Clinical Profile of Enteric Fever in Children of a Tertiary Care Centre in Kathmandu, Nepal

Abstract

Background: Enteric fever, commonly known as typhoid fever is a global public health problem. It is one of the common infectious diseases of humans, fever lasting for more than 7 days. It is transmitted by faecooral route and common in the areas with poor sanitation. Globally, majority of the Typhoid fever is caused by Salmonella enterica var typhi, one fifth of the infection is caused by Salmonella enterica var paratyphi. This study was conducted to describe clinical and laboratory parameters among children with enteric fever.
 Methods: It was a descriptive cross-sectional study conducted in the Pediatric ward and Pediatric Intensive Care Unit (PICU) of Nepal Medical College Teaching Hospital (NMCTH), Atterkhel, Kathmandu, Nepal from 2015 January to 2015 December. Inclusion criteria: clinical details and laboratory parameters of children aged 13 months to 15 years old with diagnosis of enteric fever was obtained in the proforma and descriptive statistics were calculated.
 Result: A total of 1,020 children with the sign and symptom suggestive of enteric fever were admitted in the inpatient department (Pediatrics) during the study period. All the enteric fever suspected children were tested for blood culture, Widal test and complete blood count, out of them 80 children were diagnosed as enteric fever. Male female ratio is 1.6:1. Fever was the most common clinical feature observed in 95% cases and other common features were loose motion (37.5%), vomiting (33.8%) and abdominal pain (27.5%). Hepato-splenomegaly is common finding of Enteric fever reported in 85.0% and 43.7%. Majority of the patients had normal leucocyte count (71.0%) and leucopenia reported in 20.0%.
 Conclusion: Fever and hepato-splenomegaly were the major clinical presentation of typhoid fever in our study. Other less common features were loose motion, vomiting and abdominal pain. This finding may be useful for the pediatrician and other health professionals for the early diagnosis of enteric fever.

Salmonella infection among the pediatric population at a tertiary care children’s hospital in central Nepal: a retrospective study

“…Only 3% of Salmonella ser. Paratyphi B infection cases among the Nepalese population have been reported, rendering it an uncommon bloodstream infection (Pokhrel et al, 2009;Karkey et al, 2010;Zellweger et al, 2017;Garrett et al, 2022), which is quite similar (n = 1, 0.1%) to our study observation but differs (higher, 10%) from another scientific publication in Nepal (Budhathoki et al, 2020). The higher proportion of ser.…”

“…Children in the age group between 1 and 5 years were the most commonly infected (n = 42, 46.1%), with the least among those aged between 11 and 15 years (n = 12, 13.2%), similarly to the findings in India (Das et al, 2016), Pakistan (Rafiq et al, 2009;Britto et al, 2017), and other studies in the series (Mahle and Levine, 1993;Pang et al, 1995). However, this was in contrast (lower, 26.5%, 21.3%, and 14%,) to other publications in Pakistan, Nepal, and India for the age group between 1 and 5 years, respectively (Siddiqui et al, 2006;Budhathoki et al, 2020;Behera et al, 2021). The age-related variation in our findings highlights the possibility of reduced documentation of the disease, poor clinical suspicion, prior antimicrobial treatment before blood culture, and difficulty in withdrawing blood resulting in poor laboratory and clinical outcomes (Britto et al, 2018), along with immunological reasons such as immature and unstable gut microbiome and gut immune function in children between 1 and 5 years of age, easily exposing them to bacterial infections such as S. Typhi in comparison to older ones (Nuriel-Ohayon et al, 2016).…”

“…The findings from our study could be attributed to prior antimicrobial treatment received by the affected age group (1-5 years) before obtaining a blood sample for culture and sensitivity (Britto et al, 2018). Additionally, only 1.04% of Paratyphi A cases according to our estimates are comparable to a publication from Pakistan (Siddiqui et al, 2006) but discordant (higher, 17% and 12%) to few studies from Nepal (Prajapati et al, 2008;Budhathoki et al, 2020) and another population-based enteric fever surveillance (higher, >99%), respectively (Garrett et al, 2022). The variation in Paratyphi A cases in our findings could be attributed to the asymptomatic infections manifested by this ser.…”