Abstract: Enteric fever has been implicated in complications such as severe sepsis and in alteration of some biochemical and hematological parameters. Enteric fever affects the intestine, which is also the site for lipid absorption, but its possible effect on lipid metabolism is unclear. The present study was aimed at estimating the lipid profile of enteric fever patients in Enugu metropolis. Lipid profile of 200 enteric fever patients and 100 apparently healthy subjects in Enugu metropolis were determined using standard techniques. Enteric fever was investigated using rapid slide titration method and the confirmatory test done with Enterocheck-WB ® kit. Serum Total Cholesterol (TC), Triacylglycerol (TG), High-Density Lipoprotein Cholesterol (HDL-C), Low-Density Lipoprotein Cholesterol (LDL-C) and Very Low Density Lipoprotein Cholesterol (VLDL-C) were assayed using standard operative procedures. Statistical analysis was done with graph pad prism computer soft ware using student&apos;s t-test to test for statistical significance. P-values of &lt;0.05 were considered to be statistically significant. The lipid profile of all the patients showed non-significant difference (p&gt;0.05) when compared with the control. However, when the male and female subjects where separately analyzed, TC and LDL-C significantly increased (p&lt;0.05) in the male subjects compared to the male controls, whereas the female subjects showed significant decrease (p&lt;0.05) compared to the female control. The study suggests that lipid profile is not significantly altered in enteric fever infection and thus may be useless in enteric fever management

C Ikegwuonu Ifeoma

C Maduka

C Ude Victor

E Neboh Emeka

Ignatius

J C Onyeanusi

Mba Chika

Miriam

O Aniagolu

CiteSeerX

Asian Journal of Medical Sciences 7(3): 26-29, 2015 
ISSN: 2040-8765; e-ISSN: 2040-8773 
© Maxwell Scientific Organization, 2015 
Submitted: January  19,  2015 Accepted:  February  14,  2015 Published: July 25, 2015 
 
Corresponding Author: E. Neboh Emeka, Department of Medical Biochemistry, College of Medicine, Enugu State University 
of Science and Technology (ESUT), Enugu, Nigeria, Tel.: +2348073314440 
26 
 
Assessment of Lipid Profile of Enteric Fever Patients in Enugu Metropolis, South-East 
Nigeria: Useful or Useless? 
 
1
C. Ikegwuonu Ifeoma, 
2
J.C. Onyeanusi, 
3
E. Neboh Emeka, 
3
C. Ude Victor, 
4
C. Maduka Ignatius,  
5
O. Aniagolu Miriam and 
6
Mba Chika B. 
1
Department of Medical laboratory Sciences, College of Medicine, Nnamdi Azikiwe  
University (NAU) Nnewi, Nigeria 
2
Department of Medical Laboratory Sciences, College of Medicine, University of Nigeria  
Enugu Campus (UNEC),  
3
Department of Medical Biochemistry, College of Medicine, Enugu State University of Science and 
Technology (ESUT), Enugu, 
 
4
Department of Human Biochemistry, College of Medicine, Nnamdi Azikiwe University,  
Nnewi Anambra State,  
5
Department of Chemical Pathology, College of Medicine, Enugu State University of Science and 
Technology (ESUT), Enugu, 
6
Department of Medical Laboratory Sciences, Faculty of Health, Ebonyi State University, Abakaliki, 
Ebonyi State, Nigeria 
 
Abstract: Enteric fever has been implicated in complications such as severe sepsis and in alteration of some 
biochemical and hematological parameters. Enteric fever affects the intestine, which is also the site for lipid 
absorption, but its possible effect on lipid metabolism is unclear. The present study was aimed at estimating the lipid 
profile of enteric fever patients in Enugu metropolis. Lipid profile of 200 enteric fever patients and 100 apparently 
healthy subjects in Enugu metropolis were determined using standard techniques. Enteric fever was investigated 
using rapid slide titration method and the confirmatory test done with Enterocheck-WB
®
 kit. Serum Total 
Cholesterol (TC), Triacylglycerol (TG), High-Density Lipoprotein Cholesterol (HDL-C), Low-Density Lipoprotein 
Cholesterol (LDL-C) and Very Low Density Lipoprotein Cholesterol (VLDL-C) were assayed using standard 
operative procedures. Statistical analysis was done with graph pad prism computer soft ware using student’s t-test to 
test for statistical significance. P-values of <0.05 were considered to be statistically significant. The lipid profile of 
all the patients showed non-significant difference (p>0.05) when compared with the control. However, when the 
male and female subjects where separately analyzed, TC and LDL-C significantly increased (p<0.05) in the male 
subjects compared to the male controls, whereas the female subjects showed significant decrease (p<0.05) compared 
to the female control. The study suggests that lipid profile is not significantly altered in enteric fever infection and 
thus may be useless in enteric fever management. 
 
Keywords: Apoproteins, hyperlipidemia, total cholesterol, typhoid infection 
 
INTRODUCTION 
 
The bacterial genus Salmonella, was firstly isolated 
from animal intestine (Crum, 2003).
 
Salmonella 
comprises of two species, Salmonella bogori (S.bogori) 
and S.enterica. Of all the subspecies of Salmonella 
enterica, only subspecies enterica is associated with 
disease in worm blooded animals such as man 
(Kimbrough and Miller, 2000). Salmonella is divided 
into distinct serologic groups (A through E) on the 
bases of their somatic O-antigens (Amal and Eman, 
2010; Pang et al., 1998).
 
 
The agents that cause enteric fever are therefore 
Salmonella enterica subspecies enterica serovar typhi 
and serovar paratyphi (A, B and C) (Amal and Eman, 
2010). Although Paratyhi-A and typhi cause a similar 
illness, with relapsing fever, paratyphi-A generally 
causes a milder disease (Parry et al., 2006; McClelland 
et al., 2004).
 
 
Enteric fever is a major public health problem in 
developing countries of the world with an estimated 
annual incidence of 540 per 100,000 individuals 
(Katung, 2000).
 
Enteric fever is endemic in the 
economically disadvantaged countries in Africa and has 
also been shown to be more severe in infants and the 
elderly (Preston and Borezyk, 1994; Gatsing et al., 
2006). Symptoms of enteric fever include high fever, 
constipation, extreme fatigue, head ache, joint pain and 
 
 
Asian. J. Med. Sci., 7(3): 26-29, 2015 
 
27 
rash across the abdomen as rose spots (Lesser and 
Miller, 2001).
 
 
Lipids are known to play important roles in 
virtually all aspects of biological life, providing energy 
storage and metabolic fuels serving as hormone 
precursors acting as functional and structural 
components of bio-membranes, aiding digestion and 
forming insulation to allow nerve conduction or prevent 
heat loss (Brites et al., 1998; Burtis et al., 2001).
 
Hyperlipidemia, therefore, refers to the increase in the 
plasma concentrations of triacylglycerols (TGs) or 
cholesterol, both exposing the body to the dangers of 
formation of artherosclerotic plaques with 
hypertriglyceridemia  being   more  common  (Murray 
et al., 2003).
 
 
Complications of enteric fever include liver and 
spleen enlargement, anaemia, intestinal bleeding, joint 
heart and brain infection and these lead to severe sepsis 
which is known to alter the lipid profile (Khosla et al., 
1991). The effect of enteric fever in the stomach and 
intestines may also affect the lipid absorption and lead 
to alteration in the plasma lipid concentrations of such 
patients, hence the need for the present study.  
The general objective of the present study is to 
determine the effect of enteric fever on lipid profile of 
enteric fever patients in Enugu metropolis. The result of 
this study will help in the diagnosis and disease-
treatment monitoring of enteric fever patients in our 
locality.  
 
MATERIALS AND METHODS 
 
Study setting: The study was conducted at the 
Department of Chemical Pathology, University of 
Nigeria Teaching Hospital, (UNTH) Ituku-Ozalla, 
Enugu State.  
 
Study population: The subjects comprised of a total of 
300 adults (170 females and 130 males) with the age 
groups of 20-40 years. Two hundred patients (120 
females and 80 males), recruited from the University of 
Nigeria Teaching Hospital UNTH Ituku-Ozalla, ESUT 
Teaching Hospital G.R.A, Enugu, Ntasiobi-ndi-no-
n’afufu Hospital Enugu and Annunciation Hospital, 
Emene Enugu, made up the test subjects. The severity 
of the disease was evaluated by the severity of 
abdominal pain, high fever, extra-intestinal 
manifestations of the disease and general well being. 
The control subjects were 100 apparently-healthy 
subjects (50 females and 50 males), recruited from the 
same locality of the hospitals. Informed consent was 
obtained by all the subjects and ethical clearance 
obtained from the Hospitals before the commencement 
of the study.  
 
Inclusion criteria: Subjects were included in the study 
if they were diagnosed with enteric fever, with 
symptoms such as abdominal pain, high fever and 
extra-intestinal manifestations of the disease.  
Exclusion criteria: All the subjects having malaria 
infection, diabetes mellitus, hypertension, obesity and 
renal problems were excluded from the study.  
 
Specimen collection and processing: Five mls of 
fasting blood samples were collected from the subjects 
via a clean vene-puncture from the median cubital vein 
into a clean, labeled plain tube. The fresh blood 
samples were immediately tested for typhoid fever 
while the rest of the samples were allowed to clot and 
retract and then centrifuged at 3000 rpm for 5 min using 
desk-top centrifuge (Bran Scientific Co England ®). 
The sera were separated from the clot and deep-frozen 
at -20°C and used within 5 days of collection.  
 
ANALYTICAL METHODS 
 
Screening test for enteric fever: Rapid slide titration 
method was used to carryout the widal test on all the 
blood samples, (Kimbrough and Miller, 2000) using 
commercial antigen suspension. Samples with positive 
widal test results (high antibody titre from O 1/160 and 
H 1/160 and above) were further tested using 
Enterocheck-WB ® kit for confirmation and subjected 
to lipid profile test.  
 
Enteric fever confirmatory test: Enterocheck-WB Kit 
form Zephyr Biomedicals India which was sensitive to 
the study environment, was used for confirmatory test. 
Enterocheck-WB utilizes the principle of 
immunochromatography. The kit components were 
brought to room temperature and placed on flat 
horizontal surface. Exactly 5 µL of serum sample was 
dispensed into the specimen port “A” whereas 5 drops 
of running buffer was added into the reagent port “B” 
and the result read at the end of 15 mins.  
 
Lipid profile estimation: Enzymatic estimation TC 
was done by the method of Allain et al. (1974) whereas 
the method of Fossati and Principe (1982), was used for 
enzymatic estimation of TG. Precipitation/enzymatic 
method of Allain et al. (1974), Burstein et al. (1970) 
and Groove (1979) was used for HDL-Cholesterol 
estimation. All the kit reagents were produced by 
Biosystem S.A ® Barcelona (Spain). The LDL and 
VLDL were both estimated in the serum using the 
Friedewald formula (Friedewald et al., 1972).
 
 
 
Statistical analysis: Data entry and statistical analysis 
utilized the graph pad prism computer soft ware. Data 
was analyzed using student’s t-test to test for statistical 
significance. P-values of <0.05 were considered to be 
statistically significant. 
 
RESULTS 
 
Table 1 represents the lipid profile (mmol/L) of 
enteric fever patients  and  control. The  table  showed a  
 
 
Asian. J. Med. Sci., 7(3): 26-29, 2015 
 
28 
Table 1: Lipid Profile (MMOL/L) among enteric fever patients and control  
Lipid profile 
parameters 
Patients  
(n = 200) 
Controls  
(n = 100) p-value 
Triacylglycerides 
(TG) 
1.4±0.47 1.32±0.31 0.0904 
Total Cholesterol 
(TC) 
4.54±1.15 4.49±0.95 0.6694 
HDL-C 1.19±0.39 1.24±0.31 0.2168 
LDL-C 2.73±1.03 2.65±0.82 0.5365 
VLDL-C 0.64±0.21 0.60±0.40 0.056 
 
Table 2: Lipid profile of male patients and age-matched controls 
Lipid profile 
parameters Patients (n = 80) 
Controls  
(n = 50) p-value 
Triacylglycerides 
(TG) 
1.37±0.42 1.27±0.31 0.1598 
Total Cholesterol 
(TC) 
4.74±1.56* 4.22±0.92 0.0343 
HDL-C 1.25±0.42 1.22±0.34 0.7878 
LDL-C 2.87±1.34* 2.42±0.71 0.029 
VLDL-C 0.62±0.49 0.57±0.14 0.159 
* = statistically significant compared to the control 
 
Table 3: Lipid profile of female patients and age-matched controls 
Lipid profile 
parameters 
Patients  
(n = 120) 
Controls  
(n = 50) p-value 
Triacylglycerides 
(TG) 
1.42±0.49 1.38±0.31 0.5655 
Total Cholesterol 
(TC) 
4.41±0.75* 4.77±0.89 0.009 
HDL-C 1.16±0.36 1.26±0.26 0.008 
LDL-C 2.62±0.74* 2.90±0.86 0.0381 
VLDL-C 0.65±0.22 0.62±0.14 0.4221 
* = statistically significant compared to the control 
 
non-significant (p<0.05) decrease in HDL-C and 
increase in the rest of the parameters in the test subjects 
when compared with the controls. The total cholesterol 
and LDL-C however, showed a significant increase 
(p<0.05) in the male test subjects when compared to the 
male controls (Table 2). A comparison between the 
female patients and control revealed a significant 
decreased (p<0.05) in LDL-C and total cholesterol in 
the test subjects (Table 3).  
 
DISCUSSION 
 
Lipid profile has been known to be altered in 
patients with severe sepsis and few studies regarding 
the status of lipid levels in enteric fever show that the 
analysis of the lipid profile may be essential in making 
a diagnosis (Levy et al., 2000). In the present study we 
tested the hypothesis that plasma lipid profile may be 
altered in patients with enteric fever. The results 
showed no statistically significant difference (p<0.05) 
in the studied lipid profile parameters of the overall 
patients (males and females), when compared to the 
control (Table 1).  
The observed result is not in agreement with the 
study by Khosla et al. (1991)
 
which reported elevated 
levels of LDL-C and triacylglycerides in acute enteric 
fever patients in India. The observed difference may be 
attributed to difference in the patient population form 
different geographical locations, environmental factors 
and nutritional lifestyle (NCEP, 1993). It may also be 
as a result of methodologic differences or difference in 
severity of the disease, as the patients in the study by 
Khosla et al. (1991) were patients with complications 
of enteric fever such as severe sepsis which they 
reported, lead to alteration in lipid profile.  
Furthermore, there was a significant increase in the 
total cholesterol and LDL-C of the male patients 
compared to control, whereas in female patients, a 
significant decrease (p<0.05) was recorded in total 
cholesterol and LDL-C of the patients compared to the 
control. This sex-related increase in total cholesterol 
and LDL-C in males may be as a result of decrease in 
concentration  of  LDL-receptors  in  the liver, (Burtis 
et al., 2001)
 
since LDL-receptors help in the removal of 
LDL-C from the circulation. It could also be as a result 
of reduced LDL binding due to defective LDL 
receptors.  
Typhoid fever characterized by increased chronic 
inflammatory cells infiltrates in the mucosal lesions. 
The excessive local production of soluble mediators 
from activated monocytes and polymorphonuclear 
leukocytes has been implicated in mediating the tissue 
injury (Weiss, 1989).
 
Important among these mediators 
are oxygen free radicals.  
Disturbances in lipoproteins resulting from 
peroxidative attack may affect their normal metabolism 
and the subsequent distribution of both lipid and 
vitamin moieties to peripheral organs (Amal and Eman, 
2010).
 
The increased total cholesterol and LDL-C of 
male patients when compared with female is in 
agreement with the report of NCEP (1993) that before 
menopause, women tend to have lower total cholesterol 
compared to men of the same age-range. Menopause, 
however, is associated with increased LDL-C in post-
menopausal women (Ikekpeazu et al., 2009).
 
 
Although the present study showed that the 
increased LDL-C and total cholesterol levels may be 
sex-influenced/sex-dependent, the concurrent increase 
in total cholesterol and LDL-C in the present study may 
be attributed to the fact that cholesterol is a major 
constituent of LDL-C, in addition to apoproteins (Burtis 
and Ashwood, 1999).
 
 
 
CONCLUSION 
 
The present study showed that there was no 
significant alteration in the concentration of serum 
lipids of enteric fever patients. Lipid profile estimation 
in such population may not be used in the diagnosis or 
treatment monitoring of enteric fever. 
 
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Assessment of Lipid Profile of Enteric Fever Patients in Enugu Metropolis, South-East Nigeria: Useful or Useless?

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Assessment of Lipid Profile of Enteric Fever Patients in Enugu Metropolis, South-East Nigeria: Useful or Useless?

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