Fever Pattern Research Articles

COVID-19, parvovirus and acute HIV infection in the gamut of diagnosis of fever and rash

Coronavirus disease-19 (COVID-19) patients continue to experience different symptoms each day. Many patients were seen with common symptoms such as fever, fatigue, myalgia, respiratory symptoms (e.g., dry cough, dyspnea), smell and taste disorders, gastrointestinal symptoms, and dermatological findings. Although, fever lasting <7 days has been reported in most patients, it has been seen in patients with persistent or recurrent fever patterns in the second week of illness. Although, any symptoms accompanying fever during the pandemic suggest the diagnosis of COVID-19, other etiologies should also be kept in mind. In this case report, we present two patients who were admitted with fever and rash were initially thought to have COVID-19 but were diagnosed with acute parvovirus infection and acute HIV infection finally. These cases are presented to draw attention to the importance of taking a good history and making a rational differential diagnosis.

Enteric Fever Pattern among Patients Attending General Hospital Kaltungo

Salmonella typhi and Salmonella paratyphi causes typhoid and paratyphoid fevers respectively. Out of the one thousand two hundred and six (1206) sample analyzed for Typhoid and Paratyphoid fevers using tile method; 748 (62.0%) were positive while 458 (38%) were negative. Females were found to have the highest positivity rate of 413 (68.4%), while males had 335 (55.5%) positivity rate. The age bracket with the highest positivity rate 0-10years and above (28.3%), followed by 11-20years (26.2%). The age bracket with the lowest percentage positivity was 60years and above (6.0). We therefore wish to conclude that women should take personal hygiene serious and people from the following age groups of 0-10years and those at age 11-20 regardless of their sex should do likewise as Salmonellosis was found to be high among those categories of people.

Geographic Pattern of Typhoid Fever in India: A Model-Based Estimate of Cohort and Surveillance Data.

BackgroundTyphoid fever remains a major public health problem in India. Recently, the Surveillance for Enteric Fever in India program completed a multisite surveillance study. However, data on subnational variation in typhoid fever are needed to guide the introduction of the new typhoid conjugate vaccine in India.MethodsWe applied a geospatial statistical model to estimate typhoid fever incidence across India, using data from 4 cohort studies and 6 hybrid surveillance sites from October 2017 to March 2020. We collected geocoded data from the Demographic and Health Survey in India as predictors of typhoid fever incidence. We used a log linear regression model to predict a primary outcome of typhoid incidence.ResultsWe estimated a national incidence of typhoid fever in India of 360 cases (95% confidence interval [CI], 297–494) per 100 000 person-years, with an annual estimate of 4.5 million cases (95% CI, 3.7–6.1 million) and 8930 deaths (95% CI, 7360–12 260), assuming a 0.2% case-fatality rate. We found substantial geographic variation of typhoid incidence across the country, with higher incidence in southwestern states and urban centers in the north.ConclusionsThere is a large burden of typhoid fever in India with substantial heterogeneity across the country, with higher burden in urban centers.

Clinicoepidemiological Observations of Enteric Fever in Infants: Experiences From a Tertiary Care Pediatric Hospital in North India.

BackgroundThere is a lack of evident data to explain the true scenario of age-specific enteric fever in India. The current study aimed to evaluate the burden and disease pattern of enteric fever among infants in a tertiary care pediatric hospital.MethodsA prospective laboratory-based surveillance was conducted from April 2018 to January 2020 at a children’s hospital in North India, under the Surveillance for Enteric Fever in India study. The study included children <1 year of age in whom Salmonella serovar Typhi/Salmonella serovar Paratyphi grew in cultures from blood or sterile body fluid. The key outcome measures included disease spectrum and clinical presentation.ResultsOf the 10 737 blood cultures from infants, 26 were positive for S. Typhi or S. Paratyphi. The majority of cases occurred in infants aged 6–12 months, with the youngest being 1 month old. Fever with abdominal pain and diarrhea were the common symptoms, with 46% of infants requiring inpatient care. All of the isolates were susceptible to ceftriaxone. Third-generation cephalosporins were used as the first-line therapy for hospitalized infants. The average duration of fever was 8.6 days. The overall case-fatality rate among infants with enteric fever was 7.4%.ConclusionsEnteric fever is a major contributor to disease and death among children. Robust surveillance studies are required to understand the true disease burden.

Measuring temperature in children, conveniently and accurately: a comparative study on different modalities of thermometry

Background: Fever is one of the most common complaints in children in day-to-day practice. The pattern and grade of fever provide some evidence in determining the etiology of fever. Equally important is the identification and documentation of hypothermia in neonates. Hence there is need for an accurate thermometry mode, which should also be convenient to use in children.Methods: This was a cross-sectional observation study on all the neonates and children satisfying the inclusion criteria. Infrared forehead thermometer and digital axillary thermometer were used to record temperature and compared with Infrared tympanic temperature which was taken as gold standard.Results: A total of 240 neonates and children were evaluated. Strong positive correlation was observed between Means of Forehead Thermometer (FT) and Ear Thermometer (ET) with correlation coefficient of 0.777 and p value &lt;0.001. Similar correlation was also observed with Axillary Temperature (AT) with correlation coefficient of 0.944 and p&lt;0.001.Conclusions: Non-contact Infrared thermometer may be used in neonates and children without causing discomfort. It gives instant and comparable readings which are especially significant in the current coronavirus disease (COVID) pandemic setting.

Nineteenth‐century mortality trends: a reply to Szreter and Mooney†

AbstractIn a recent article in this journal I challenged Szreter and Mooney's account of a mortality crisis in English industrial and manufacturing cities in the periodc. 1830–1850. I argued, first, that there was no robust evidence for a major fall in urban life expectancies in this period; second, that there was evidence for a rise in mortality in early childhood, but that this rise occurred in rural as well as urban populations, and persisted until the 1860s; and third, that an increase in virulence of scarlet fever made a major contribution to this rise. Szreter and Mooney contested these conclusions on two main grounds: that my methodology for estimating urban life expectancies differed from theirs; and that the geography and chronology of scarlet fever patterns did not fit those of early childhood mortality. Here I demonstrate that these criticisms are invalid. Using their methodology I still find no evidence for a dramatic drop in urban life expectancies in the 1830s–40s. I also present new evidence that scarlet fever was a major cause of childhood mortality by the late 1830s and 1840s, in rural as well as urban populations, and could therefore account for the observed rise in early childhood mortality in this period.

SPATIAL PATTERN OF DISTRIBUTION OF DENGUE FEVER IN GORONTALO CITY IN 2019-2020

Gorontalo City is an endemic area of ​​dengue hemorrhagic fever, in 2019 the Incidence Rate was 55.06 per 100,000 population, in 2020 there was a decrease in the Incidence Rate but not significantly at 49.36 per 100.00 population The complexity of risk factors associated with the spread of Fever BLOODING DENGUE often causes related agencies to be less appropriate in planning prevention and control programs in their coverage areas. Therefore, an analysis of the distribution pattern of dengue hemorrhagic fever was carried out so that it could be utilized by the relevant agencies in controlling dengue hemorrhagic fever cases. The purpose of this study was to determine the pattern of distribution of dengue hemorrhagic fever cases in Gorontalo City. This research is a type of descriptive research with a spatial analysis approach. The analytical method used is Average Nearest Neighbor (ANN). The number of samples in this study were 138 which were analyzed based on kelurahan units. The results of the analysis showed that in 2019 there was a spatial pattern with NNR 0.608 < 1 which means the distribution pattern is clustered, while in 2020 there is a spatial pattern with NNR 0.624 <1 which means the distribution pattern is clustered. This study concluded that the distribution of dengue fever cases in Gorontalo City in 2019 and 2020 showed a clustered pattern. Areas with a clustered distribution pattern indicate areas that are prone to dengue hemorrhagic fever.

ANALYSIS OF THE DISTRIBUTION OF THE EVENT OF DENTAL FEVER THROUGH THE APPLICATION OF GEOGRAPHIC INFORMATION SYSTEM DATA

Every year dengue hemorrhagic fever (DHF) is still a public health problem, especially in Gorontalo City. Monitoring activities for patients need to be carried out to prevent disease transmission caused by mosquito bites as an intermediary vector. The utilization of Geographic Information Systems (GIS) related to the monitoring and identifying DHF mosquitoes has recently been widely used in public health science. This study aims to describe the pattern of the spread of dengue fever events through the application of geographic information system data in surveillance activities. This research is a descriptive-analytic study with an ecological approach and geographic information; the design used is Time Series. The research was conducted over six months. The study results based on the results of the Spearmen correlation test between climatic conditions and the incidence of DHF obtained a significance value of p 0.05. The distribution pattern of dengue fever in Gorontalo City is not related to climatic factors (temperature, humidity, rainfall, and rainy days). Conclusion: The distribution pattern of dengue fever in Gorontalo City is not related to climatic factors, including temperature, humidity, rainfall, and rainy days.

Epidemiological patterns of Rift Valley Fever from diverse habitats during an extreme unprecedented flooding of Lake Baringo basin, Kenya, 2012-2013

Mosquitoes’ ecology and associated arboviruses are heavily influenced by precipitation and retention of water in the environment. In 2011 and 2014, unprecedented floods occurred in the Lake Baringo basin inundating approximately 88 km2 of the shoreline land. This caused abrupt environmental changes raising fears of an outbreak of Rift Valley Fever (RVF) disease. This study was carried out to determine the situation of RVF disease in livestock from diverse habitats during the extreme unprecedented flooding phenomenon that occurred in the Lake Baringo basin, in 2012-2013. Blood was drawn from the ear vein of livestock selected randomly from the three study areas (lakeshore land, swamp marshy, and dry rangeland habitats). Mosquitoes were trapped using CDC light traps and identified morphologically. From a total of 77 blood samples, eight were positive for RVF virus (RVFV) representing an overall infection of 12%. RVF prevalence from livestock residents in flooded lakeshore land habitat was 2.6% (N=77) compared to the swamp marshy habitat at 7.8% (N=77). No infections were recorded from dry rangeland (0%). Mosquitoes of genus Mansonia dominated the catches in flooded lakeshore (98%). Highest individual catches of mosquitoes of genus Aedes was from swamp marshy area whose abundance was 96.8% and below 2% in other habitats. The Simpson’s Diversity Index for mosquitoes from swamp marshy habitat was 0.56, dry rangeland 0.57, and lakeshore land 0.13. The flooded lakeshore land was the most affected by the unprecedented floods resulting in uneven mosquito diversity and subsequently low prevalence of RVF in this habitat. This could be attributed to prolonged disruption of biotic and abiotic factors creating unfavorable breeding sites of multiple species of primary vectors of RVF in flooded lakeshore land unlike in other habitats.

Evaluation of Neighborhood Socio-Economic Status, as Measured by the Delphi Method, on Dengue Fever Distribution in Jeddah City, Saudi Arabia.

Dengue fever, a mosquito-transmitted viral disease, is present in many neighborhoods in Jeddah City, Saudi Arabia. One factor likely to affect its distribution is the socio-economic status of local neighborhoods; however, the absence of socio-economic census data in Saudi Arabia has precluded detailed investigation. This study aims to develop a proxy measure of socio-economic status in Jeddah City in order to assess its relationship with the occurrence of dengue fever. The Delphi method was used to assess the socio-economic status (high, medium or low) of local neighborhoods in Jeddah City. A Geographic Information System (GIS) was applied to understand the distribution of dengue fever according to the socio-economic status of Jeddah City neighborhoods. Low-socio-economic status neighborhoods in south Jeddah City, with poor environmental conditions and high levels of poverty and population density, reported most cases of dengue fever. Nevertheless, dengue continues to increase in high socio-economic status neighborhoods in the northern part of the city, possibly due to ideal breeding conditions caused by the presence of standing water associated with high levels of construction. Moreover, the low-socioeconomic-status neighborhoods had the highest average number of cases, being 3.95 times that of high-status neighborhoods for the period 2006–2009. The Delphi approach can produce a useful and robust measure of socio-economic status for use in the analysis of patterns of dengue fever. Results suggest that there are nuances in the relationship between socio-economic status and dengue that indicate that higher status areas are also at risk. A useful additional tool for researchers in Saudi Arabia would be the development of census data or other systematic measures that allow socio-economic status to be included in spatial analyses of dengue fever and other diseases.

Demand-driven spreading patterns of African swine fever in China.

African swine fever (ASF) is a highly contagious hemorrhagic viral disease of domestic and wild pigs. ASF has led to major economic losses and adverse impacts on livelihoods of stakeholders involved in the pork food system in many European and Asian countries. While the epidemiology of ASF virus (ASFV) is fairly well understood, there is neither any effective treatment nor vaccine. In this paper, we propose a novel method to model the spread of ASFV in China by integrating the data of pork import/export, transportation networks, and pork distribution centers. We first empirically analyze the overall spatiotemporal patterns of ASFV spread and conduct extensive experiments to evaluate the efficacy of a number of geographic distance measures. These empirical analyses of ASFV spread within China indicate that the first occurrence of ASFV has not been purely dependent on the geographical distance from existing infected regions. Instead, the pork supply-demand patterns have played an important role. Predictions based on a new distance measure achieve better performance in predicting ASFV spread among Chinese provinces and thus have the potential to enable the design of more effective control interventions.

Antimicrobial sensitivity patterns of enteric fever in Pakistan: a comparison of years 2009 and 2019.

Pakistan is one of the endemic regions for typhoid fever and paratyphoid fever. This study aimed to identify the evolving antimicrobial sensitivity patterns of Salmonella species causing enteric fever and its implications on the clinical prescribing of antimicrobials. This was a retrospective descriptive study conducted at a university hospital. Antimicrobial resistance was defined in terms of non-resistant, multidrug resistant (MDR) and extended drug resistant (XDR) as per WHO guidance. Data were collected from the years 2009 and 2019. Chi squared was applied to test for statistical significance (p < 0.05). A total of 200 patients (100 from 2009 and 100 from 2019) were included in the study. Non-resistant enteric fever cases reduced from 100% in 2009 to 44% in 2019, whereas the MDR and XDR enteric fever cases increased to 16% and 40%, respectively (p < 0.05). Cross tabulation carried out for individual drugs showed an independent rise in the sensitivities of individual first-line antimicrobials. Antimicrobial resistant enteric fever has become a big challenge for Pakistan. The choice of antibiotic prescription has narrowed down to broader spectrum antimicrobials making it difficult to treat, leading to increased morbidity and mortality.

Correlation of Coronary Artery Abnormalities with Fever Pattern in Patients with Kawasaki Disease

To investigate the incidence of coronary artery abnormalities (CAAs) by fever pattern after intravenous immunoglobulin (IVIG) therapy in patients with Kawasaki disease. This retrospective cohort study included 172 patients with Kawasaki disease aged ≤12years who underwent IVIG therapy and had no CAAs before treatment. Resistance to initial IVIG was defined as persistent fever ≥37.5 °C for ≥24hours after therapy or the recurrence of Kawasaki disease after initial defervescence. The patients were divided into 3 groups: IVIG responders, nonresponders with persistent fever, and nonresponders with recurrent fever. CAAs were evaluated 2 or 4weeks and 12months after onset and were defined by a coronary artery z-score ≥2.5. The incidence of CAAs within 12months after onset was significantly higher in nonresponders with persistent fever (27%) compared with the other 2 groups. On multivariate logistic regression analysis, being a nonresponder with persistent fever was an independent risk factor for having CAAs within 12months after the onset of Kawasaki disease (OR, 6.48; P=.007). In patients with Kawasaki disease resistant to IVIG therapy, persistent fever, but not recurrent fever, was found to be a risk factor for the incidence of CAAs. Aggressive additional therapy may be beneficial to prevent CAA formation in patients with Kawasaki disease with persistent fever.

A Rare Case of Mixed Type Severe Malaria Co-infection with Dengue Complicated by Expanded Dengue Syndrome

Background Malaria and dengue are the most prevalent vector-borne diseases worldwide. Both diseases are endemic in similar tropical regions. Each infection has a specific mosquito vector. Hence, overlapping of the habitat cannot be easily available. In co-infection, the clinical features were more like dengue mono-infection than malaria mono-infection. Therefore, clinically, it is difficult to diagnose co-infection dengue and malaria. Case Illustration A 42-yo Javanese man, presented with 10-days of fever that was clinically and serologically consistent with symptoms of vivax malaria. Plasmodium vivax was found in the ring, trophozoite and schizonts form in the thick blood smear examination with parasitemia index 84.410 parasite/µl. In the course of the disease, patients were found to have a mixed infection with Plasmodium ovale. The patients also experience complications of spontaneous bleeding, thrombocytopenia and worsening respiratory conditions leading to acute respiratory distress syndrome (ARDS) which increases suspicion of co-infection with dengue virus. Laboratory tests to enforce dengue infection are carried out with the results obtained positive IgG and IgM that indicate recurrent infections. The patient is then given the management of severe malaria and expanded dengue syndrome according to the Indonesia Ministry of Health of guideline. On the 11th day of hospitalizations, the patients showed a significant cure rate and continuing ambulatory therapy with Primaquine 15 mg oral until day 14th. Conclusion The incidence of heavy bleeding in malaria patients is very low. Thus, malaria patients who experience unclear fever patterns and heavy bleeding should be systematically investigated for suspicion of dengue virus co-infection.

Clinico – Etiological profile of Acute Undifferentiated fever in children 6 months - 15 years

Introduction: Acute febrile illness (AFI) is defined as a patient with fever of 38?C or higher at presentation or history of fever that persisted for 2–14 days with no localizing source. Fever is the main clinical symptom of various tropical infectious diseases. Materials and Methods: Retrospective observational examination was directed after endorsement from the Institutional Ethics Committee in Paediatric division, Apollo General Hospital, AIMSR, Jubilee hills from January 2016 till December 2019. Inclusion criteria: All the patients who were conceded in the ward or emergency unit complications of intense febrile infections, patients a half year to 15 years old were taken for the investigation. Exclusion criteria: Patients with associated infections when the complications cannot be attributed to febrile illness or patients with haematological malignancies, autoimmune disorders, and those on immunosuppressant were excluded from the study. Results: In present investigation, an aggregate of 290 patients with intense identical fever were assessed out of these 157 (63%) were male and 133 (36.6%) were female. In this investigation typhoid fever was the most well-known reason for undifferentiated fever (33.7%) trailed by malaria (25.5%), dengue fever (19.6%), urinary tract disease (8.2%), Acute gastroenteritis (5.5%), Pneumonia (3.1%), Bronchiolitis (2.4%), Hepatitis (1.0%) and Pharyngotonsillitis (0.6%%). Conclusions: It is important to know the aetiology and clinical pattern of acute undifferentiated fever for their proper management and it will help to prevent morbidity and mortality. Keywords: Acute Undifferentiated fever, Acute febrile illness, Typhoid fever, Malaria, Dengue fever.

“CLINICAL PROFILE AND PREDICTORS OF ILLNESS SEVERITY IN CHILDREN WITH DENGUE FEVER”

BACKGROUND &amp; OBJECTIVES: Dengue illness has become exceedingly common over the last few years globally. Due to their unique characteristics, incidence as well as mortality is higher in pediatric population as compared to adults. This study was undertaken to study clinical pattern of dengue fever in children and to identify factors predicting a more severe disease. METHODS: We conducted this hospital based prospective study at A.N.M.M.C.H, Gaya, Bihar over 2 years from January 2016- December 2017. Children &gt;1 month and &lt;15 years age with fever ≥ 3 days and symptoms suggestive of Dengue infection were included and evaluated for dengue infection by testing for NS1 antigen, IgM and IgG against Dengue infection. Children were classied into 3 clinical groups: Dengue without warning signs (DWWS), Dengue with warning signs (DWS) and severe Dengue (SD) as per WHO classication. Clinical and laboratory parameters were compared in the 3 groups. RESULTS: 114 children with Dengue were studied. 62 (54.4%) were males as compared to 52 (45.6%) females. 41 (36%) had DWWS, 53 (46.5%) had DWS and 20 (17.5%) had SD. Mean age was 74.1 months (SD 18.2 months) and mean weight was 21.4 kg (S.D 5.1 kg). Common symptoms were fever (100%), myalgia (76.6%), chills (62.3%), nausea/ vomiting (63.2%) and rash (53.5%). Common signs were ushed appearance (36.8%), positive Hess test (27.2%), bleeding manifestation (13.2%) and hypotension (36.8%). Laboratory investigations revealed anaemia (18.4%), thrombocytopenia (81.6%), Leucopenia (69.3%), elevated transaminase (41.2%), abnormal RFT (5.3%). 27.1% had prolonged aPTT while 21% had prolonged PT. Nausea/vomiting, bleeding, oliguria, capillary leak and liver enlargement (&gt;2 cm) were signicantly more common in severe dengue (p&lt;0.05) whereas rash was commoner in non severe dengue. Lab parameters signicantly more common in SD included rising hematocrit, falling platelets, high urea/creatinine/ALT and hypoalbuminemia &amp; hypocholesterolemia. CONCLUSIONS: DF affects children irrespective of age. Symptoms more common in SD were nausea/vomiting, bleeding and decreased urine. Signs commoner in SD were features of capillary leak and hepatomegaly (&gt;2 cm). Rising hematocrit, falling platelets, high urea, creatinine and ALT but hypoalbuminemia and low cholesterol were found to be statistically signicant laboratory parameters associated with SD.

Sociodemographic predictors of knowledge, mosquito bite patterns and protective behaviors concerning vector borne disease: The case of dengue fever in Chinese subtropical city, Hong Kong.

Geographic pattern of dengue fever is changing due to the global environmental and climate changes in the 21st century. Evidence of community’s knowledge, mosquito bite patterns and protective behavior practices in non-endemic regions is limited. This study examined the knowledge of dengue, mosquito bite patterns, protective behavior practices and their associated factors in Hong Kong, a non-endemic subtropical city. A population-based random telephone survey (n = 590) was conducted three weeks after the government announcement of a local dengue outbreak in August 2018. Sociodemographic status, awareness, knowledge, protective measures, bite patterns of mosquito were collected. Results indicated high level of community awareness of the local outbreak (95.2%), symptom identification (84.0%) and adoption of at least one mosquito protective measures (nearly 80%). About 40% of respondents reported that they were bitten by mosquitoes during the study period, a high mosquito season in Hong Kong. Mosquito bites were prevalent near grassy area (63.4%), at home (42.6%) and at public transportation waiting spots (39.6%). Younger people (< 25 years old), female, those who lived on lower floors (≤the 6th) and near grassy area were at higher risk of mosquito bites at home. Respondents perceived higher threat of dengue to society were more likely to practice mosquito prevention. While residential factors affected their indoor prevention, other socio-demographic factors affected the outdoor prevention. Practicing prevention behaviors were associated with self-reported mosquito bite at home. Furthermore, the general prevention uptake rate unchanged after the announcement of local dengue outbreak. Although the uptake rate of protective measures during August was high, 40% participants reported they were bitten. Also public locations are more common area for bites, which suggested stronger mosquito prevention and control on public environments and more personal protective behaviors should be advocated.

Bayesian spatial survival modelling for dengue fever in Makassar, Indonesia

ObjectiveTo understand the spatial pattern of dengue fever (DF) patients’ survival and investigated factors influencing DF patients’ survival. MethodA Bayesian spatial survival method via a conditional autoregressive approach was used to analyze the factors that influence DF patients’ survival in 14 sub-districts from January 2015 to May 2017 in Makassar city, Indonesia. Bayesian spatial and a non-spatial model were compared by using deviance information criterion. ResultsThe spatial model was more suitable than a non-spatial model. Under the Bayesian spatial model, there was a substantive relationship between age, grade and DF patients’ survival time. ConclusionsThe relative risk map and related factors of DF patients’ survival can indicate the health policy makers to give special attention to the high risk areas in order to faster and more targeted treatment.

Sensitivity Patterns of Isolated Salmonella Typhi in Children with Typhoid Fever

<i>Background and objective</i>: Enteric fever is a common febrile illness and one of te major health problem in Bangladesh. So the present study was conducted to determine the demographic characteristics, clinical profile, hematological feature and current sensitivity patterns of isolated S typhi in patients suffering from enteric fever in some of the tertiary care hospitals in Dhaka. <i>Materials & Methods</i>: This was a cross sectional study conducted in the Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital (DMCH) and SSMCH – Sir Salimullah Medical College & Hospital (SSMCH), Dhaka, Bangladesh for a period of one year from July 2015 to June 2016. A total number of 100 children with enteric fever were studied and diagnose were based on clinical features, Wedel test and blood culture. <i>Results</i>: Out of 100 diagnosed enteric fever children, 60 (60%) were male and 40 (40%) were female. Fever was present in all patients. Other most common manifestation are loss of appetite, vomiting, diarrhea, headache and constipation. Coated tongue was the predominant examination finding followed by hepatomegaly, splenomegaly and abdominal tenderness. Sensitivity to ceftriaxone was 100% in our study while resistance to nalidixic acid was 90%. MDR S.typhi is still a threat but there was re-emergence of sensitivity to Cotrimoxazole and Chloramphenicol. <i>Conclusion</i>: The study concluded that clinical pattern of typhoid fever conforms well to that of known pattern of the disease in children. Blood culture profile shows widespread emergence of nalidixic acid related resistant strains and the sporadic occurrence of cephalosporin resistant strains of S. Typhi. However, the first line antibiotics such as chloramphenicol and cotrimoxazole still have a role to play in the treatment of typhoid due to re-emergence of sensitivity.

Seasonal variation of enteric fever in Kathmandu, Nepal

Background: Enteric fever is a global health problem and it is more common in low income countries where there is frequent faecal contamination of water and food hygiene is not maintained or not regulated .We have investigated the seasonal difference of enteric fever and antibiotic sensitivity patterns of those isolated organisms Methods and materials: The study was prospective, hospital based and done from April 2018 to July 2019.Blood culture was done for all suspected cases of blood stream infections and isolation, identification and antibiotic susceptibility test was done by following standard method Results: During 16 month period all together 49 Salmonella enterica serovars Typhi (n = 41) and Salmonella enterica serovar Paratyphi (n = 8) was isolated. The study revealed that enteric fever was prevailing throughout the year. However, 75.66% (31/41) were isolated in the rainy season (May to September) and least number of Salmonella enterica serovars Typhi was isolated in winter season (5/35). Similarly, 87.8%(7/8) Salmonella enterica serovars Paratyphi A was also isolated maximum number during the same period. Antibiotic sensitivity test showed that all the isolates of Salmonella enterica serovars Typhi were sensitive to amoxicillin, cefixime, and 92.3 of isolates were sensitive to cefotaxime and 91.4 to azithromycin. In contrast all the isolates were resistant to nalidixic acid and ciprofloxacin. Similarly, all the Salmonella enteric serovars Paratyphi were sensitive to amoxicillin and cefixime and all the isolates were resistant to nalidixic acid and ciprofloxacin. On the other hand, only 25% of Salmonella enterica serovars Paratyphi were sensitive to azithromycin and 37.5% of isolates were sensitive to cefotaxime. Conclusion: Thus, it is concluded that enteric fever is endemic in Kathmandu, Nepal and the infection rate is high in rainy season (May to August).The Amoxicillin and cefixime are highly effective to treat Enteric fever caused by Salmonella enterica serovars Typhi and paratyphi.