DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20173779

Clinical profile of enteric fever in tertiary care hospital of Kashmir

Sheikh Mushtaq, Altaf Ahmad Bhat, Ghulam Nabi Rather, Rukaya Akhter, Iqra Bhat, Tariq Wani

Abstract


 

Background: Enteric fever is common cause of pyrexia in children and its diagnosis poses several problems, the diagnosis most often remains either as an unsubstantiated clinical impression or a serological diagnosis and occasionally confirmed by blood culture. Typhoid fever is a commonly encountered systemic disease caused by the gram-negative bacteria Salmonella enterica serovar typhi. It is a major public health problem in India. The incidence of enteric fever can be regarded as an index of sanitary measure practiced in our country. Aim of our study was to know the clinical profile, hematological features of clinically and serologically suspected typhoid cases, antibiotic pattern in use, the time to defervescence with the treatment received and over all hospital stay days.

Methods: This was a retrospective record file review of all admitted children for pyrexia under evaluation who were clinically suspected as cases of enteric fever and serologically proven by significant titres of O and H antigen and few were culture proven cases of enteric fever carried out at a tertiary care children hospital in Kashmir valley over the period January 2012 to January 2016.

Results: During this period, a total of 129 children with typhoid fever were admitted to Pediatric ward. Of the 129 children, 69 (53.5%) were boys and 60 (46.5%) were girls. The age range of the study population was 1 year to 15 years. The predominant symptoms of typhoid fever were fever 123 (95.3%), anorexia/weakness 58 (45.0%), abdominal pain 53 (41.1%), pallor 47 (36.4%), coated tongue 42 (32.6%), headache 30 (23.3%) and gastrointestinal symptoms/ dysentry 9 (7.0%). Diarrhea 25 (19.4%) was more common than constipation 5 (3.9%) in this study. Hepatomegaly 26 (20.2%) and splenomegaly 67 (51.9%), lymphadenopathy 24 (19.4%) and seizure in 5 cases (3.9%) were other major physical findings. Typhoid complications were seen in the form of jaundice (deranged LFTs) 25 (19.4%), abdominal distention 20 (15.5%) and tenderness 14 (10.9%), encephalopathy 5 (3.9%), shock 3 (2.3%) and UTI 4 (3.1%). Blood culture was positive in 36 (27.9%), 20 (15.5%) percent of the isolates were Salmonella typhi, while 16 (12.4%) were Salmonella paratyphi A. low yield was attributed to oral antibiotics received outside hospital setting. Ceftriaxone was used to treat all the patients diagnosed with enteric fever. Oral Azithromycin was added to treatment regime in those patients who were persistently febrile after 6 days. Those patients who were discharged before 14 days, therapy was completed with oral cefixime. The mean duration of hospital stay was 9.6 days for uncomplicated cases. Leukopenia was seen in majority of the patients with mean cell count of 6492.7cubic/mm. The mean time to defervescence in patients who received prior antibiotics was 4 days while that in those who did not receive prior antibiotics was 5 days.

Conclusions: Atypical presentations are seen in typhoid fever patients so we need to be cautious about it, clinical symptoms and signs can vary with different regional studies, may be attributed to use of empirical oral antibiotic that alter the clinical presentation of enteric fever. Low culture positivity is due to prior or ongoing antibiotic treatment outside hospital setting. Leucopenia could be an important marker of typhoid. Ceftriaxone is important available cephalosporin for sensitive cases. Combination treatment was used to treat persistently febrile child. 


Keywords


Children, Enteric fever, Salmonella, Typhoid

Full Text:

PDF

References


Chowta MN, Chowta NK. Study of Clinical Profile and Antibiotic Response in Typhoid Fever. Indian J Med Microbiol. 2005;23:125-7.

Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Nelson’s text book of Pediatrics. 18th ed. Saunders; New York: Elsevier; 2007:1186-90.

House D, Wain J, Ho VA, Diep TS, Chinh NT, Bay PV, et al. Serology of typhoid fever in an area of endemicity and its relevance to diagnosis. J Clin Microbiol. 2001;39:1002-7.

Olsen SJ, Pruckler J, Bibb W, Nguyen TM, Tran MT, Sivapalasingam S, et al. Evaluation of rapid diagnostic tests for typhoid fever. J Clin Microbiol. 2004;42:1885-9.

Frenek RW, Mansour A, Nakhla I, Sultan Y, Putnam S, Wierzba T, et al. Short-course azithromycin for the treatment of uncomplicated typhoid fever in children and adolescents. Clin Infect Dis. 2004;38:951-7.

Clinh NT, Parry CM, Ly NT, Ha HD, Thong MX, Diep TS, et al. A randomized control comparison of azithromycin and ofloxacin for treatment of multidrug-resistant or nalidixic acid resistant enteric fever. Antimicrob Agents Chemother. 2000;44:1855-59.

Butler T, Sridhar CB, Daga MK, Pathak K, Pandit RB, Khakhria K, et al. Treatment of typhoid fever with azithromycin versus chloramphenicol in a randomized multicentre trial in India. J Antimicrob Chemother. 1999;44:243-50.

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

Kadhiravan T, Wig N, Kapil A, Kabra SK, Renuka K, Misra A. Clinical outcomes in typhoid fever : Adverse impact of infection with nalidixic acid – resistant Salmonella typhi. BMC Infectious Diseases. 2005;5:37.

Deshmukh CT, Nadkarni UB, Karande SC. An analysis of children with typhoid fever admitted in 1991. J Postgrad Med. 1994;40:204-7.

Ananthanarayan R, Paniker CKJ. Textbook of Microbiology. 6th ed. (Orient Longman Private Ltd., Hyderabad, India); 2000:267-80.

Jog S, Soman R, Singhal T, Rodrigues C, Mehta A, Dastur FD. Enteric fever in Mumbai–clinical profile, sensitivity patterns and response to antimicrobials. JAPI. 2008;56:237-40.

Walia M, Gaind R, Mehat R, Paul P, Aggarwal P, Kalaivani M. Current perspectives of enteric fever: A hospital- based study from India. Ann Trop Paediatr. 2005;25:161-74.

Singh SD, Shrestha S, Shrestha N, Manandhar S. Enteric fever in children at Dhulikhel Hospital. J Nepal Paediatr Society. 2013;23;32(3):216-20.

Abdullah F, Haider N, Fatima K. Enteric fever in Karachi: Current antibiotic susceptibility of salmonellae isolates. JCPSP. 2012;22:147-50.

Butt T, Ahmad Salman N, Razmi SY. Changing trends in drug resistance among typhoid salmonellae in Rawalpindi, Pakistan. East Mediterr Health J. 2005;11:1038-44.

Rodrigues C, Shenai S, Mehta A. Enteric fever in Mumbai: the good news and the bad news. Clin Infect Dis. 2003;36:535.

Gautam V, Gupta N, Chaudhary U, Arora DR. Sensitivity pattern of Salmonella serotypes in Northern India. Brazilian J Infect Dis. 2002;6:281-7.

Safdar A, Kaur H, Elting L, Rolston KV. Antimicrobial susceptibility of 128 14. Salmonella enterica serovar typhi and paratyphi A isolates from northern India. Chemotherapy. 2004;50:88-91.

Chande C, Shrikhande S, Kapale S, Agrawal S, Fule RP. Change in antimicrobial resistance pattern of Salmonella typhi in central India. Indian J Med Res. 2002;115:248-50.