Abstract
BackgroundIndia is endemic for enteric fever, and it is not known whether the variations in clinical manifestations between patients are due to host, environmental or pathogen factors.Blood culture surveillance was conducted at St. John’s Medical College Hospital, Bangalore, between July 2016 and June 2017. Clinical, laboratory and demographic data were collected from each case, and bacterial isolates were subjected to whole genome sequencing. Comparative analysis between adults and paediatric patients was carried out to ascertain differences between adult and paediatric disease.ResultsAmong the 113 cases of blood culture-confirmed enteric fever, young adults (16–30 years) and children < 15 years accounted for 47% and 37% of cases, respectively. Anaemia on presentation was seen in 46% of cases, and 19% had an abnormal leucocyte count on presentation. The majority received treatment as inpatients (70%), and among these, adults had a significantly longer duration of admission when compared with children (p = 0.002). There were atypical presentations including arthritis, acute haemolysis and a case of repeated typhoid infection with two separate S. Typhi genotypes. There was no association between infecting genotype/serovar and treatment status (outpatient vs inpatient), month of isolation, duration of admission, patient age (adult or child), antimicrobial susceptibility, Widal positivity or haematologic parameters.ConclusionsAmidst the many public health concerns of South India, enteric fever continues to contribute substantially to hospital burden with non-specific as well as uncommon clinical features in both paediatric and adult populations likely driven by host and environmental factors. Robust clinical surveillance as well monitoring of pathogen population structure is required to inform treatment and preventive strategies.
Highlights
This hospital-based surveillance took place in a tertiary care setting in Bangalore, South India, as described previously [7]
Amidst the many public health concerns of South India, enteric fever continues to contribute substantially to hospital burden with non-specific as well as uncommon clinical features in both paediatric and adult populations likely driven by host and environmental factors
The Indian subcontinent is endemic for enteric fever, a febrile illness caused by Salmonella enterica serovars Salmonella enterica serovar Typhi (Typhi)
Summary
Methods This hospital-based surveillance took place in a tertiary care setting in Bangalore, South India, as described previously [7]. The stored isolates were sequenced, and the identity of these genomes were confirmed by multilocus sequence typing (MLST) and subsequently genotyped as described previously [7]. These were linked to electronic patient records for relevant demographic and laboratory (complete blood counts, liver function tests and Widal serology) details after relevant ethics approvals [7]. Longitudinal as well as a cross-sectional data from two separate hospital-based studies in Southern India confirmed that 4.3.1 was the dominant genotype in both settings, making up 77.8% and 88.2 % of the pathogen population in the respective study sites [6, 7]
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