Clinical and Laboratory Features of Enteric Fever in Children and Antibiotic Sensitivity Pattern in a Tertiary Care Hospital of a Low- and Middle-Income Country

Abstract

Background: Globally, enteric fever (EF) significantly gives rise to an appalling death toll. It is an endemic illness in Bangladesh and South Asia. The condition manifests in a wide range of clinical features in children. Nowadays, antibiotic resistance is an international stumbling block that hampers the appropriate treatment and outcome of EF. Objective: The study evaluated the clinical and laboratory characteristics and antibiotic sensitivity pattern of Salmonella enterica in children. Methods: This prospective research was conducted at Delta Medical College and Hospital, Dhaka, Bangladesh, from January 2017 to December 2019. A total of 200 pediatric cases of EF were included in this study who were either culture positive or had significantly raised Widal test titer for Salmonella with suggestive clinical features. Results: All the patients had a fever, and most had coated tongue, vomiting, abdominal pain, organomegaly, and diarrhea. Among the selected 200 cases of EF, 43.5% were Salmonella typhi culture-positive. A high erythrocyte sedimentation rate (ESR) was observed in a substantial number (53%) of patients. Ceftriaxone was the most sensitive (100%) antibiotic through laboratory analysis, followed by cefotaxime (95.1%). Among the oral antibiotics used, cefixime (92.8%) was the most sensitive. Conclusion: EF in children can present with varied clinical manifestations. Selective antibiotic treatment according to sensitivity patterns is crucial for effective illness management and will reduce morbidity and mortality in the pediatric population.

Profile of Enteric Fever in Children Admitted to a Tertiary Care Center in North India

“…On the contrary, a low culture positivity of 43.5 and 20.2% was reported by various authors. 12,15 In our study, S. Typhi (74.3%) was predominant while S. Paratyphi was predominant in the study by Malini et al S. Typhi in our study showed 100% sensitivity to azithromycin, cotrimoxazole, and ceftriaxone, 96% to ampicillin and chloramphenicol, and 2% to ciprofloxacin. Malini et al reported 100% sensitivity to azithromycin, ampicillin, and ceftriaxone, 89% to cotrimoxazole, and 0% to ciprofloxacin.…”

“…10 Fever was the most common presenting complaint in all cases, similar to observations of other authors. 11,12 Anemia was observed in nearly 63% children, and reflects the general anemia rate in Punjab (57.3%), attributed to the iron-deficient diet, childhood illnesses, and parasitic infections. 13 Edema noted in one patient was due to underlying hypoalbuminemia and failure to thrive, and may not be due to enteric fever itself.…”

A phase II clinical trial of a Vi-DT typhoid conjugate vaccine in healthy Indonesian adolescents and adults: one-month evaluation of safety and immunogenicity

“…Globally, about 215 000 deaths occur from about 26 million cases of typhoid and paratyphoid fever per year [ 6 , 7 ] Data from CDC showed that in 2019 in South-East Asia, there were 306 cases of typhoid fever per 100,000 persons [ 8 , 9 ].…”