Prevalence of enteric fever in the patients admitted to paediatric ward in a rural tertiary care teaching hospital: a retrospective study


  • K. Santosh Kumar Department of Pediatrics, CRRI, Tagore Medical College and Hospital, Rathinamangalam, Chennai, Tamil Nadu, India
  • B. I. Sasireka Department of Pediatrics, Tagore Medical College and Hospital, Chennai, Tamil Nadu, India
  • I. Kannan Department of Microbiology, Tagore Medical College and Hospital, Chennai, Tamil Nadu, India



Enteric fever, Prevalence, Paediatrics, Salmonella typhi, Widal test


Background: Enteric fever or typhoid is one of the major cause of morbidity among the human population in many regions of the world. The current knowledge on epidemiological aspects comes from studies in adult populations. However, there are conflicting opinion about the prevalence rate in paediatric age groups. Hence, in the present study an attempt has been made to find the prevalence of the enteric fever among paediatric age group in a teaching hospital of rural area.

Methods: The retrospective study was carried out in Tagore Medical College and Hospital, Rathinamangalam village, Tamil Nadu, a rural teaching hospital in India over a period of 1st January 2015 to 31st December 2017. Data regarding admitted children below 12 years of age with signs and symptoms suggestive of enteric fever were recorded.

Results: Total of 224 cases of enteric fever case were admitted during the study period. There were 115 (51%) males and 109 (49%) females. Most of the patients were above the age of 4 years. The leading clinical feature were fever (100%), headache (92.85%), followed by coated tongue (88.4%), anorexia (85.71%) and hepatomegaly (79.02%).

Conclusions: It is imperative to include Enteric fever in the differential diagnosis of febrile paediatric patients with abdominal symptoms. Even though blood culture is the confirmatory test, Widal test plays supportive role in diagnosis of enteric fever, especially when patients come after a course of antibiotics. In the present study, ciprofloxacin is still a good drug for the treatment of enteric fever.


Wain J, Hendriksen RS, Mikoleit ML, Keddy KH, Ochiai RL. Typhoid fever. Lancet. 2015;385:1136-45.

Azmatullah A, Qamar FN, Thaver D, Zaidi AK, Bhutta ZA. Systematic review of the global epidemiology, clinical and laboratory profile of enteric fever. J Glob Health 2015;5:020407.

Rudan I, Tomaskovic L, Boschi-Pinto C, Campbell H. Global estimate of the incidence of clinical pneumonia among children under five years of age. Bull World Health Organization. 2004;82:895903.

Crump JA, Luby SP, Mintz ED. The global burden of typhoid fever. Bull World Health Organization. 2004;82:346-53.

Akinyemi K, Smith S, Oyefolu A, Coker A. Multidrug resistance in Salmonella enterica serovar typhi isolated from patients with typhoid fever complications in Lagos, Nigeria. Public Health. 2005;119:321-7.

Feng YC. The epidemiology of typhoid fever in the Dong Thap Province, Mekong Delta region of Vietnam. Am J Trop Medi Hygiene. 2000;62:644-8.

Shah NK. Indian conjugate Vi typhoid vaccine: do we have enough evidence? Indian Pediatr. 2009;46:181-2.

Lanh MN, Van Bay P, Ho VA, Thanh TC, Lin FY, Bryla DA et al. Persistent efficacy of Vi conjugate vaccine against typhoid fever in young children. New Engl J Med. 2003 Oct 2;349(14):1390-1.

Lin FY, Ho VA, Khiem HB, Trach DD, Bay PV, Thanh TCet al. The efficacy of a Salmonella typhi Vi conjugate vaccine in two-to-five-year-old children. New Engl J Med. 2001;344:1263-9.

Ochiai RL, Acosta CJ, Danovaro-Holliday M, Baiqing D, Bhattacharya SK, Agtini MD et al. A study of typhoid fever in five Asian countries: disease burden and implications for controls. Bull World Health Organization. 2008 Apr;86(4):260-8.

Clinical and Laboratory Standards InstitutePerformance Standards for Antimicrobial Susceptibility Testing; Twenty-Second Informational Supplement. CLSI Document M100-S22. Wayne, PA: CLSI. 2012.

Zaki SA, Karande S. Multidrug-resistant typhoid fever: a review. J Infect Dev Ctries. 2011;5:324-37.

Mahle WT, Levine MM. Salmonella typhi infections in children younger than five years of age. Pediatr Infect Dis J. 1993;12:627-31.

Boyle MH, Racine Y, Georgiades K, Snelling D, Hong S, Omariba W et al. The influence of economic development level, household wealth and maternal education on child health in the developing world. Soc Sci Med. 2006;63(8):2242-54.

Kutty YR. Women’s education and its influence on attitudes to aspects of child-care in a village Comm Kerala Soc Sci Med. 1989;29:1299-1303.

Crump JA, Mintz ED. Global trends in Typhoid and paratyphoid fever. Clin Infect Dis. 2010;50:241-6.

Kariuki S, Revathi G, Kiiru J, Mengo DM, Mwituria J, Muyodi J et al. Typhoid in Kenya is associated with a dominant multidrug-resistant Salmonella enterica serovar Typhi haplotype that is also widespread in Southeast Asia. J Clin Microbiol. 2010;48:2171-6.

Zaki SA, Karande S. Multidrug-resistant typhoid fever: a review. J Infect Dev Ctries. 2011;5:324-37.

Rowe B, Ward LR, Threlfall EJ. Ciprofloxacin-resistant Salmonella Typhi in the UK. Lancet. 1995;346:1302.

Pai H, Byeon J-H, Yu S, Lee BK, Kim S. Salmonella enterica serovar Typhi strains isolated in Korea containing a multiresistance class 1 integron. Antimicrob. Agents Chemother. 2003;47:2006-8.

Panigrahi D, al-Aneziz AH, West PW. Plasmid mediated multidrug resistance in Salmonella typhi in Kuwait. Trop Med Int Health. 1996;1:439-42.

Ploy MC, Chainier D, Thi NHT, Poilane I, Cruaud P, Denis F et al. Integron-associated antibiotic resistance in Salmonella enterica serovar Typhi from Asia. Antimicrob Agents Chemother. 2003;47:1427-9.






Original Research Articles