CHARACTERISTIC FEATURES OF CULTURE POSITIVE ENTERIC FEVER IN PEDIATRIC TEACHING HOSPITAL IN SULAIMANI GOVERNORATE

Abstract

Background 
 Typhoid fever is still common disease in our country, and at the present time we are facing resistant cases to usual antibiotics. 
 Objectives 
 This study has been carried out to identify the clinical and laboratory characteristics of these microorganisms.
 Materials and Methods
 This is a prospective study done from October 2008 to October 2009, in Sulaimani Pediatric Teaching hospital. Blood cultures were taken from patients suspected of having Typhoid fever ,only patients with positive cultures were included in this study. Data regarding age, sex, residency, clinical presentation, duration of fever at presentation, response to treatment and antibiotic susceptibility were all analyzed by SPSS version 16.0.
 Results
 Ninety six patients whom with culture proved cases of Enteric fever, 55 males and 41 females. The age of the patients were from 1 month -14 years with an average of 6.8 years. The duration of fever before attendance to medical care was (2-19) days with a mean of 7 days. Mean days needed for subsidence of fever was 5 days ranging from 2-10 days. Mean duration of admission was about 8.5 days, while mean duration of treatment was 14 days. Headache was the most common symptom (67.7%) followed by abdominal pain in 56.6%, diarrhea in 31.2%, While the symptoms least encountered were confusion 5.2% and constipation 1%. Splenomeagly was the commonest sign (56.2%) followed by hepatomegaly (35.4%) and neck stiffness was positive in (3.1%)of the patients whom had normal CSF examination. The mean WBC count was 5.378 109/l, with 61% of the patients having neutrophilia and 20.7% having lymphocytosis and 18.3% having equal distribution. Most of the isolates were sensitive to amikacin 87%, followed by doxycycline 85.7%, ciprofloxacin 81.5%, azithromycin 60%. Cefotaxime and ceftriaxone had sensitivities of about 52-54%, while there was 75% resistance to chloramphenicol and nearly 99% resistance to ampicillin. All cases were culture positive; 99% for Salmonella typhi and only 1% grew Salmonella para typhi A and B. The incidence of complications was about 10.4%,GIT bleeding being the most common 4.2% followed by renal failure and hepatitis 2% and ataxia 1.1%. Mortality rate was (1.1%).
 Conclusion
 Typhoid fever has different presentations according to the locality and also may change its presentation in form of outbreaks in a specific locality. The disease was multidrug resistant, this may be due to previous misuse of antibiotics.