Clinico-epidemiological profile and patterns of antibiotic sensitivity of among paediatric patients diagnosed with enteric fever

Abstract

Background: Enteric fever (typhoid and paratyphoid fever) is a major public health concern in developing countries including India. Wide variation in clinical presentations makes its diagnosis on clinical ground a challenging task. Emergence of strain with polymicrobial resistance is a matter of serious concern. Aims: This study was conducted to evaluation of clinic-epidemiological profile and patterns of antibiotic sensitivity of enteric fever cases among paediatric patients. Methods: A prospective observational study was conducted in the Department of Paediatric, Kalawati Saran Children Hospital, New Delhi, India for 18 months.  Total 200 Children aged below 18 years with history of fever of more than 7-10 days duration were included in this study. In each case, age, sex, presenting complaint, laboratory investigations and antibiotic sensitivity pattern are collected and analysed. Results: Out of 200 cases, 135 cases (67.5%) were males and 65 cases (32.5%) were females. Most of the cases were aged between 6 and 12 years. 49 cases were below 6 years, representing 23.5%. 51 cases were aged above 12 years, representing 25.5%. 100 cases were aged between 6 and 12 years (50%). The most common symptom was fever (100%), followed by anorexia (63.5%), vomiting (43.5%), pain abdomen (19%), diarrhea (11%), headache (10.5%), and cough (6%). The most common sign we observed in physical findings, was toxic look in 70% of the cases followed by coated tongue in 48.5%, hepatomegaly 42%, splenomegaly 20.5%, hepatosplenomegaly in 14.5% of cases and pallor in 6% of cases. Anemia found in 42 (21%) cases, leucopenia and leucocytosis was observed in 64(32%) cases and 35(17.5%) cases respectively. Neutropenia found in 85(42.5%) cases and neutrophilia was found in 61(30.5%) cases. Eosinopenia was seen in 91(45.5%) cases, eosinophilia in 17(8.5%) cases and thrombocytopenia in 30(15%) cases. SGOT levels was elevated (>200IU/ml) in 25(12.5%) cases and SGPT (>200IU/ml) in 29(14.5%) cases. The elevated levels of liver enzymes lasted only few days. Salmonella typhiO titres>1:100 was seen in 192(96%) cases and TH titres>1:200 in 151(75.5%) cases. Blood culture positive for Salmonella typhinoted in 44(22%) cases. Out of 200 cases only 62 cases had been immunized with typhoid vaccine. All of them had taken typhoid polysaccharide vaccine more than 3 years prior to illness. The most common sensitivity was seen in all the cases ceftriaxone (97%) and followed by cefixime(95%) , ofloxacin (93%), ciprofloxacin (80%), chloramphenicol (79%), cefotaxime (76%),amoxicillin (63%) and azithromycin in  (51%). S. typhiwas more sensitive to ceftriaxone, cefixime followed by ofloxacin. Least sensitivity was seen with azithromycin. Conclusion: Typhoid fever is a multisystem disease with variable clinical presentations. No sign or symptom is specific for its diagnosis which needs correlation with lab investigations which again are not always helpful. Polymicrobial resistance mandates heightened focus on preventive measures.

Keywords: Children, Clinical profile, Coated tongue, Typhoid fever.