Enteric Fever in children from Navi Mumbai — Clinical Profile, Hematological features, Sensitivity Patterns and Response to Antimicrobials

Aims To study and compare the clinical profile, hematological features, antimicrobial susceptibility pattern of the isolates and the time to defervescence with treatment among children with culture proven enteric fever presenting at two different healthcare facilities in Mumbai.Material and Methods It is a prospective analysis of culture proven cases of enteric fever carried out at two set ups: a trust hospital providing medical care to the Mathadi workers and their families in Navi Mumbai and the other a private nursing home. The two hospitals cater to patients from two different socioeconomic strata. The Mathadi Trust hospital provides health care to potters from low socioeconomic strata while patients at the private hospital at Vashi belong to a higher socioeconomic background The above two hospital settings were selected in order to compare the characteristics of enteric fever in two different scenarios. Cases of enteric fever, diagnosed by a positive blood culture over a period of 16 months between January 2008 and April 2009 were analyzed. The clinical picture at the time of presentation, complete blood count, peripheral smear, history of typhoid immunization, results of blood culture and antimicrobial sensitivity pattern and response to treatment were recorded, compared and analysed.Results A total of 98 cases were included in the study; 42 from the trust hospital and 56 from the private nursing home. Amongst the patients from the trust hospital, 95% (40 out of 42)of the isolates were Salmonella typhi and rest (2, 5%)were Salmonella paratyphi while at the private hospital 64% (36 out of 56) were Salmonella typhi and the rest (20, 36%) were Salmonella parayphi. A or B .13 out of these 20 patients with paratyphoid were immunized against typhoid with the Vi polysaccharide vaccine. Leucocytosis with counts more than 11,000/mm3 was seen in 12% (12 out of 98) of patients. Thrombocytopenia (platelet count<1.5 lacs) was seen in 30%. None of the patients had eosinopenia. Thirty percent received antibiotics prior to blood culture sampling and in 70% of patients the cultures were obtained in the 1st week of febrile illness. The mean time to defervescence was 5 days.Conclusions Isolating salmonella from the blood of patients with enteric fever presenting as febrile illness without focus is not difficult and gives unequivocal diagnosis with antimicrobial sensitivity. The higher percentage prevalence of S. paratyphi in patients attending the private nursing home may be attributed to vaccination with Vi polysaccharide vaccine. Neutrophilic leucopenia is the norm in enteric fever but leucocytosis is also seen in patients with enteric fever. Thrombocytopenia is a common occurrence and lack of eosinopenia not uncommon.Prevalence of Nalidixic acid resistance was high. Addition of a secondantibiotic did not reduce the time to defervescence.