SALMONELLA TYPHI AND CHRONIC ABDOMINAL PAIN IN CHILDREN. BY:PROF DR: OSAMA ELFIKY

CHRONIC ABDOMINAL PAIN: -Pain lasting two weeks or longer it may Be persistent or recurrent..

Abdominal pain appears to account for up to 4percent of all pediatric office visits. Some studies suggest that 13percent of middle school students and 17percent of high school students experince weekly attacks of abdominal pain..

CAUSES OF CHRONIC ABDOMINAL PAIN. THE COMONEST CAUSES INCLUDE: Renal calculi. Chronic appendicits. Chronic cholycstitis. Chronic hepatitis. Chronic pancreatitis. IntestinalT.B. Parasitic infestations. Ulcerative colitis.

Famelial meditrranian fever. Lead poisining. Porphyria. GIT infections as salonellosis.

SALMONELLA ENTERRICA Salmonellae are gram-negative motile bacilli. They belong to the family Enterobacteriaceae. Saalmonellae are potential enteric pathogenes leading to food born Illness.

DISEASES CAUSED BY SALMONELAA Typhoid fever. Bacteremia. Enterocolitis Focal infections as osteomylitis.

Abdominal pain is a common feature of typhoid fever.Now how can salmonella Causes chronic abdominal pain? This may be due to one of the following: 1-Diagnosis of typhoid fever may be missed due to the non specific Features as diarrhea,vomitting or Predominant respiratory symptoms. Chronicity may be due to short Course of antibiotics with use of Low dosage.

2-Salmonella typhi colonizes the gall Bladder and billiary tree and spreads To the intrahepatic bile ducts.

Because salmonella is one of the causes Of chronic abdominal pain astudy was Carried out by us to evaluate the magnitude of this problem in Benha univerisity hospital pediatric department.In the priod from jauary 2010 to january children of both sexes their mean age was {9.2years} complaining of chronic Abdominal pain were enrolled in this Study.Those chidren were subjected To thourghu history taking,comlete

Clinical examination and investigations In the form of : Complete urine and stool analysis Complete blood picture and CRP. Widal test and salmonella IGM. Abdominal sonography.

Results of our study revealed that Ascaris was present in 18{ 9%}of cases,Ent.cyst in 59{29.5%},Giardia in 11{5.5%} of cases H.nana in 11{5.5%} of cases,Oxyuris in 14{7%} of cases,Renal gravels in 13{6.5%},Stone kideny in 3{1.5%} of cases Chronic calcular cholycystits 8{4%} of cases and finally 29{14.5%}of cases were prooved to have salmonellosis by salmonella IGM.

From the previous results it is evident that Salmonellosis comes the second in order Of occurence preeceding other causes of abdominal pain which we think that they Are more prevelant such as giardiasis, ascaris,oxyuris or H.nana.

We observed in our study that cases having salmonellosis and other parasitic Diseases suffered abdominal pain after Receving antiparasitic medications. Their pain was curred after they received The specific treatment for salmonellosis.

Accoringly we reccomend: 1-Proper dignosis and treatment of Febrile ilnesses of chldren if there is Suspecition of salmonella infection To avoid development of chronicity and carrier state. 2-National wide epidemiolgical studies To evaluate the magnetud of the problem.

3-These studies must involve carier detection espicially among food handelers. 4-Trceing sources of infetions as contminated water supplay and foods As beef, poultary,eggs and milk products. 5-Vaccination of high risk population as food handelers. THANK YOU.