Current perspectives of enteric fever: a hospital based study of 185 culture positive cases from Ahmedabad, India

Abstract

Background: Enteric fever is endemic in Ahmedabad and its diagnosis and treatment is fraught with problems. The last two decades have seen a change in clinical pattern of enteric fever with emergence of multi drug resistant strains. Hence, the study was carried out with the aims to study the clinical profile, hematological features, sensitivity pattern, response to antimicrobials and outcome of culture proven enteric fever.Methods: This was a retrospective study carried out at a tertiary care teaching hospital at Ahmedabad, India from January 2014 to December 2016.Results: Out of the 185 study patients, 35.8 % were less than 5 years of age. Of the total 185 isolates, 160 (86.4%) were Salmonella typhi while 25 (13.6%) were Salmonella paratyphi A. Following sensitivity patterns were recorded: cotrimoxazole (93%), chloramphenicol (93%), ampicillin (96.2%), nalidixic acid (98.4%), cephalosporins (100%) and azithromycin (70.8%). Leukocytosis was seen in significant number of patients less than 5 years of age as compared to more than 5 years. 91.9% patients were treated by ceftriaxone as a monotherapy with defervescence time of 3.8 days and no mortality.Conclusions: Effective vaccination strategy targeting children less than 5 years can decrease the burden of this disease. Presence of fever without focus and leukocytosis in less than 5 years suggests possibility of enteric fever. Salmonella have once again become sensitive to first line antibiotics like ampicillin, cotrimoxazole and chloramphenicol. There is a good rate of sensitivity to nalidixic acid but high rate of resistance against azithromycin in this part of the country. Ceftriaxone as a monotherapy is quite effective in the treatment.