SUMMARYImmunological events in the acute, recovery and convalescent stages of typhoid fever were correlated with the occurrence of renal disease in 24 consecutively selected patients.Serum complement levels (C3) were significantly reduced in patients with renal disease during the acute state (p<0.01) and increased to normal levels in the recovery phase. IgG and IgM immunoglobulin levels were significantlylower than control values in all three stages (p<0.05). While IgA levels were elevated to above control levels in patients with and without renal disease in all three stages, IgA levels were lower in patients with renal disease compared tothose without renal involvement in the acute stage (p<0.025). The percentage of T cells was increased significantly in all three stages (p<0.01).Seven patients showed renal abnormalities. All of them had glomerular disease demonstrated by proteinuria of 1.0g or greater per 24h, associated with significant haematuria. Almost all of these patients were glucose-six-phosphate-dehydrogenase (G.6.P.D.) deficient. Serum blood urea nitrogen was elevated in five of these patients who were G.6.P. D. deficient,and two of them developed classical acute tubular necrosis.It appears that renal involvement in typhoid fever commonly occurs as transient glomerular or tubular disease in G.6.P.D. deficient individuals. Glomerular disease is associated with a decrease in serum complement (C3) level in acute stage.
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