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Category: Volume 07 Issue 03 March 2019
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Title: Enteric fever - Clinical presentation, lab parameters, Complications and Sensitivity pattern in a tertiary care centre in Rural Maharashtra

Authors: Dr Mahesh H Ahirrao, Dr Bhagyashri Ahirrao, Dr Jagdish Pakhare, Dr Nandkumar V Dravid, Dr Karuna Shejwal, Dr Ashish Patil

 DOI: https://dx.doi.org/10.18535/jmscr/v7i3.127

Abstract

Introduction: Enteric Fever is endemic in South East Asia and poses a significant health problem in developing countries including India. Though treatable, enteric fever is known to cause potentially life threatening complications such as encephalopathy and enteric perforations. Diagnosis and management of enteric fever in pediatric age group pose several problems because of non- specific symptomatology. We conducted this prospective study to analyze clinical presentation, lab parameters, Sensitivity pattern and Complications in pediatric patients admitted with the diagnosis of enteric fever.

Materials and Methods: This was a prospective cohort study in which pediatric patients having enteric fever were included on the basis of a predefined inclusion and exclusion criteria. The study was conducted in a tertiary care medical college situated in a rural area. Informed consent was obtained from the guardians of the cases. Detailed history and demographic details were noted and thorough clinical examination was done in all the cases. Complete blood count, blood culture and sensitivity and Widal test was done in all the cases. Complications during hospital stay were also noted down. SSPE 16 version software was used for statistical analysis. P value less than 0.05 was taken as statistically significant.

Results: Out of 80 studied cases there were 46 (57.50%) males and 34 (42.50%) females with a M:F ratio of 1: 0.73. The most common sign was fever which was present in all (100%) the cases. The other signs and symptoms were headache (33.75%), high grade fever (28.75%), vomiting (28.75%) abdominal pain (21.25%) and chills (16.25%). On clinical examination isolated hepatomegaly and splenomegaly was present in 16 (20.00%) and 7 (8.75%) patients respectively whereas hepatosplenomegaly was present in 14 (17.50%) patients. Leukopenia was seen in 26 (32.50%) patients whereas leukocytosis was present in 7 (8.75%) patients. thrombocytopenia and deranged hepatic function tests were seen in 13 (16.25%) and 7 (8.75%) patients respectively. Blood culture was positive in 39 (48.75%) patients. Widal test was found to be positive in 41 (51.25%) patients.75 (93.75%) patients responded well to administration of antibiotics. 5 (6.25%) patients developed complications such as meningeal signs (3.75%), bleeding diathesis (1.25%)and enteric perforation (1.25%).

Conclusion: Enteric fever is endemic in developing countries including India. Varied symptomatology makes its diagnosis difficult particularly in pediatric age group. Delayed diagnosis may lead to complications such as encephalopathy, bleeding diathesis and enteric perforation.

Keywords: Enteric Fever, Encephalopathy, Enteric perforation, Culture and Sensitivity.

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Corresponding Author

Dr Bhagyashri Ahirrao

Assistant Professor, Department of Pathology ACPM Medical College Dhule, India