Abstract
BackgroundTyphoid fever remains a major health problem in the developing world. Intestinal perforation is a lethal complication and continues to occur in impoverished areas despite advances in preventive and therapeutic strategies.ObjectivesTo estimate the case fatality rate (CFR) and length of hospital stay among patients with typhoid intestinal perforation in developing countries.Data SourcesPeer-reviewed publications listed in PubMed and Google Scholar.Study EligibilityThe publications containing data on CFR or length of hospitalization for typhoid fever from low, lower middle and upper middle income countries based on World Bank classification. Limits are English language, human research and publication date from 1st January 1991 to 31st December 2011.ParticipantsSubjects with reported typhoid intestinal perforation.InterventionsNone, standard practice as reported in the publication.Study Appraisal and Synthesis MethodsSystematic literature review followed by meta-analysis after regional classification on primary data. Descriptive methods were applied on secondary data.ResultsFrom 42 published reports, a total of 4,626 hospitalized typhoid intestinal perforation cases and 706 deaths were recorded (CFR = 15·4%; 95% CI; 13·0%–17·8%) with a significant regional differences. The overall mean length of hospitalization for intestinal perforation from 23 studies was 18.4 days (N = 2,542; 95% CI; 15.6–21.1).LimitationsMost typhoid intestinal perforation studies featured in this review were from a limited number of countries.ConclusionsThe CFR estimated in this review is a substantial reduction from the 39.6% reported from a literature review for years 1960 to 1990. Aggressive resuscitation, appropriate antimicrobial coverage, and prompt surgical intervention may have contributed to decrease mortality.ImplicationsThe quantification of intestinal perforation outcomes and its regional disparities as presented here is valuable in prioritizing and targeting typhoid-preventive interventions to the most affected areas.
Highlights
Typhoid fever is caused by the gram negative bacillus Salmonella enterica serovar Typhi (S. typhi) [1] continues to be a public health problem in developing countries [2]
The case fatality rate (CFR) estimated in this review is a substantial reduction from the 39.6% reported from a literature review for years 1960 to 1990
We present an updated review of CFR, age and gender characteristics, and length of hospital stay associated with typhoid intestinal perforation by geographical regions from articles published from 1991 to 2011 in low income, lower middle income and upper middle income countries [20]
Summary
Typhoid fever is caused by the gram negative bacillus Salmonella enterica serovar Typhi (S. typhi) [1] continues to be a public health problem in developing countries [2]. It is transmitted via the faecooral route through ingestion of contaminated food or water. Intestinal perforation is a potentially fatal complication of typhoid fever secondary to the inflammation and necrosis of Peyer’s patches when not treated early and appropriately. Typhoid fever remains a major health problem in the developing world. Intestinal perforation is a lethal complication and continues to occur in impoverished areas despite advances in preventive and therapeutic strategies
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