Case Fatality Rate and Length of Hospital Stay among Patients with Typhoid Intestinal Perforation in Developing Countries: A Systematic Literature Review

Abstract

BackgroundTyphoid fever remains a major health problem in the developing world. Intestinal perforation is a lethal complication and continues to occur in impoverished areas despite advances in preventive and therapeutic strategies.ObjectivesTo estimate the case fatality rate (CFR) and length of hospital stay among patients with typhoid intestinal perforation in developing countries.Data SourcesPeer-reviewed publications listed in PubMed and Google Scholar.Study EligibilityThe publications containing data on CFR or length of hospitalization for typhoid fever from low, lower middle and upper middle income countries based on World Bank classification. Limits are English language, human research and publication date from 1st January 1991 to 31st December 2011.ParticipantsSubjects with reported typhoid intestinal perforation.InterventionsNone, standard practice as reported in the publication.Study Appraisal and Synthesis MethodsSystematic literature review followed by meta-analysis after regional classification on primary data. Descriptive methods were applied on secondary data.ResultsFrom 42 published reports, a total of 4,626 hospitalized typhoid intestinal perforation cases and 706 deaths were recorded (CFR = 15·4%; 95% CI; 13·0%–17·8%) with a significant regional differences. The overall mean length of hospitalization for intestinal perforation from 23 studies was 18.4 days (N = 2,542; 95% CI; 15.6–21.1).LimitationsMost typhoid intestinal perforation studies featured in this review were from a limited number of countries.ConclusionsThe CFR estimated in this review is a substantial reduction from the 39.6% reported from a literature review for years 1960 to 1990. Aggressive resuscitation, appropriate antimicrobial coverage, and prompt surgical intervention may have contributed to decrease mortality.ImplicationsThe quantification of intestinal perforation outcomes and its regional disparities as presented here is valuable in prioritizing and targeting typhoid-preventive interventions to the most affected areas.

Clinicopathological study of Ileal perforation: study in tertiary center

“…6 In this histopathology reports Nonspecific inflammation of the terminal ileum was another predominant cause. In such cases, the operative findings were similar to that of typhoid fever but no laboratory evidence of the disease was found.…”

“…6 First, typhoid intestinal perforation CFR is high even today in Africa and Asia, alerting to the importance of typhoid prevention and control activities in those regions.…”

“…Very rarely, small intestinal lymphomas may present with perforation. 6 Males have more tendencies to have perforation than females. perforations has poor out come and lead to wound infection, increase in duration of hospital stay, MODS, SIRS, undue delays in chemotherapy and ultimately mortality.…”

Economic evaluation of typhoid vaccination in a prolonged typhoid outbreak setting: The case of Kasese district in Uganda

“…To calculate number of deaths due to typhoid fever, typical values were used for the case fatality rate for typhoid patients without IP (0.6-2.1% across all age-groups) [2,20]. For typhoid patients with IP the case fatality rate considered was 17-22% across all age-groups, according to a recent review of the evidence [21]. Average vaccine effectiveness over the duration of immunity of the vaccine (3 years) was considered to vary between 30% and 70% [22].…”

“…Health care seeking behavior included patients cared for at home, hospitalizations (for IP and non IP patients), and outpatient treatment. Length of illness (4-7 days for patients without IP, and 17-24 days for patients with IP) was taken from a recent review and previous published evidence for typhoid [14,21] (Table 1). …”