Clinico-microbiological profile of adults with enteric fever

Abstract

Background: Enteric fever is a major public health problem; the burden of disease worldwide is approximately 11.9–26.9 million cases and 129,000–217,000 deaths each year. The burden of disease in India is approximately 6 million per year. Enteric fever is caused by Gram-negative bacteria Salmonella typhi or Salmonella paratyphi A, B or C, which is a bloodstream infection. The re-emergence of susceptibility of old antibiotics such as ampicillin, co-trimoxazole, and chloramphenicol in S. typhi has been observed. Aims: The objective of the study was to study the antibiotic sensitivity pattern of S. typhi, S. paratyphi A and S. paratyphi B and also the clinical and laboratory profile of enteric fever with respect to blood counts, liver function tests and typhoid serology in adult patients with enteric fever. Materials and Methods: The study was conducted in the Department of Internal Medicine and Microbiology at Sir Ganga Ram Hospital in 76 adult patients of blood culture-positive enteric fever. Clinical and laboratory profile of patients was recorded. Antibiotic sensitivity patterns were studied in all cases and the prevalence of multidrug-resistant strains, if the present was established. Results: The mean age in this study was 31.46 + 11.29 years. There were 46 male patients and 30 female patients. Fever was present amongst all patients (100%). Myalgia/headache was present amongst the majority of patients (98.7%). Pain in the abdomen (57.9%) was present. Leucopenia and leucocytosis were present in 25% and 2.6% of patients, respectively. Serum glutamic-oxaloacetic transaminase and serum glutamic-pyruvic transaminase were abnormal amongst 36.8% and 38.2% of patients, respectively. Complications, such as ileal perforation and gastrointestinal (GI) bleed, were not seen in the patients of enteric fever in this study. Typhidot IgM was positive in 50% of patients. S. typhi (blood culture) was amongst more than half of the patients (69.7%) and S. paratyphi A was 30.3%. Ampicillin was resistant to 5.3% and chloramphenicol and cotrimoxazole each were resistant to 2.6%. Levofloxacin was resistant to 38.2%. Ceftriaxone, azithromycin and cefixime were sensitive to 100%. Multidrug resistance (resistance to ampicillin, chloramphenicol and cotrimoxazole) was seen in 2.6% of cases, which was associated with S. typhi. There was no multidrug resistant (MDR) strain seen with S. paratyphi A. Conclusions: This study showed that fever, myalgia/headache, pain in the abdomen, nausea/vomiting and diarrhoea were the common clinical manifestations of enteric fever. Other important conclusions were low percentages of comorbidities, low occurrence of leucocytosis, high typhidot IgM positivity, low MDR and most of the drugs were 100% sensitive. Ileal perforation and GI bleeding were not found in any case of enteric fever in this study.