Bloodstream Infection among Children Presenting to a General Hospital Outpatient Clinic in Urban Nepal

Abstract

BackgroundThere are limited data on the etiology and characteristics of bloodstream infections in children presenting in hospital outpatient settings in South Asia. Previous studies in Nepal have highlighted the importance of murine typhus as a cause of febrile illness in adults and enteric fever as a leading bacterial cause of fever among children admitted to hospital.MethodsWe prospectively studied a total of 1084 febrile children aged between 2 months and 14 years presenting to a general hospital outpatient department in Kathmandu Valley, Nepal, over two study periods (summer and winter). Blood from all patients was tested by conventional culture and by real-time PCR for Rickettsia typhi.ResultsPutative etiological agents for fever were identified in 164 (15%) patients. Salmonella enterica serovar Typhi (S. Typhi) was identified in 107 (10%), S. enterica serovar Paratyphi A (S. Paratyphi) in 30 (3%), Streptococcus pneumoniae in 6 (0.6%), S. enterica serovar Typhimurium in 2 (0.2%), Haemophilus influenzae type b in 1 (0.1%), and Escherichia coli in 1 (0.1%) patient. S. Typhi was the most common organism isolated from blood during both summer and winter. Twenty-two (2%) patients were PCR positive for R. typhi. No significant demographic, clinical and laboratory features distinguished culture positive enteric fever and murine typhus.ConclusionsSalmonella infections are the leading cause of bloodstream infection among pediatric outpatients with fever in Kathmandu Valley. Extension of immunization programs against invasive bacterial disease to include the agents of enteric fever and pneumococcus could improve the health of children in Nepal.

Evaluating the Trends of Bloodstream Infections among Pediatric and Adult Patients at a Teaching Hospital of Kathmandu, Nepal: Role of Drug Resistant Pathogens

“…Pradhan et al also reported the similar rates of BSI in pediatric population in their study [26]. In this study, more pediatric patients (9.3%) were found with BSI as compared to adult patients (6.6%) and this difference was statistically significant ( p < 0.05).…”

Maternal-child health

“…A study on fever of unknown origin in Ghana revealed that S. Typhi remains the most prevalent bacterial species causing bacterial blood stream infections (BBSI), where 40.7% (59/145) of BBSI were caused by S. Typhi (Groß et al, 2011). The same situation can be found in Kathmandu Valley where Salmonella infections are the leading cause of bloodstream infection among pediatric outpatients with fever (Pradhan et al, 2012). Clinical Studies in Minna (Nigeria) also revealed a high prevalence of typhoid fever (44.4%) among children within the age group 1-10 years which is also similar with an earlier report of 43.9% prevalence rate in Cebu City, India.…”

Laboratory and Molecular Surveillance of Paediatric Typhoidal Salmonella in Nepal: Antimicrobial Resistance and Implications for Vaccine Policy

“…(A) Tempest regression of root-to-tip distance as (in the SNP alignment) a function of sampling time, with the root of the tree selected using heuristic residual mean squared (each point represents a tip of the maximum likelihood tree). The slope is a crude estimate of the substitution rate for the SNP alignment, the x-intercept corresponds to the e of the root node, and the R 2 is a measure of clocklike behaviour (B) Date randomisation test with the left most box plot showing the posterior substitution rate estimate from the SNP alignment of the data with the correct sampling times, and the remaining 20 boxplots showing the posterior distributions of the rate from replicate runs using randomised dates. The data are considered to have strong temporal structure if the estimate with the correct sampling times does not overlap with those from the randomisations.…”

“…As in most developing countries, invasive bacterial infections account for a significant proportion of paediatric morbidity and mortality in Nepal 1,2 . Enteric fever, caused by Salmonella enterica serovars Typhi ( S. Typhi) and Paratyphi A ( S. Paratyphi A), is the most common cause of bloodstream infection in Nepal 1,2 and on a global scale causes an estimated 26 million cases of enteric fever annually of which a large proportion are in children 3,4 . In Nepal, it is estimated that 13% of febrile paediatric cases attending outpatient care are blood culture positive for S. Typhi or Paratyphi A 2 .…”

“…Enteric fever, caused by Salmonella enterica serovars Typhi ( S. Typhi) and Paratyphi A ( S. Paratyphi A), is the most common cause of bloodstream infection in Nepal 1,2 and on a global scale causes an estimated 26 million cases of enteric fever annually of which a large proportion are in children 3,4 . In Nepal, it is estimated that 13% of febrile paediatric cases attending outpatient care are blood culture positive for S. Typhi or Paratyphi A 2 . Single nucleotide polymorphism (SNP) genotyping of S. Typhi isolated in a study of paediatric enteric fever cases at Patan Hospital in Kathmandu, Nepal during 2005 and 2006 suggested that, among children treated as inpatients, those aged ≤4 years were susceptible to a wider range of haplotypes due to immune naivety 5 .…”