scholarly journals Clinical profile of enteric fever in tertiary care hospital of Kashmir

2017 ◽  
Vol 4 (5) ◽  
pp. 1754
Author(s):  
Sheikh Mushtaq ◽  
Altaf Ahmad Bhat ◽  
Ghulam Nabi Rather ◽  
Rukaya Akhter ◽  
Iqra Bhat ◽  
...  
Keyword(s):  
Blood Culture ◽  
Typhoid Fever ◽  
Hospital Stay ◽  
Enteric Fever ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Clinical Profile ◽  
Febrile Child ◽  
Oral Antibiotic ◽  
The Mean

 Background: Enteric fever is common cause of pyrexia in children and its diagnosis poses several problems, the diagnosis most often remains either as an unsubstantiated clinical impression or a serological diagnosis and occasionally confirmed by blood culture. Typhoid fever is a commonly encountered systemic disease caused by the gram-negative bacteria Salmonella enterica serovar typhi. It is a major public health problem in India. The incidence of enteric fever can be regarded as an index of sanitary measure practiced in our country. Aim of our study was to know the clinical profile, hematological features of clinically and serologically suspected typhoid cases, antibiotic pattern in use, the time to defervescence with the treatment received and over all hospital stay days.Methods: This was a retrospective record file review of all admitted children for pyrexia under evaluation who were clinically suspected as cases of enteric fever and serologically proven by significant titres of O and H antigen and few were culture proven cases of enteric fever carried out at a tertiary care children hospital in Kashmir valley over the period January 2012 to January 2016.Results: During this period, a total of 129 children with typhoid fever were admitted to Pediatric ward. Of the 129 children, 69 (53.5%) were boys and 60 (46.5%) were girls. The age range of the study population was 1 year to 15 years. The predominant symptoms of typhoid fever were fever 123 (95.3%), anorexia/weakness 58 (45.0%), abdominal pain 53 (41.1%), pallor 47 (36.4%), coated tongue 42 (32.6%), headache 30 (23.3%) and gastrointestinal symptoms/ dysentry 9 (7.0%). Diarrhea 25 (19.4%) was more common than constipation 5 (3.9%) in this study. Hepatomegaly 26 (20.2%) and splenomegaly 67 (51.9%), lymphadenopathy 24 (19.4%) and seizure in 5 cases (3.9%) were other major physical findings. Typhoid complications were seen in the form of jaundice (deranged LFTs) 25 (19.4%), abdominal distention 20 (15.5%) and tenderness 14 (10.9%), encephalopathy 5 (3.9%), shock 3 (2.3%) and UTI 4 (3.1%). Blood culture was positive in 36 (27.9%), 20 (15.5%) percent of the isolates were Salmonella typhi, while 16 (12.4%) were Salmonella paratyphi A. low yield was attributed to oral antibiotics received outside hospital setting. Ceftriaxone was used to treat all the patients diagnosed with enteric fever. Oral Azithromycin was added to treatment regime in those patients who were persistently febrile after 6 days. Those patients who were discharged before 14 days, therapy was completed with oral cefixime. The mean duration of hospital stay was 9.6 days for uncomplicated cases. Leukopenia was seen in majority of the patients with mean cell count of 6492.7cubic/mm. The mean time to defervescence in patients who received prior antibiotics was 4 days while that in those who did not receive prior antibiotics was 5 days.Conclusions: Atypical presentations are seen in typhoid fever patients so we need to be cautious about it, clinical symptoms and signs can vary with different regional studies, may be attributed to use of empirical oral antibiotic that alter the clinical presentation of enteric fever. Low culture positivity is due to prior or ongoing antibiotic treatment outside hospital setting. Leucopenia could be an important marker of typhoid. Ceftriaxone is important available cephalosporin for sensitive cases. Combination treatment was used to treat persistently febrile child. 

scholarly journals CLINICAL PROFILE OF TYPHOID FEVER IN CHILDREN

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Shaitan Singh Balai
Keyword(s):  
Typhoid Fever ◽  
Enteric Fever ◽  
Tertiary Care ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Clinical Profile ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Main Complaint ◽  
Clinical Signs And Symptoms

Background: The present study describes the clinical presentation of enteric fever at a tertiary care centre. Methods: The study was a hospital based prospective observational study conducted on  children of age 2 -18 years who presented with fever of 5 days or more with clinical signs and symptoms suggestive of typhoid fever and positive Widal test or Typhidot tests were included in the study. The demographic and clinical features of the patients were described. Results: All the children presented with fever as the main complaint (100%). Commonest sign noticed was toxic look (84%) followed by coated tongue (79%) and splenomegaly (61%). Hepatomegaly was also noted in 34% of cases. Conclusion: This study was undertaken to observe the clinical profile of typhoid fever in children admitted in a tertiary care hospital. Typhoid fever remains to be as an endemic disease in this locality. All the signs and symptoms of the disease are nonspecific common with other acute febrile illnesses; a definitive diagnosis of the disease is required for treatment and to prevent transmission. Keywords: Enteric fever, Splenomegaly, Toxic look

scholarly journals Blood Culture and Widal Test as Diagnostic Tools for Enteric Fever with Antibiogram in a Tertiary Care Centre at Dhaka in Bangladesh

2021 ◽  
pp. 97-106
Author(s):  
Sushmita Roy ◽  
Iftikhar Ahmed ◽  
Provash Chandra Saha ◽  
Bhuiyan Mohammad Mahtab Uddin ◽  
Mejbah Uddin Ahmed ◽  
...  
Keyword(s):  
Blood Culture ◽  
Typhoid Fever ◽  
Antibody Titer ◽  
Antibiotic Susceptibility ◽  
Enteric Fever ◽  
Tertiary Care ◽  
Diagnostic Methods ◽  
Diagnostic Tools ◽  
Widal Test ◽  
Sensitivity Pattern

Background: Enteric fever still exists as one of the major public health issue occurring in our country. Antimicrobials are the mainstays of treatment of typhoid fever. Due to rapidly growing antibiotic resistance, Salmonella spp. is required to be periodically tested for susceptibility patterns. This will also enable planning of rational use of antibiotics. Objective: To observe the diagnostic accuracy of enteric fever by blood culture and Widal test in a tertiary care center, at Savar, Dhaka; Bangladesh. Antimicrobial sensitivity pattern of this study will guide to modify recent changes in the trends of antimicrobial use at the local level. Methodology: Blood samples were collected from 2194 febrile patients with clinically suspected enteric fever cases at a Tertiary Care Outdoor Centre from January 2017 to March 2020. Blood culture was performed to isolate S. typhi and S. paratyphi. Widal tests were done for the determination of antibody titer. An antibody titer of ≥1:80 for anti TO and anti TH were taken as a cut off value to indicate recent infection of typhoid fever. Antibiotic susceptibility testing was carried out using modified disk diffusion (Kirby–Bauer) technique. Results: Out of 111 Salmonella isolates, 74 (5%) were S. typhi and 37 (25%) were S. paratyphi A.  Total 697 samples were positive for Widal test. A large number of isolates showed resistance to commonly used antibiotics such as nalidixic acid (94.6%), chloramphenicol (87.3%), amoxicillin (76.6%), cephradine (53.1%), azithromycin (46.8) etc. Resistance to cefixime and cefipime, ceftriaxone tended to increase than past. Imipenem, moxifloxacin and cefuroxime are escalating resistance which is alarming. Conclusion: Blood culture is the most reliable among the diagnostic methods but it needs 5 to 7 days for delivery of final report. This delay leads to late diagnosis as well as provision of irrational usage of antibiotics. It is concluded that widal test would remain relevant as a diagnostic tool for enteric fever, which is more convenient, cheaper and faster than the other molecular tests. Our study revealed the antibiotic susceptibility of Salmonella isolates will be recommended for addressing the drug resistance.

scholarly journals Clinical outcome of infants younger than two months in children ward of a tertiary care hospital, Nepal

2016 ◽  
Vol 3 (2) ◽  
pp. 15-18
Author(s):  
Ganesh Shah ◽  
Dinesh Dharel ◽  
Anish K Shah ◽  
Bikal Sapkota ◽  
Asmita Bhattarai
Keyword(s):  
Blood Culture ◽  
Clinical Outcome ◽  
Skin Infection ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Facility ◽  
Clinical Profile ◽  
Care Hospital ◽  
Young Infants ◽  
Level Hospital

 Introductions: Newborn and young infants are most vulnerable for preventable deaths, particularly in developing countries. This study was conducted to see the clinical profile and outcome of infants less than two months of age admitted in children ward of Patan Hospital.Methods: This descriptive retrospective study was conducted at Patan Hospital, over 12 months from April 2014 to March 2015. Hospital records of all admitted infants aged less than two months were reviewed. The demographic characteristics, clinical profile and clinical outcome were descriptively analyzed.Results: Out of 2062 admissions in children ward, 614 (29.8%) were infants aged less than two months, out of which 482 were neonates less than 28 days. Among these neonates, 114 were inborn. Out of 436 infections, blood culture was positive in 37 (8.9%). There were 4 (0.04%) deaths, 4 (0.04%) referral and 22 (0.25%) left against medical advice. Infection 436 (436) was the commonest cause of illness, of which neonatal sepsis was 163 (37.4%), pneumonia 130 (30%) staphylococcal skin infection 39 (8.7%) and UTI 34 (7.8%). There were 71 (11.6%) cases of neonatal hyperbilirubinemia. Blood culture was positive in 55 (9%) with CONS being the commonest organism isolated; 19 (51.3%).Conclusions: Children ward contributes significantly to the care of sick infants less than two months of age, especially out born ones, requiring neonatal care facility in tertiary level hospital of Nepal. As most admissions are for infection, followed by hyperbilirubinemia, pediatrics wards need to be equipped and staffed accordingly to meet the need of sick young infants.Journal of Patan Academy of Health  Sciences. 2016 Dec;3(2):15-18

scholarly journals Utility of A Single Widal Test in The Diagnosis of Typhoid Fever

2012 ◽  
Vol 35 (2) ◽  
pp. 53-58 ◽  
Author(s):  
ABM Shahidul Alam ◽  
Fahim Ahmed Rupam ◽  
Farhana Chaiti
Keyword(s):  
Blood Culture ◽  
Typhoid Fever ◽  
Predictive Value ◽  
Salmonella Typhi ◽  
Definitive Diagnosis ◽  
Blood Cultures ◽  
Widal Test ◽  
Female Ratio ◽  
The Mean ◽  
Agglutinin Titer

Background & objectives: The clinical diagnosis of typhoid fever is difficult, as the presenting symptoms are often diverse and similar to those observed with other febrile illnesses. The definitive diagnosis of typhoid fever requires the isolation of Salmonella typhi or paratyphi from the patient concerned. Since patients often receive antibiotics prior to a confirmatory diagnosis, there is uncertainty that bacteria can be isolated from the blood cultures. Besides this, the facilities for blood culture are not always available or feasible. All these limitations have made Widal test the most utilized diagnostic test for typhoid fever. Many studies have produced data which had cast serious doubts on the value of the Widal Test and thus reappraisal of the role of a single Widal test is needed.Methods & materials: This study was carried out to determine the changes in clinical pattern of enteric fever. A total of 153 children, aged 0 to 14 years, diagnosed as typhoid fever (either positive blood culture for Salmonella typhi or paratyphi) were induced in the study. Of them, 86 children were with a definitive diagnosis of typhoid or paratyphoid fever as indicated by the isolation of S. typhi or S. paratyphi from the blood and 17 had negative blood culture but were clinically suspected of having typhoid fever. The control group was comprised of 50 children with non-typhoidal fevers The Widal test was carried out using rapid slide agglutination method and its accuracy was assessed by comparing the findings with that obtained through blood culture.Result: The mean age of the patients was 5.2 ± 2.8 years and the youngest and oldest patients were 0.7 and 14 years respectively and male to female ratio was roughly 1:1. Nearly one-quarter (24.6%) of the patients had been suffering from the disease for >10 days and the mean duration of illness was 8.2 ± 3.3 days. Widal Test result showed that an ‘O’ agglutinin titer of cut-off value e”1:40 gave a sensitivity of 87.2%, a specificity of 47.1%, a positive predictive value (PPV) of 89.2% and a negative predictive value (NPV) of 42.1%. The sensitivity and NPV decreased with the increase in titer levels and were 56.9% and 31.5% at cut-off value of e” 1:320, while the specificity and PPV increased with the increase in titer levels from 47.1% and 89.2% respectively at a titer of e”1:40 to 100% at a titer of e” 1:320. The ‘titer behaved in the same way as did the ‘O’ agglutinin titer. Similarly when H’ agglutinin was used the sensitivity and NPV decreased from 65% and 31.7% at a titer of e”1:40 to only 25% and 20% respectively at a titer of > 1:320, while specificity and PPV increased from 76.4% and 81.1% at >1:40 to 94.1% and 95.6% respectively at e” 1:320. When either ‘O’ or ‘H’ antibody titer of e”1:160 was used, a good sensitivity (71%), specificity (70.6%) and PPV (92.4%) resulted, though NPV decreased to 32.4%.Conclusion: The Widal test can be of diagnostic value when blood cultures are not available nor practically feasible.DOI: http://dx.doi.org/10.3329/bjch.v35i2.10377  Bangladesh J Child Health 2011; Vol 35 (2): 53-58

scholarly journals Comparative Widal Reaction for IgG/IgM Complement C3, lymphocyte and Neutrophils Assay in Patients with Suspected Typhoid Fever in Selected Hospitals in Kaduna State, Nigeria

2020 ◽  
pp. 3618-3627
Author(s):  
Ella E. E. ◽  
Tijjani S. ◽  
Aminu M.
Keyword(s):  
Typhoid Fever ◽  
Plasma Levels ◽  
Lymphocyte Count ◽  
Enteric Fever ◽  
Complement C3 ◽  
Immunochromatographic Assay ◽  
Agglutination Reaction ◽  
Complement Factors ◽  
The Mean ◽  
Haematological Indices

Typhoid also known as enteric fever is endemic in Nigeria most often diagnosed by the widal reaction though the results of this test are being questioned in many quarters. This has necessitated the search for other methods for analysis. This work is aimed at comparing the widal reaction with the rapid immunochromatographic assay the complement C3 and selected haematological indices. Two ml of blood was collected from 350 patients with suspected typhoid infection and analysed by the widal slide agglutination reaction and the IgG/IgM Immunochromatographic assay. Complement C3 was assayed by ELISA while neutrophils and Lymphocyte counts were also performed. The finding showed that 41(11.7%) and 29 (8.3%) were positive for S. typhi IgG and IgM respectively out of 350 patients. It was found that 207 patients had O-antigen widal reaction titres 1/80 and above for S. typhi out of which, 30 (14.5%) and 22(22.6%) were IgG and IgM positive respectively. Those with reactions 1/80 and above to the H-antigen were 118 with 24(20.3%) cases of IgG and 13(11.0%) of IgM. The mean neutrophil and lymphocyte count in the IgM positive were 48.90 ± 20.060 and 60.28±17.64 as compared to the negatives (48.46 ±18.95 and 55.02±19.19 respectively). The mean neutrophil and lymphocyte count of IgG positive were 50.68±19.65 and 57.22±19.72) while the negatives were 48.20±1.08 and 55.23±19.04. the mean plasma levels of complement factors C3 in the IgG positive was 630.70±327.41 as compared to those that are negative (626.97±247.72). The complement C3 levels was significantly higher (P =0.000) in the IgM positive (816.45±406) as compared to the IgM negatives (610.33±233.40). No significant association was observed between the clinical features and the typhoid positives.

scholarly journals CLINICAL PROFILE OF TYPHOID FEVER IN CHILDREN

2021 ◽  
Vol 5 (12) ◽  
Author(s):  
Poonam Meena ◽  
Satish Meena ◽  
Ashok Meena ◽  
Kailash Meena
Keyword(s):  
Typhoid Fever ◽  
Prospective Study ◽  
Enteric Fever ◽  
Clinical Presentation ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Definitive Diagnosis ◽  
Clinical Profile ◽  
Widal Test ◽  
Clinical Signs And Symptoms

Background: The present study describes the clinical presentation of typhoid fever. Methods: The study was a hospital based prospective study. Children of age 2 -18 years who presented with fever of 5 days or more with clinical signs and symptoms suggestive of typhoid fever and positive Widal test or Typhidot tests were included in the study. Results: Commonest sign noticed was toxic look (88.00%) followed by coated tongue (79.00%) and splenomegaly (63.00%). Hepatomegaly was also noted in 35.00% of cases. Conclusion: Typhoid fever remains to be as an endemic disease in this locality. All the signs and symptoms of the disease are nonspecific common with other acute febrile illnesses; a definitive diagnosis of the disease is required for treatment and to prevent transmission. Keywords: Enteric fever, Splenomegaly, Toxic look

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

2020 ◽  
Vol 7 (4) ◽  
pp. 901
Author(s):  
Shekar V. ◽  
Chapay Soren ◽  
Lakshmi Aparnadevi V. V. ◽  
Umadevi M. ◽  
Malathi Vanka
Keyword(s):  
Typhoid Fever ◽  
Clinical Presentation ◽  
Tap Water ◽  
Tertiary Care ◽  
Antibiotic Sensitivity ◽  
Public Health Problem ◽  
Clinical Profile ◽  
Drinking Water Source ◽  
Chloramphenicol Resistance ◽  
Sensitivity Pattern

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.

scholarly journals Clinical spectrum of enteric fever in children admitted to a tertiary care hospital

2020 ◽  
Vol 7 (7) ◽  
pp. 1530
Author(s):  
Jawad Nazir Wani ◽  
Abdus Sami Bhat ◽  
Saleem Yusuf ◽  
Umer Amin Qureshi
Keyword(s):  
Public Health ◽  
Blood Culture ◽  
Health Problem ◽  
Enteric Fever ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Clinical Spectrum ◽  
Care Hospital ◽  
Presenting Symptoms ◽  
Normal White Blood Cell

Background: Enteric fever is a common public health problem with variable clinical presentation. The aim of study was to study the clinical spectrum of enteric fever in children.Methods: This was a prospective study conducted over period of one year from January 2019 to January 2020 in the Department of Paediatrics at Govt Medical College Srinagar. It included all patients in the age group of 1-18 years who were clinically suspected to have enteric fever and had either a positive blood culture for Salmonella or a positive Widal test.Results: This study included total of 76 patients out of which 36 were males and 40 were females. The most common presenting symptoms were fever anorexia, vomiting, diarrohea, abdominal pain, headache and constipation. The most common signs were coated tongue, toxic look, hepatomegaly, splenomeagly, pallor, jaundice and abdominal distension. Complications were seen in in 8 (10.5%) patients. Myocarditis was seen in 3 patients. Encephalopathy and hepatitis was seen in 2 patients each. Pneumonia was seen in 1 patient. Majority of patients had normal white blood cell count (4000-11000/cumm). Leukopenia (<4000/cumm) was seen in 10% patients and leukocytosis (>11000/cumm) was seen in 15% patients. Thrombocytopenia was seen in 9% patients. Blood culture was positive in 36 (47.36%) patients. Salmonella typhi was seen in 33 patients whereas Salmonella paratyphi A was seen in 3 patients. All culture positive cases were sensitive to ceftriaxone, cefixime and azithromycin. Ciprofloxacin resistance was seen in 11 (14.4%) patients.Conclusions: Enteric fever is a common public health problem with fever as most common presenting symptom. Culture yield can be increased in enteric fever by drawing blood culture prior to administration of antibiotics. Ceftriaxone is highly efficacious as monotherapy in enteric fever.

scholarly journals Convulsive status epilepticus in children: clinical profile and outcome in a tertiary care hospital

2019 ◽  
Vol 6 (2) ◽  
pp. 280
Author(s):  
Madhu P. K. ◽  
Krithika R.
Keyword(s):  
Status Epilepticus ◽  
Hospital Stay ◽  
Tertiary Care ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Refractory Status Epilepticus ◽  
Clinical Profile ◽  
Convulsive Status Epilepticus ◽  
Care Hospital ◽  
Mortality And Morbidity

Background: The outcome of status epilepticus (SE) depends on various determinants such as age, type and duration of SE, etiology, management and associated comorbidities. This study was undertaken to describe the clinical profile and outcome of children with convulsive status epilepticus presenting to pediatric intensive care unit (PICU).Methods: Eighty-seven children between the age group 1 month to 12 years who at presentation or during the PICU stay had convulsive status epilepticus (CSE) were included in the study. Clinical profile, etiological spectrum and outcome at the end of hospital stay were analysed.Results: Median age of CSE was 4 years and 55 (63.2%) were below 5 years of age.  Acute symptomatic etiology of CSE was a significant risk factor (p= 0.03) for refractory status epilepticus (RSE) which was seen in 31 patients (39%). Acute symptomatic etiology was the cause of CSE in 46 (59.2%) children. Remote symptomatic (26.4%), cryptogenic (18.4%) and progressive (2.3%) were other etiologies. Neuro-infection (29.8%) and febrile seizures (11.5%) were the most common acute symptomatic causes. Mortality and morbidity occurred in 23 (26.4%) and 8 (9.2%) patients respectively. Remaining 56 (64.6%) returned to baseline condition at the end of hospital stay. Longer duration (p= 0.03) and acute symptomatic etiology (p=0.049) were significant risk factors for mortality.Conclusions: Most common causes of CSE in children are acute symptomatic. Longer duration of status is associated with higher mortality. Hence, termination of seizure activity at the earliest, prudent management of respiratory or circulatory impairments in these children and improving the overall health care to prevent neuro-infections are important steps to improve outcome.

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