kingdom; Department of Clinical Microbiology, University College London Hospital,

London, United Kingdom; London School of Hygiene and Tropical Medicine, London, United Kingdom

Abstract.

Our current knowledge of the clinical characteristics of enteric fever is drawn mainly from population-based studies in disease-endemic countries, and there are limited data published on cases in returning travelers. We report the clinical characteristics of enteric fever in 92 travelers returning to London, United Kingdom. Salmonella typhi and S. paratyphi resulted in an almost indistinguishable clinical picture. Rose spots and relative bradycardia were found only in a few patients. A total of 91% of the patients had a normal leukocyte count, which was associated with a markedly increased level of alanine aminotransferase in 82%. A total of 57% of the S. typhi isolates had decreased susceptibility to ciprofloxacin and resistance to nalidixic acid; these isolates were from southern Asia. Thirty percent were multidrug resistant; all were from southern Asia and Nigeria. None of the paratyphoid isolates were multidrug resistant but rates of decreased susceptibility to fluoroquinolones were higher than in S. typhi (74%).

Virtually all patients (83 of 91, 91%) had normal total leukocyte counts, although a significant proportion were lymphopenic (36 of 90, 40%) (Table 3). All patients had an elevated C-reactive protein level on admission; in 33 (36%) it was > 100 mg/L. The erythrocyte sedimentation rate was normal for 20 patients (29%). Most had a significant transaminitis, with almost all (75 of 91, 82%) having an increased level of alanine aminotransferase (ALT) during their illness. The maximum ALT level was three times the upper reference limit at some time during admission in 56 (62%) of patients. None of the 31 (34%) patients tested for co-infection with hepatotrophic viruses (hepatitis A, B, C, and E viruses, cytomegalovirus, Epstein-Barr virus, or parvovirus) had positive serologic results. Laboratory indices were compared between persons with typhoid infections and those with paratyphoid infections. There were no significant differences between them except for two characteristics: paratyphoid was associated with a lower neutrophil count and typhoid was associated with a lower hemoglobin level in males.

Hematologic and biochemical characteristics of patients with enteric fever*

Parameter

All patients

Infected with Salmonella typhi

Infected with S. paratyphi

Total leukocytes, × 103/µL (n = 91)

6.2 ± 2.0 (2.4–11.4)

6.6 ± 1.9 (3.2–10.8)

5.8 ± 2.1 (2.4–11.4)

Neutrophils, × 103/µL (n = 90)

4.1 ± 1.5 (1.2–8.8)

4.5 ± 1.5† (2.0–8.8)

3.8 ± 1.5 (1.2–7.7)

Lymphocytes, × 103/µL (n = 90)

1.5 ± 0.8 (0.4–5.2)

1.6 ± 0.7 (0.7–4.5)

1.5 ± 0.9 (0.4–5.2)

Hemoglobin, g/dL

Males (n = 56)

14.1 ± 1.3 (11.3–17.6)

13.8 ± 1.2† (11.3–16.9)

14.5 ± 1.4 (11.7–17.6)

Females (n = 35)

12.6 ± 1.4 (8.9–14.8)

12.2 ± 1.6 (8.9–14.5)

13.0 ± 1.0 (11.2–14.8)

Bilirubin, mg/dL (n = 91)

11.5 ± 7.1 (2.0–63.0)

12.1 ± 9.0 (2.0–63.0)

10.9 ± 4.5 (4.0–27.0)

Maximum (n = 90)

13.2 ± 7.9 (4.0–63.0)

14.3 ± 9.7 (4.0–63.0)

12.2 ± 5.6 (5.0–31.0)

ALT, IU/L (n = 91)

108.9 ± 131.1 (9.0–768.0)

111.6 ± 126.0 (15.0–744.0)

106.2 ± 137.4 (9.0–768.0)

Maximum (n = 90)

224.3 ± 203.1 (11.0–898.0)

239.0 ± 196.8 (18.0–752.0)

209.0 ± 210.7 (11.0–898.0)

Serum albumin, g/L (n = 91)

41.1 ± 3.6 (29.0–48.0)

40.7 ± 3.5 (34.0–47.0)

41.4 ± 3.8 (29.0–48.0)

Sodium, mmol/L (n = 82)

134.7 ± 3.6 (124.0–143.0)

133.7 ± 3.7 (124.0–140.0)

135.8 ± 3.2 (129.0–143.0)

CRP, mg/L (n = 91)

96.2 ± 21.0 (9.0–318.0)

97.7 ± 56.1 (9.0–261.0)

94.6 ± 75.7 (11.0–318.0)

ESR, mm/hr (n = 68)

33.7 ± 21.0 (2.0–116.0)

35.0 ± 22.3 (10.0–116.0)

32.3 ± 19.9 (2.0–94.0)

We did find relative lymphopenia. One could not find out the significance of relative lymphopenia. Absolute lymphoctosis has to be confirmed by other workers.

YK Seedat

Typhoid fever can cause lymphopenia. The cause is attributed to transient bone marrow suppression. 

Abro, Ali Hassan, et al. "Hematological and biochemical changes in typhoid fever." Pak J Med Sci 25.2 (2009): 166-171.

Leucopenia with neutropenia and a relative lymphocytosis are believed to be common findings in patients with typhoid fever. This paper reviews 191 adult patients with typhoid. The total and differential leucocyte counts done on admission were analysed. In this study leucopenia was found in only 24.6% of patients. Whilst complications occurred at any white cell count, the prevalence of complications increased significantly to 70% in patients with a white cell count above 8 x 10(9)/l. Neutropenia was found in 25% of patients, and none of the patients had an absolute lymphocytosis, whereas 75.8% of patients had true lymphopenia.

Dear Sir/Madam,

See the link below may be useful for you.

The white cell count in typhoid fever.

www.ncbi.nlm.nih.gov/pubmed/1496717Pages similaires

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The white cell count in typhoid fever. ... of patients, and none of the patients had an absolute lymphocytosis, whereas 75.8% of patients had true lymphopenia.

I agree that lymphopenia occurs in typhoid fever, It may be relative or absolute. I am not certain of the mechanism of absolute lymphopenia. The depression of the bone marrow may not be a satisfactory explanation.

Its very common. In fact, if you don't have lymphopaenia you might not have the right diagnosis

I agree with  all  who  observed that   lymphopenia can occur in typhoid fever,

Changes in some haematological parameters in typhoid patients ...

https://www.ijcmas.com/vol-3-1/Obeagu%20Emmanuel%20Ifeanyi.pdf

Cell blood dysfunction as lymphopenia can occur in case of hemorragic fever like typhoid, Ebola...

My statement has been given previously.

I think so

@ Dr. Sidharta Chatterjee

The answer is 'yes'. Please see the following RG links.

Article Imported Enteric Fever: Case Series from the Hospital for Tr...

Article The white cell count in typhoid fever

Article Hemophagocytic Lymphohistiocytosis Associated with Salmonell...

Thanks!

Thanks for all the tips! This was extremely helpful

Yes it can occur in pediatric age group.

Yes U can get lymphopenia in typhoid specially in pediatric age group. In one study which I conducted in Solapur, its found that 3 patients had lymphopenia.