Age-related clinical and microbiological characteristics of enteric fever in India

Abstract

A retrospective, hospital-based study at Safdarjang Hospital, India, was undertaken between January 1999 and December 2003 to estimate age-related epidemiological, clinical and microbiological characteristics in enteric fever cases. A total of 750 blood-culture-proven cases of enteric fever were studied. The majority of cases occurred in children aged 5-12 years and 24.8% of cases were in children up to 5 years of age. Salmonella serotypes showed an age-related predilection, with paratyphoid fever more common in adults. Classically-described clinical features of the disease were comparable among patients under and above 5 years of age. Hepatomegaly, anaemia and complications in general were more frequent in children up to 5 years of age. The antimicrobial resistance pattern, irrespective of Salmonella serotype, did not reveal a statistically significant difference across age groups for the different antibiotics tested. Multidrug resistance was seen only in Salmonella enterica serotype Typhi but not in S. Paratyphi A isolates. However, resistance to nalidixic acid was comparable in both serotypes. Age-related differences of serotype isolation rates, clinical presentation and associated complications are noteworthy for better case management and policy planning. More epidemiological studies regarding reasons for age-related differential serotype patterns would enable and guide public health strategies to contain enteric fever in endemic locations.

Comparison of Salmonella typhi and Paratyphi A Occurrence in a Tertiary Care Hospital

“…These observations were consistent with various studies [14,17,18]. Enteric fever cases have occurred throughout the year in our study which implies that safety of drinking water and sanitation have not improved much over the period or a large number of carriers are present in the society [19].…”

Antibiotic resistance among Salmonella enterica serovars Typhi and Paratyphi A in Pakistan (2001-2006)

“…Moreover, our finding is in contrast to data from Delhi reporting no difference in antimicrobial resistance across age groups in their patients [30]. Our data of higher resistance to co-trimoxazole, chloramphenicol and ampicillin among isolates from the younger age group and greater fluoroquinolone resistance in strains from older patients is consistent with antimicrobial usage in these two patient groups.…”

“…Comparison of strain distribution between adults and children showed that children bore 79.3% of the S. Typhi burden as compared to 59.9% of S. Paratyphi A. This difference, while similar to that reported from India [29,30], is difficult to explain. It is possible to hypothesise that, when compared to S. Typhi, the lower overall prevalence of S. Paratyphi A in the community reduces chances of exposure and hence likelihood of disease in the younger age group.…”

Antimicrobial resistance pattern of Salmonella enterica servars in Southern Delhi

“…These figure are consistent with other studies. [15][16][17][18] Proper treatment with antibiotics can reduce the mortality from 30% to 0.5%. 19 But constant rise in antibiotic resistance in S. enterica has become a therapeutic concern for clinicians in endemic regions for patients and travelers who visit these regions and are not vaccinated.…”

“…16 Single mutation in gyrA is said to be responsible for decreased susceptibility to ciprofloxacin whereas combination of 2 or more mutations in gyrA, gyrB, parC and parE makes them resistant. 17 Ciprofloxacin is concentrated in human monocytes and increases their bactericidal activity against intracellular bacteria which may explain why it is still effective in achieving clinical cure in patients with salmonella infections, which is intracellular. But plasmid mediated quinolone resistance has already been reported.…”