DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20201151

Clinical profile and antibiotic sensitivity pattern of typhoid fever in children: a hospital based prospective study from a tertiary care center

Shekar V., Chapay Soren, Lakshmi Aparnadevi V. V., Umadevi M., Malathi Vanka

Abstract


Background: Typhoid fever is a serious public-health problem in many developing countries including India. There is a wide spectrum of clinical presentation and with the emergence of multidrug resistant typhoid now a days, the treatment has become still more complex. The present study authors describe the clinical profile and antibiotic sensitivity pattern of typhoid fever in children from a tertiary care in Mahabubnagar, Telangana, South India.

Methods: This hospital based prospective observational study was done in Department of Pediatrics, SVS Medical College, Mahabubnagar, Telangana over a period of 3-year period from January 2017 to December 2019. The study was approved by institutional ethics committee. Written informed consent was obtained from children’s parents. All pediatric patients diagnosed as typhoid fever if presented with fever (temperature >38ºC) for at least 3 days with positive blood culture for S. typhi or paratyphi were included in the study. The demographic profile and clinical data were recorded and tests including antibiotic sensitivity and resistance were done.

Results: A total of 136 patients were included in the study. Majority of the children were between 8 to 12-year age group (38.2%). Out of 136 children, 78 were males and 58 were females. Majority of the cases were from rural areas accounting for 69%. Drinking water source was tap water in 63% cases and bore well water in 37% cases. Majority (65%) belonged to lower socioeconomic class and 68% were during rainy seasons. The clinical findings observed were fever (100%), vomiting (98, 72%), diarrhea (55.8%), headache (45.5%), and splenomegaly (42.6%). Other clinical features found were coated tongue, abdominal pain, hepatomegaly, constipation, and dehydration. Six children had complications, 3 had enteric hepatitis, 2 had shock, and 1 had encephalopathy. Ampicillin, amoxicillin and chloramphenicol resistance was observed in 76%, 71% and 22% of patients with typhoid fever respectively. Maximum sensitivity was observed with ceftriaxone (95%), followed by aztreonam (92%), ciprofloxacin (84.5%), and azithromycin (77%).

Conclusions: Clinical presentation in the study subjects was similar to available reports from literature. Increasing resistance of salmonella to Ampicillin and amoxicillin were observed.


Keywords


Antibiotic sensitivity, Ceftriaxone, Salmonella, Typhoid fever

Full Text:

PDF

References


Buckle GC, Walker CL, Black RE. Typhoid fever and paratyphoid fever: systematic review to estimate global morbidity and mortality for 2010. J Global Health. 2012 Jun;2(1): 010401.

Mehta PJ, Hakim A, Kamath S. The changing faces of salmonellosis. J Assoc Phys Ind. 1992 Nov;40(11):713.

Paniker CK, Vimala KN. Transferable chloramphenicol resistance in Salmonella typhi. Nature. 1972 Sep;239(5367):109-10.

Mehta SR, Narula HS, Roy SK. Atypical presentation of enteric fever. MJAFI. 1987;43:58-60.

Issit DD and Anstee DJ. Applied blood group Serology. 4th Ad. Montgomem Scientific Public; 1996:218-46.

Shrestha SK, Basnet S. Antibiotic sensitivity pattern in culture positive typhoid fever cases isolated at Patan hospital. J Pathol Nepal. 2019 Mar 29;9(1):1450-2.

Baviskar SP, Bendale AG. A clinical profile and associated factors with typhoid fever inchildren at tertiary health care center. Med Pulse Intern J Pediatr. May 2017;2(2):12-4.

Ganesh R, Janakiraman L, Thiruvengadam V, Sathiyasekeran M. Profile of Typhoid Fever in Children from a Tertiary CareHospital in Chennai-South India. Ind J Pediatr. 2010;77:1089-92.

Walia M, Gaind R, Paul P, Mehta R, Aggarwal P, Kalaivani M. Age-related clinical and microbiological characteristics of enteric fever in India. Trans Royal Soci Trop Med Hyg. 2006 Oct 1;100(10):942-8.

Siddiqui SS, Koppa SK, Kale AV. Clinical profile of typhoid fever in children at a tertiary care hospital: a cross sectional study. Int J Contemp Pediatr. 2017;4:1951-4.

Jeeyani HN, Prajapati BS, Bloch A. Enteric fever in children: clinical profile, sensitivity patterns and response to antimicrobials. GCSMC J Med Sci. 2015;4(1):40-3.

Maheshwari V, Kaore NM, Ramnani VK. Clinico-Epidemiological Profile of Confirmed Cases ofEnteric fever in Rural area of central India. Int J Curr Microbiol App Sci. 2015;4(12):541-7.

Bhatti S. Enteric fever in adult patients at Akuh, 1998-2001: Epidemiology, Clinical features, lab diagnosis and antibiotic susceptibility patterns. Q Pakistan J of Med SC. 2002 Apr.

Parande MA, Patil CG, Rayate MV, Lukde MU. Epidemiological profile of enteric fever cases admitted in SCSMGH, Solapur. Natl J Commun Med. 2011;2(1):91-5.

Pandey KK, Srinivasan S, Mahadevan S, Nalini P, Rao RS. Typhoid fever below five years. Ind Pediatr. 1990 Feb;27(2):153-6.

Arora R, Gupta A, Joshi N, Kataria V, Lall P, Anand A. Multidrug resistant typhoid fever: study of an outbreak in Calcutta. Cough. 1992 Jan 1;39:37-8.

Sood SC, Taneja PN. Typhoid Fever. Clinical Picture and Diagnosis. Ind J Child Health. 1961;10(2):69-76.

Walia M, Gaind R, Mehta R, Paul P, Aggarwal P, Kalaivani M. Current perspectives of enteric fever: a hospital-based study from India. Annal Trop Paediatr. 2005 Sep 1;25(3):161-74.