A Study of Clinical Profile of Multidrug Resistant Typhoid Fever In Children.
A Study of Clinical Profile of Multidrug Resistant Typhoid Fever
Keywords:
Multidrug resistant typhoid fever (MDRTF), Salmonella Typhi (S.Typhi)Abstract
Background: Salmonella typhi infection remains a serious problem in developing country. It has been estimated that approximately 12.5 million cases of typhoid fever occurs annually in the developing countries with 7.7 million cases in Asia alone. The disease is predominantly a disease of school age children and young adults and is reported to be a milder in infants and young children. Methods: A total of 150 children with clinical and/or laboratory diagnosis of typhoid fever admitted to the tertiary care level government hospital attached with the Government medical college in Pediatrics ward were reviewed during the months of JUNE to MAY for demographic data such as age, sex, clinical features, result of laboratory tests and antibiotic sensitivity in vivo. Results: There were 88 male and 62 female patients, from the age group ranging from 2 years to 12 years. Predominant symptoms were fever, abdominal pain , vomiting and headache. Hepatomegaly was almost twice as frequent as spleenomegaly. Common clinical signs of typhoid fever in adults such as relative bradycardia and rose spots were seldom documented in children. Fever, Toxic look, coated tongue and hepato-spleenomegaly were common clinical signs of clinical presentation in children. The positivity rate of WIDAL test and Blood Culture was 71.33% and 5.33% respectively. Hepatitis, Bronchitis and Encephalopathy were commonly observed complications of Multidrug resistant typhoid fever in this study. Antibiotics sensitivity in vivo revealed resistance rates of 78.12% for Ampicillin, 84.2% for Trimethoprim-Sulfamethoxazole (Co-trimoxazole), 19.5% for Ciprofloxacin, 14.28% for Ofloxacin and 20% for Cefotaxime. Conclusions : No resistance was detected against Cefixime and Ceftriaxone. Except the two patients died during the period of observation of this clinical study, all paediatrics patients survive from their illness completely
References
2. Reed et al : Typhoid fever in neonate. IJCP’S Med. News; July: 23-24, 1996.
3. Kapoor J.P. et al: Typhoid fever in young children. Indian Ped. 22: 811-13, 1985.
4. Khalap N V.: Typhoid fever in children. Ind. Jr. of child health 6: 799-804, 1957.
5. Martinez L., Alvaro Pascual et al: Quinolone resistance from a transferable plasmid. Lancet 351: 797-799, 1998.
6. Park J.E. and Park K.:Text book of preventive and social medicine, 15th edition, 174-177, 1997.
7. Abel Gonzalez-Cortes et al: Water-borne transmission of chloramphenicol resistant S.typhi in Mexico.Lancet,Sept.15 : 604-607,1973.
8. Anand A.C., Kataria V.K. et al : Epidemic multi-drug resistant typhoid fever in eastern India .Lancet 1: 352, 1990.
9. Samantray S K.et al., : Typhoid fever: An analysis of 500 cases. The practitioner 218 :400-408, 1977.
10. Shanahan P. M. Am. Jr. of Cli. Microbiology : 1595-1600, 1998.
11. V.V.Khadilkar et al : Drug resistant typhoid fever, an emerging problem. Indian Pediatrics 27 : 1227-28 , 1990
12. Wang Fu, Xian Jin Cu et al : Treatment of typhoid fever with ofloxacin. Jr of Antimicrobes and chemotherapy 23 : 785-88, 1989.
13. Ananthnarayan R. and Panikar C.K.J. : Text book of microbiology, 2nd edition, 1983.
14. Rajgopal V. et al. : bone marrow culture in the diagnosis of typhoid fever. Ind. Jr. of patho. Microbio. 29 : 15-19,1986.
15. Rattan A., Malik A. et al : Application of modified widal test in specific diagnosis of typhoid fever. Indian Ped. 27 : 295-97, 1990.
16. Sudhindra B.K.: Typhoid fever in young children . Indian Ped. 32 : 1127, 1995.
17. Ivanoff B., Levine M.M et al: Vaccinations against typhoid fever, present status. WHO bulletin 72: 957 – 971, 1994.
18. Ahmet Yaramis, Idris Yildirim et al : clinical and laboratory presentation of typhoid
fever. International pediatrics 16 (4) : 227-231, 2001.
19. Koul P.B., Murali M.V. et al: Multi-drug resistant salmonella typhi infection: Clinical profile and therapy. Indian Ped. 28: 357-61, 1991.
20. Arora R K., Gupta A et al : Multi-drug resistant typhoid fever: study of an outbreak in Calcutta. Indian ped. 29: 61-65, 1992.
21. Muralidharan K.: clinical profile of resistant typhoid fever in children. A dissertation submitted to Gujarat Uni. sept. 1994.
22. Sen S., Goyal R.S. et al : Ciprofloxacin in the management of multi-drug resistant typhoid fever. Indian Pediatrics 28 : 417-19, 1991.
23. Jain S., Chitnis DS et al: Outbreak of chloramphenicol resistant typhoid fever. Indian Pediatrics 24: 193-97,1987.
24. Mishra S, Patwari A K. et al: multi-drug resistant typhoid fever. Indian ped. 29: 443-448, 1992.
25. Raghuraman T. S., L. Krishnamurthy et al. : Clinical profile and therapy in typhoid fever. Ind. Ped. 31 : 196-199, 1994.
26. Samantray S K.et al., : Typhoid fever: An analysis of 500 cases. The practitioner 218 :400-408, 1977.
27. Saxena P.N., Sharma N.L.: A clinical study of typhoid fever in children. Indian Ped. 4: : 439-444, 1967.
28. Topley J.M.: Mild typhoid fever. Archives of dis. In Chld. 61 : 164-67, 1986
29. Garg et al.: Clinical profile of multi-drug resistant typhoid fever in Jaipur city. Indian ped. 31: 191-193, 1994.
30. Harmesh Singh et al.: Chloramphenicol resistant typhoid fever. Indian ped. 28: 433, 1991.
