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Clinical profile and treatment outcome of typhoid fever in children at a teaching hospital, Ahmedabad, Gujarat, India

Rohit Modi.

Abstract
Background: Salmonella typhi is responsible for the occurrence of enteric fever, which is likely a fatal multisystemic disorder. The diagnosis of typhoid fever is challenging because of the diversified clinical manifestations. 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. However, the diagnosis most often remains either as an unsubstantiated clinical impression or a serological diagnosis and occasionally confirmed by blood culture.

Objective: To evaluate the varied clinical presentations, complications, and prognosis of enteric fever.

Materials and Methods: A prospective study was done at Pediatrics Department of a teaching institute to study the clinical profile and clinical course of enteric fever for a period of 1 year from November 2012 to October 2013. In this prospective study, 98 consecutive serological or culture positive cases of enteric fever were studied. A detailed history, clinical profile, and complications encountered at the time of admission and during the course of stay in the hospital were recorded.

Result: Of the 98 children, 54 (55.10%) were girls and 44 (44.90%) boys, with the male: female ratio of 0.81:1. None of the patients included in the study had taken typhoid vaccine in the past. Leukopenia was seen in 11.2% and leukocytosis in 17.4% patients. Lymphocytosis was observed in 70.4% patients. The most common symptoms were fever (100%), abdominal pain (57.14%), vomiting (50%), anorexia (30.61%), and cough (13.26%). The most common signs observed in patients by the pediatrician were toxic look (92.85%), coated tongue (66.32%), pallor (39.79%), hepatomegaly (36.73%), and splenomegaly (20.40%). The mean duration of hospital stay was 6.4 0.86 days, and there was no mortality in our series. Most of the patients responded to treatment with cephalosporin (91.84%). Complications of typhoid fever were seen in 8.16% of patients. None of the patients included in the study had taken typhoid vaccine in the past.

Conclusion: Endemicity, outside eating, poor sanitation, and poor personal hygiene were the commonest observed causative factors. So, public awareness about safe drinking and feeding practices, proper sanitation, and hygiene is the most useful preventive measure to prevent morbidity from typhoid fever.

Key words: Clinical profile, treatment outcome, typhoid fever, children



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