Liver and Kidney Biochemical Profile of Typhoid Fever Patients at the Dschang District Hospital, West Cameroon: A Cross-Sectional Study

  • Cerge Kamhoua Natheu Biochemistry Research Unit of Medicinal Plants, Food Science and Nutrition; University of Dschang, Faculty of Sciences, Department of Biochemistry, Cameroon. Po Box: 67 Dschang-Cameroon
  • Solange Dabou Biochemistry Research Unit of Medicinal Plants, Food Science and Nutrition; University of Dschang, Faculty of Sciences, Department of Biochemistry, Cameroon. Po Box: 67 Dschang-Cameroon
  • Sylvie Nadine Ongbayokolak Biochemistry Research Unit of Medicinal Plants, Food Science and Nutrition; University of Dschang, Faculty of Sciences, Department of Biochemistry, Cameroon. Po Box: 67 Dschang-Cameroon
  • Bruno Phélix Telefo Biochemistry Research Unit of Medicinal Plants, Food Science and Nutrition; University of Dschang, Faculty of Sciences, Department of Biochemistry, Cameroon. Po Box: 67 Dschang-Cameroon
Keywords: Typhoid fever, Biomarkers, Hepatotoxicity, Nephrotoxicity


Background: Typhoid fever remains prevalent in developing countries and most often affects liver and kidney. This study aimed to assess biochemical disturbances of the liver and kidney in patients with typhoid fever at the Dschang District Hospital, appreciate the implication of the disease duration as well as the type and the duration of treatment.Methods and materials:  This cross-sectional study was conducted at the Dschang District Hospital, Cameroon. A total of 263 participants and a structure questionnaire was used to collect sociodemographic data. Stool culture was used for the diagnosis of typhoid fever. Liver and kidney biomarkers were access using spectrophotometric technic. Results: By these technics, 112 healthy individuals (Control Group, CG), and 151 patients diagnosed with typhoid fever (Study Group, SG) were obtained. A significant lower level of albumin (p<0.05) was noted in SG compare to CG while other biochemical parameters of the liver and kidney function (ALT, AST, T-BILI, C-BILI, ALP, γ-GT, urea and creatinine) presented a significant higher levels at varying degrees, especially for ALT (p <0.001), AST, ALP, urea and creatinine (p <0.01), T-BILI, C-BILI and γ-GT (p <0.05). Relatively to the variation of biochemical parameters with respect to the duration of illness in the patients before their arrival to the hospital, except albumin which had a significant (p<0.05) decreased level from the first to the third week of the disease, ALT and AST had a significant (p<0.05) increased level from the first to the third week of the disease and, T-BILI, C-BILI, UC-BILI, ALP and γ-GT from the second to the third week of the disease. Relatively to the type of drug intake, the serum level of ALT, γ-GT, albumin and creatinine were significantly increased (p<0.05) with fluoroquinolones and indigenous (medicinal plants) intake while the serum level of AST, T-BILI, C-BILI, UC-BILI, ALP, urea and creatinine clearance were significantly (p<0.05) increased only with indigenous intake. Relatively to the duration of treatment, except creatinine clearance that significantly (p<0.05) decreased at the third week of treatment, the serum level of ALAT, ASAT, C-BILLI, ALP, γ-GT and albumin were significantly (p<0.05) increased from the first to the third week of the treatment, the serum level of T-BILI, UC-BILI and urea from the second to the third week of the treatment, and the serum level of creatinine at the third week of the treatment. There was a significant correlation between disease duration, drug intake duration and the serum level of ALT, AST, total bilirubin, conjugated bilirubin, unconjugated bilirubin, ALP, γ-GT, urea, creatinine, albumin and creatinine clearance. Conclusion: The results of this study suggest that typhoid fever negatively affects the proper functioning of the liver and kidneys, which varies depending on the duration of the illness, self-medication with conventional drugs such as fluoroquinolones and medicinal plants, and the duration of treatment.


. Bhutta, Z.A. Integrating Typhoid Fever Within the Sustainable Development Goals: Pragmatism or Utopia? Clin. Infect. Dis. 2019, 68, S34–S41.

. Bano-Zaidi, M.; Aguayo-Romero, M.; Campos, F.D.; Colome-Ruiz, J.; Gonzalez, M.E.; Piste, I.M.; Magaña, C.P.; Gamboa, M.G.Y. Typhoid fever outbreak with severe complications in Yucatan, Mexico. Lancet. Glob. Heal. 2018, 6, e1062–e1063.

. Rajput, R.; Jain, D.; Kumar, A.; Mittal, A. Typhoid Fever Presenting With Acute Renal Failure And Hepatitis Simultaneously - A Rare Presentation. ARS Medica Tomitana 2016, 22, 80–82.

. Ohl, M.E.; Miller, S.I. Salmonella: A Model for Bacterial Pathogenesis. Annu. Rev. Med. 2001, 52, 259–274.

. Çamlar, S.A.; Kır, M.; Aydoğan, C.; Bengoa, Ş.Y.; Türkmen, M.A.; Soylu, A.; Kavukçu, S. Salmonella glomerulonephritis and haemophagocytic lymphohistiocytosis in an adolescent. Turk Pediatr. Ars. 2016, 51, 173–175.

. Cruz Espinoza, L.M.; McCreedy, E.; Holm, M.; Im, J.; Mogeni, O.D.; Parajulee, P.; Panzner, U.; Park, S.E.; Toy, T.; Haselbeck, A.; et al. Occurrence of Typhoid Fever Complications and Their Relation to Duration of Illness Preceding Hospitalization: A Systematic Literature Review and Meta-analysis. Clin. Infect. Dis. 2019, 69, S435–S448.

. ]Martin, P.G. Renal Function Testing. Physician Assist. Clin. 2019, 4, 561–578.

. WM, A.; DW, N. Biochemical Markers of In Vivo Hepatotoxicity. J. Clin. Toxicol. 2016, 06.

. Veeraraghavan, B.; Pragasam, A.K.; Bakthavatchalam, Y.D.; Ralph, R. Typhoid fever: Issues in laboratory detection, treatment options & concerns in management in developing countries. Futur. Sci. OA 2018, 4.

. Michalak, K.; Sobolewska-Włodarczyk, A.; Włodarczyk, M.; Sobolewska, J.; Woźniak, P.; Sobolewski, B. Treatment of the Fluoroquinolone-Associated Disability: The Pathobiochemical Implications. Oxidative Med. Cell. Longev. 1990–2012 2017.

. Adikwu, E.; Deo, O. Fluoroquinolones Reported Hepatotoxicity. Pharmacol. & Pharm. 2012, 03, 328–336.

. OKuda, M.O.; Imura, N.K.; Nui, K.I. Short Communication Interactions of Fluoroquinolone Antibacterials, DX-619 and Levo‰oxacin, with Creatinine Transport by Renal Organic Cation Transporter hOCT2. Drug Metab. Pharmacokinet. 2006, 21, 432–436.

. Fuller, A. Ciprofloxacin-Induced Renal Failure. Southwest Respir. Crit. Care Chronicles 2015, 3, 32–38.

. Ozougwu, J.C.; Alozie, K.C.; Imakwu, C.A.; Eziuzor, S.C.; Akwari, D.K. Changes in Renal Parameters Associated with Typhoid Infection. Int. J. Trop. Dis. Heal. 2019, 38, 1–6.

. Srikanth and Kumar Liver Function Tests Abnormalities in Enteric Fever-A Recent Update. IOSR J. Dent. Med. Sci. 2015, 14, 2279–861.

. Shawki and Jameel A study of the Biochemical and Haematological parameters in Patients of Typhoid Fever. Diyala J. Pure Sci. 2017, 13, 1–10.

. Kwo, P.Y.; Cohen, S.M.; Lim, J.K. ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries. Am. J. Gastroenterol. 2017, 112, 18–35.

. Galluzzi, L.; Kepp, O.; Kroemer, G. RIP kinases initiate programmed necrosis. J. Mol. Cell Biol. 2009, 1, 8–10.

. Paulo, S. TYPHOID FEVER AS CELLULAR MICROBIOLOGICAL MODEL. Rev. Inst. Med. Trop. Sao Paulo 2003, 45, 185–191.

. Han, D.W. Intestinal endotoxemia as a pathogenetic mechanism in liver failure. World J. Gastroenterol. 2002, 8, 961–965.

. Ahmed, A.; Ahmed, B. Jaundice in typhoid patients: Differentiation from other common causes of fever and jaundice in the tropics. Ann. Afr. Med. 2010, 9, 135–140.

. Vaishnavi, C.; Singh, S.; Kochlar, R.; Bhasin, D.; Singh, G.; Singh, K. Prevalence of Salmonella enterica Serovar Typhi in bile and stool of patients with biliary diseases and those requiring biliary drainage for other purposes. Jpn. J. Infect. Dis. 2005, 58, 363–365.

. Lowe, D.; John, S. Alkaline Phosphatase; 2018;

. Valla, D.-­Charles Cholestase. Hépato-Gastro Oncol. Dig. 2013, 20, 618–27.

. Carvalho, J.R.; Machado, M.V. New insights about albumin and liver disease. Ann. Hepatol. 2018, 17, 547–560.

. Higgins, C. Urea and creatinine concentration, the urea:creatinine ratio 2016.

. Gulati, K.; Reshi, M.R.; Rai, N.; Ray, A. Hepatotoxicity : Its Mechanisms , Experimental Evaluation and Protective Strategies. Am. J. Pharmacol. 2018, 1, 1–9.

. Sleep, D. Albumin and its application in drug delivery. Expert Opin. Drug Deliv. 2015, 12, 793–812.

. Lacour, B.; Massy, Z. Diagnostic, suivi biologique de l’insuffisance rénale chronique et prise en charge de l’insuffisance rénale chronique terminale. Rev. Francoph. des Lab. 2013, 2013, 59–73.

. Mandal, S.; Mandal, M.D.; Pal, N.K. Enhancing chloramphenicol and trimethoprim in vitro activity by Ocimum sanctum Linn. (Lamiaceae) leaf extract against Salmonella enterica serovar Typhi. Asian Pac. J. Trop. Med. 2012, 5, 220–224.

. Ezekwesili-Ofili, J.; Onyemelukwe, N.; Agwaga, P.; Orji, I. The bioload and aflatoxin content of herbal medicines from selected states in Nigeria. African J. Tradit. Complement. Altern. Med. AJTCAM 2014, 11, 143–7.