Typhoid fever is an infection disease of world occurrence, but as it is strictly related with low socioeconomic levels it occurs most frequently in developing countries. In this work we present the experience of Instituto Evandro Chagas (IEC) with that disease since 1987 up to 2004, period in which a number of 443 cases was accumulated, all diagnosed by Salmonella Typhi’s isolation from blood or feces, being some of them complemented with Widal serologic reaction. The case were proceeding from Belém and the municipal districts of Pará state conduced to IEC by the respective Units from Health System for etiologic diagnosis of fever syndrome, most of them of persistent course, here designated as “spontaneous” demand, at that time detected during outbreak investigations occurred in the municipal districts. We discussed aspects related to the clinical presentation, with emphasis to the atypical manifestations, the distribution according to sex and age group, the seasoning, the distribution by origin area, identifying the municipal districts of larger prevalence, and the distribution by districts, in relation to the cases coming from Belém. We also discussed aspects related to the laboratorial diagnosis emphasizing the application of the cultivation methods (coproculture and hemoculture) comparing their performance concerning the time of disease and the relationship of those tests with Widal reaction, by measuring the value of these as auxiliary or complementary method in the diagnosis of the disease. Clinical, epidemiological and laboratorial analyses were made, using Bio Estat version 3.0 program by applying qui-square and G test and the statistic significance was accepted at 95% level. The results allowed us to have the following conclusions: 1) in situations of epidemic normality the typhoid fever affects more the young adult group, while, in the epidemic situations, the affected age group is the infantile; 2) there is homogeneity among the samples from cases of outbreaks and the spontaneous demand according to the gender distribution, but males are more exposed to typhoid fever; 3) in municipal districts of the State the disease was shown to be more frequent in the areas where it concentrates larger number of populations who live near rivers and, in relation to the capital, it showed larger prevalence in jurunas district; 4) the illness has a seasonal profile, which shows the largest occurrence in the second half of the year, probably favored by geo-climatic and cultural factors; 5) the typhoid fever constitutes serious problem of public health en the State do Pará, confirming its narrow relationship with the high poverty levels; 6) the leukocytic formula revealed normal pattern or leucocytosis compared to leucopenia; 7) in the laboratorial approach it should not dispense the assays that seek to the isolation in detriment of the serological test, and the coproculture and the hemoculture should be requested in all the cases without considering the time of evolution of the clinical situation; 8) in our area, where there is not availability of cultivation tests, Widal reaction can be an alternative of value diagnosis; 9) it is illness of persistent clinical course and with atypical clinical manifestations (pneumonias and cholestatic hepatitis) whose sings/symptoms, when presented, should raise the suspicion by the investigator; 10) in the areas high endemicity, the typhoid fever can cause a negative impact in the economy not only for the costs generated with laboratorial exams, treatment, hospitalizations and eventual surgical interventions, but also because it can let the worker to be away from work for a prolonged period of time.
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