Utility of Clinical and Laboratory Markers in Diagnosis of Culture Positive Enteric Fever in Children

Abstract

Introduction: Enteric fever, an infectious disease affects children mostly those who are deprived of basic sanitation and potable water. This increases the burden on the healthcare system. Moreover children are more prone to complications if treatment is not initiated early. Aim: To study the utilities of clinical (hepatomegaly, splenomegaly, coated tongue and abdominal tenderness) and laboratory markers (CRP, eosinopenia, Typhidot and Widal) in diagnosis of culture positive enteric fever in children. Methods: This prospective, observational study was done on 201 children over a period of one year in a tertiary care hospital. Result: Blood culture positive fever had a statistically significant correlation with abdominal pain (p- 0.001), vomiting (p-0.004) and loose stools (p-0.002). Blood culture positive enteric fever was significantly associated with coated tongue (p-0.007), hepatomegaly (p-<0.001), splenomegaly (p-<0.001) and abdomen tenderness (p-<0.001). 70(61.9%) of culture positive patients had positive widal. Typhi dot was positive among 70(61.9%) of blood culture positive Enteric fever. Eosinopenia has a high sensitivity (92.9%) but low specificity (25%) in diagnosis of Enteric fever.CRP has a high sensitivity (93.8%) but low specificity (17%) in diagnosis of Enteric fever. Best AUC was observed for Widal test 0.719 (95% CI 0.647-0.790). Conclusion: Clinical and laboratory findings can help the clinician to diagnose enteric fever in the absence of microbiological confirmation and initiation of antimicrobial therapy at an early stage preventing complications.