Clinical Laboratory Profile of Blood Culture Proven Enteric Fever in Children

Introduction: Enteric fever has diverse clinical presentations and laboratory findings and blood culture is gold standard for diagnosis in the children. This study was done to analyse clinical profile and laboratory findings in culture proven enteric fever. Material and Methods: The study was descriptive observational study carried out in the patient aged 14 years of age or less admitted with culture proven enteric fever admitted in a Paediatric ward of a tertiary medical centre in Lalitpur, Nepal from April 2009 to February 2018. Results: Forty children with blood culture proven were enrolled in the study. All children had fever with the mean duration of 5.3 days (1-14). The most common associated symptoms were gastrointestinal which included anorexia (47.5%), pain abdomen (37.5%), vomiting (37.5%), diarrhoea (15%) and constipation (5 %). Splenomegaly (25%) and hepatomegaly (17.5%) were the commonest signs. The majority of children (80%) had normal total leucocyte count and 32.5% of them had anaemia. There were no children with thrombocytopenia. Salmonella typhi and Salmonella paratyphi A were isolated in 70% and 30% of children respectively. None of the isolates showed drug resistance against ceftriaxone, chloramphenicol, cotrimoxazole, gentamicin, norfloxacin and ofloxacin. There was no mortality. Conclusions: Enteric fever should be suspected in all the children with fever for more than five days along with anorexia, gastrointestinal associated symptoms and normal white blood counts.

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Antibiotic Sensitivity and Resistance Patterns of Salmonella Typhi in Rajshahi Medical College Hospital

TAJ Journal of Teachers Association ◽

10.3329/taj.v33i2.51307 ◽

2020 ◽

Vol 33 (2) ◽

pp. 10-14

Author(s):

Md Azizul Haque ◽

Laila Shamima Sharmin ◽

KM Faisal Alam ◽

Md Mohimanul Hoque ◽

M Morsed Zaman Miah ◽

...

Keyword(s):

Blood Culture ◽

Enteric Fever ◽

Antibiotic Sensitivity ◽

Salmonella Typhi ◽

Medical College Hospital ◽

Personal Hygiene ◽

Care Hospital ◽

College Hospital ◽

Medical College ◽

Sensitivity Pattern

Typhoid and paratyphoid fevers, collectively known as enteric fever, is caused by Salmonella enterica subspecies serovars Typhi and Paratyphi A, B and C. Despite this declining global trend, enteric fever is still considered to be a major public health hazard in Bangladesh and other developing countries due to poor sanitation, inadequate food safety measures and poor personal hygiene. In Bangladesh, the incidence of typhoid fever was reported to be 200 episodes per 100,000 person-years during 2003–2004. Multidrug-resistant (resistance to the first-line antimicrobials ampicillin, cotrimoxazole, and chloramphenicol) strains of S. Typhi and S. Paratyphi are on the rise globally and even cases of extensively drug-resistant (XDR) typhoid cases resistant to chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, third generation cephalosporins and fluoroquinolones are being reported from many corners of the world. This descriptive, observational study was carried out in Rajshahi Medical College Hospital Hospital, Rajshahi, Bangladesh from July 2017 to June 2019. Antibiotic sensitivity pattern of total 76 cases of enteric fever due to Salmonella Typhi were studied. Blood culture was carried out by BACT ALERT-3D, Automated blood culture analyzer from BioMeriuex SA, France Patented FAN Plus method. Based on the minimum inhibitory concentration (MIC), the organism was categorized as sensitive, intermediate, and resistant against the respective antibiotics as per Clinical and Laboratory Standards Institute (CLSI) criteria. We are reporting antibiotic sensitivity and resistant patterns of S. Typhi documented in Rajshahi Medical College Hospital, a large tertiary care hospital in Northern Bangladesh. TAJ 2020; 33(2): 10-14

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Laboratory findings in enteric group fevers in the Middle East forces

Epidemiology and Infection ◽

10.1017/s0022172400019239 ◽

1946 ◽

Vol 44 (6) ◽

pp. 430-436 ◽

Cited By ~ 3

Author(s):

John C. Dick

Keyword(s):

Middle East ◽

Blood Culture ◽

Early Diagnosis ◽

Special Reference ◽

Enteric Fever ◽

Leucocyte Count ◽

Causes Of Death ◽

Laboratory Findings ◽

Normal Limits ◽

Enteric Group

1. The laboratory findings in a series of 215 cases of enteric fever are described and discussed, with special reference to early diagnosis.2. In the majority of the cases reviewed, the leucocyte count was about the lower level of normal limits, though considerable variation both upwards and downwards occurred.3. Blood culture was a very satisfactory and early method of diagnosis; the method used is described fully.4. Certain variations from normal in the behaviour of the organisms were encountered and are described.5. Bact. faecalis alkaligenes was isolated from blood culture in five cases in which enteric group organisms were also isolated from blood, faeces or urine and in three which were clinically enteric fever. The relation of these observations to the possibility of primary Bact. faecalis alkaligenes septicaemia is noted.6. Seventeen cases were fatal. The causes of death are described.

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Streptokinase clot culture compared with whole blood culture for isolation of Salmonella typhi and S. paratyphi A from patients with enteric fever

Transactions of the Royal Society of Tropical Medicine and Hygiene ◽

10.1016/0035-9203(88)90471-3 ◽

1988 ◽

Vol 82 (2) ◽

pp. 340-341 ◽

Cited By ~ 3

Author(s):

Cyrus H. Simanjuntak ◽

Stephen L. Hoffman ◽

Ruwido Darmowigoto ◽

Murad Lesmana ◽

Soeprawoto ◽

...

Keyword(s):

Blood Culture ◽

Whole Blood ◽

Enteric Fever ◽

Salmonella Typhi

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

Bangladesh Journal of Child Health ◽

10.3329/bjch.v35i2.10377 ◽

2012 ◽

Vol 35 (2) ◽

pp. 53-58 ◽

Cited By ~ 3

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 e1:40 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 e1:40 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 e1:40 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 e1:160 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

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Antibiogram of Salmonella Isolates from Blood with an Emphasis on Nalidixic Acid and Chloramphenicol Susceptibility in a Tertiary Care Hospital in Coastal Karnataka: A Prospective Study

Journal of Laboratory Physicians ◽

10.4103/0974-2727.105585 ◽

2012 ◽

Vol 4 (02) ◽

pp. 074-077 ◽

Cited By ~ 10

Author(s):

Anup Kumar Shetty ◽

Ichlampady Nagaraj Shetty ◽

Zevita Venisha Furtado ◽

Beena Antony ◽

Rekha Boloor

Keyword(s):

Blood Culture ◽

Nalidixic Acid ◽

Antibiotic Susceptibility ◽

Enteric Fever ◽

Salmonella Typhi ◽

Multidrug Resistant ◽

Care Hospital ◽

First Line ◽

Periodic Analysis ◽

Paratyphi B

ABSTRACT Background: Enteric fever is caused by the serotypes Salmonella Typhi, Salmonella Paratyphi A, Salmonella Paratyphi B and Salmonella Paratyphi C. After emergence of multidrug resistant Salmonellae Ciprofloxacin, a fluorquinolone antibiotic was the first-line therapy. Treatment failure was observed with Ciprofloxacin soon and such strains showed in-vitro resistance to Nalidixic acid. Recent reports suggest re-emergence of Chloramphenicol sensitive strains and increasing Nalidixic acid resistance. This study is aimed at detecting the current trend in the antibiogram of Salmonella isolates from blood culture in coastal Karnataka, with an emphasis on antibiotic susceptibility of Nalidixic acid and Chloramphenicol and evaluate, if there is a need to modify the strategies in the antibiotic therapy for enteric fever. Materials and Methods: Blood samples received for culture in the laboratory between June 2009 and August 2011 was cultured in Brain Heart infusion broth, bile broth or in a commercial BACTEC culture media. The growth from blood cultures were processed for identification and antibiotic susceptibility as per standard methods. Antibiotic susceptibility for Ampicillin, Trimethoprim-sulphamethoxazole, Chloramphenicol, Ciprofloxacin, Ceftriaxone and Nalidixic acid were noted. Results: Out of 9053 blood culture specimens received, Salmonella was isolated from 103 specimens. There were 85 Salmonella Typhi isolates, 16 Salmonella Paratyphi A and two Salmonella Paratyphi B. Salmonella Typhi and Salmonella Paratyphi A showed the highest resistance to Nalidixic acid. Salmonella Typhi showed highest susceptibility to Ceftriaxone and Salmonella Paratyphi A to trimethoprim-sulphamethoxazole and Chloramphenicol. Two isolates were multidrug resistant. One Salmonella Paratyphi A was resistant to Ceftriaxone. Conclusion: Routine screening of Nalidixic acid susceptibility is practical to predict fluorquinolone resistance in Salmonella and preventing therapeutic failure while treating with it. It is worthwhile to consider replacing fluorquinolones with Chloramphenicol or Ceftriaxone as the first line of therapy for enteric fever. Periodic analysis of Salmonella antibiogram should be done to formulate the best possible treatment strategies.

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Clinical Characteristics, Dynamic Profile of Radiology and Laboratory Findings in Coronavirus Disease 2019

10.21203/rs.3.rs-25659/v1 ◽

2020 ◽

Author(s):

ailing liu ◽

Jing Zhang ◽

Wei Qiao ◽

Wei Zang ◽

Yingying Zhang ◽

...

Keyword(s):

Clinical Laboratory ◽

Laboratory Data ◽

Oxygenation Index ◽

Laboratory Findings ◽

Single Centre Study ◽

History Of ◽

Group A ◽

The Mean ◽

Group B ◽

Dynamic Profile

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, more and more data from different area and different stages of disease have been needed.Methods In this retrospective, single-centre study, we included all 38 confirmed cases of Covid-19 in Weihai from Jan 24 to Feb 24, 2020. Patients were divided into group A by normal Oxygenation Index (OI), group B by abnormal OI (less than 400 mmHg).The dynamic changes in clinical laboratory parameters were tracked from day 1 to day 32 after the onset of the disease at 4-day intervals. Cases were analyzed for clinical, radiological features and laboratory data. Outcomes were followed up until Feb 24, 2020.Results 38 patients with Covid-19 were included in this study, 68.42% patients were family clustered, and 97.37% patients had a history of exposure. The mean days between exposure and onset were about 5 days. Most patients were men, mean age was 43 years, 52.6% patients had chronic diseases. Most patients had fever or cough, about a third of patients had expectoration or fatigue, and 5 (13.16%) patients had shortness of breath.

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CLINICOPATHOLOGICAL PROFILE OF SALMONELLA TYPHI AND PARATYPHI INFECTIONS PRESENTING AS FEVER OF UNKNOWN ORIGIN IN A TROPICAL COUNTRY.

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2015.021 ◽

2015 ◽

Vol 7 ◽

pp. e2015021

Author(s):

Nayyar Iqbal ◽

Aneesh Basheer ◽

Sudhagar Mookkappan ◽

Anita Ramdas ◽

Renu G'Boy Varghese ◽

...

Keyword(s):

Bone Marrow ◽

Enteric Fever ◽

Fever Of Unknown Origin ◽

Clinical Laboratory ◽

Febrile Illness ◽

Unknown Origin ◽

Salmonella Typhi ◽

Common Symptom ◽

Tropical Country ◽

The Tropics

Background: Enteric fever, a common infection in the tropics and endemic to India, often manifests as an acute febrile illness. However, presentation as fever of unknown origin (FUO) is not uncommon in tropical countries. Methods: We aim to describe the clinical, laboratory and pathological features of cases hospitalized with fever of unknown origin and diagnosed as enteric fever. All culture proven cases of enteric fever were analyzed retrospectively over a period of three years from January 2011 to December 2013.Results: Seven of 88(8%) cases with enteric fever presented as FUO. Abdominal pain was the most common symptom besides fever. Relative bradycardia and splenomegaly were uncommon. Thrombocytopenia was the most common haematological abnormality, while leucopenia was rare. Transaminase elevation was almost universal. S.Typhi and S.Paratyphi were isolated from six cases and one case respectively. Yield of organisms from blood culture was superior to that of bone marrow aspirate. Multiple granulomas were identified in 4 out of 6 (67%) of the bone marrows studied, including that due to S. Paratyphi and histiocytic hemophagocytosis was noted in two cases.Conclusion: FUO is a relatively common manifestation of enteric fever in the tropics. Clinical and laboratory features may be atypical in such cases, including absence of relative bradycardia, leucopenia and presence of thrombocytopenia, bicytopenia or pancytopenia. Moreover, in endemic countries, enteric fever should be considered as a differential diagnosis, next to tuberculosis, in the evaluation of bone marrow granulomas in cases with FUO and culture correlation should be mandatory.

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Study on the efficacy of ceftriaxone versus azithromycin for the treatment of uncomplicated enteric fever among the patients admitted in a tertiary level hospital

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20214883 ◽

2021 ◽

Vol 11 (1) ◽

pp. 1

Author(s):

Sougata Mitra ◽

Masuma Khanam ◽

M. Iqbal Hossain ◽

Rukhsana Quadir

Keyword(s):

Blood Culture ◽

Physical Examination ◽

Typhoid Fever ◽

Clinical Cure ◽

Enteric Fever ◽

Salmonella Typhi ◽

Clearance Time ◽

Medical College ◽

Fever Clearance Time ◽

Culture Positive

Background: Typhoid fever is a severe debilitating and potentially life threating illness. In Bangladesh, typhoid fever is a round the year problem which sometimes take epidemic proportions. The reasons behind such occurrences are unsafe water supply, defective sewage system and unhygienic food handling practice. This study aimed to compare the efficacy of ceftriaxone and azithromycin in the treatment of uncomplicated enteric fever.Methods: An observational study was conducted at the department of pharmacology in Dhaka medical college, Dhaka, Bangladesh. Data were collected from blood culture positive patients for Salmonella typhi and Salmonella paratyphi, who admitted in the Dhaka medical college and hospital, Dhaka during the period of July 2015 to June 2016. Data was collected by using a structured questioner, face to face interview, physical examination and investigation reports. Patients were hospitalized during the entire treatment period and at admission evaluation was made by history and physical examination in a structured format. Subjects ware asked regarding changes in symptoms and possible adverse effects of the study drugs. All patients were asked to return two weeks after completion of treatment for follow up. Blood culture of Salmonella typhi or Salmonella paratyphi were done in all cases. Total 91 patients were culture positive for either S. typhi or S. paratyphi which were finally studied.Results: During the study period out of 91 patients, 51 were receiving ceftriaxone and 40 were receiving azithromycin. Clinical cure was achieved in 46 patients (90%) of ceftriaxone group and in 31 patients (78%) in the azithromycin group. There were no significant differences of clinical cure between both treatment groups (p>0.05). Mean fever clearance time in ceftriaxone group was 3±1.4 days and was 4±1.6 days for azithromycin group. Difference in fever clearance time was statistically significant (p<0.05). No clinical relapses were detected in any study subject. No major side effects of both drugs occurred in any subject.Conclusions: These results indicated that both ceftriaxone and azithromycin were effective against enteric fever caused by sensitive organisms and multi drug resistant S. typhi and S. paratyphi. It is concluded that ceftriaxone is more effective and can be a convenient alternative for the treatment of enteric fever, especially in developing countries like us where medical resources are scarce.

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Human brucellosis: Experience from a tertiary care hospital in southern India

Tropical Doctor ◽

10.1177/0049475518788467 ◽

2018 ◽

Vol 48 (4) ◽

pp. 368-372 ◽

Cited By ~ 4

Author(s):

Sudipta Patra ◽

Vandana KE ◽

Chaitanya Tellapragada ◽

Chiranjay Mukhopadhyay

Keyword(s):

Blood Culture ◽

Tertiary Care ◽

Multivariate Logistic Regression Analysis ◽

Human Brucellosis ◽

Care Hospital ◽

Serological Tests ◽

Laboratory Findings ◽

Clinical Presentations ◽

Epidemiological Pattern ◽

Tertiary Care Setting

The aim of our study was to examine and compare the clinical presentations, complications, laboratory findings, treatment and outcome of patients with acute, subacute and chronic forms of brucellosis in a tertiary care setting. This hospital-based observational study was undertaken between April 2015 and March 2017. Patients diagnosed with brucellosis, either by blood culture and/or serology, were recruited. A total of 94 cases of brucellosis of acute, subacute and chronic forms were observed in 78.7%, 15.9% and 5.3%, respectively. Blood culture grew Brucella spp. in 70.2% cases. Serological tests showed positivity in 96.8% of the patients. Using multivariate logistic regression analysis, fever and upper back pain were significant predictors for both acute and chronic forms of the disease, respectively. There is a need to increase awareness and understand the local sero-epidemiological pattern of brucellosis as it is still little known.

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Pediatrics Infected with COVID-19: A Case Series Study on Pediatrics Hospitalized in a Referral Pediatric Hospital

International Journal of Pediatrics ◽

10.1155/2021/1135503 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Houman Hashemian ◽

Saeid Sadat Mansouri ◽

Hamid Reza Badeli ◽

Ebrahim Esmaili ◽

Majid Asgharzadeh ◽

...

Keyword(s):

Ct Scan ◽

Clinical Laboratory ◽

Treatment Strategies ◽

Case Series ◽

Pediatric Hospital ◽

Laboratory Findings ◽

Case Series Study ◽

The Mean ◽

Underlying Diseases ◽

Series Study

Introduction. COVID-19 infection which is a novel pneumonia associated with coronavirus suddenly broke out in the world. The aim of this study is to analyze and summarize the clinical characteristics of pediatric patients who were hospitalized in a referral pediatric hospital because of COVID-19 infection. Materials and Methods. Twenty-one COVID-19 infection cases confirmed by clinical and laboratory findings who were hospitalized in our center from 20 February to 19 April 2020 were included. Demography information, clinical, laboratory, and radiological findings, and treatment strategies of patients were evaluated. Results. The mean age was 91.5 ± 68.38 months (1-225), and there were 12 (57.1%) boys and 9 (42.9%) girls. Fever ≥ 38 ° C was detected in 11 (52.4%) patients. Eleven (52.3%) patients had tachypnea, and 4 (19%) of them developed tachycardia. Nine CT scans (42.85%) demonstrated a halo sign, and patchy infiltration was seen in CT scan of 7 patients (33.33%). Furthermore, bilateral crazy-paving pattern was seen in CT scan of nine (42.85%) patients. We prescribed chloroquine in 8 (38.1%), oseltamivir in 8 (38.1%), Kaletra in 6 (28.6%), and Ribavirin in 1 (4.8%) of patients. Finally, four (19.04%) patients expired which one of them suffered from ARDS. Conclusions. We found out that boys might develop more severe cases of COVID-19, and this could be more common in school age. Manifestations might be milder than adults, and the most severe cases might be associated with underlying diseases. Also, the effectiveness of drugs in the treatment of this disease needs further study.

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