Current perspectives of enteric fever: a hospital-based study from India

Walia, Mandeep; Gaind, Rajni; Mehta, Rajesh; Paul, Premila; Aggarwal, Praveen; Kalaivani, Mani

doi:10.1179/146532805x58085

Cited by 56 publications

(64 citation statements)

References 35 publications

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“…Similarly, MDR was observed in only 3.4% of our Salmonella Typhi strains. The absence of MDR in S. Paratyphi A throughout the study period is consistent with the reports from India and Nepal [7,17], and as 100% of these isolates were susceptible to chloramphenicol and cotrimoxazole, the possibility of their reuse can be considered for management of paratyphoid fever.…”

Section: Discussionsupporting

confidence: 73%

“…Such increasing isolation rates of Salmonella Paratyphi A have been reported across India [5,7,14]. This likely reflects a high degree of clinical suspicion for enteric fever, even in milder clinical presentation.…”

Section: Discussionmentioning

confidence: 89%

“…The situation was further complicated by the emergence of quinoloneresistant strains with reduced susceptibility to ciprofloxacin (MIC 0.125-1 μg/mL). Since then, several studies have reported a continuous rise in ciprofloxacin MIC levels associated with treatment failure or prolonged defervescence time with ciprofloxacin [7]. Beginning in 2004, high-level ciprofloxacin resistance was reported across India [8].…”

Section: Introductionmentioning

confidence: 99%

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Antimicrobial resistance among blood culture isolates of Salmonella enterica in New Delhi

Jain

Chugh

2013

J Infect Dev Ctries

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Introduction: Enteric fever is a global public health problem, especially in developing countries. Antimicrobial resistance is a major issue enteric fever management. This study examined current pattern of antimicrobial susceptibility among Salmonella enterica isolates from enteric fever cases at a tertiary care centre in New Delhi, India. Methodology: Blood cultures from patients with enteric fever during January 2010-July 2012 were processed using the BACTEC automated system. Antimicrobial susceptibility was tested using Kirby Bauer's disc diffusion method and/or Phoenix 100 automated system. Results: Of 344 isolates of Salmonella enterica, 266 (77.3%) were S. Typhi, 77 (22.4%) were S. Paratyphi A, and one (0.3%) was S. Paratyphi B. Resistance to nalidixic acid (NA R ) (96.7%) was most common, followed by ciprofloxacin (37.9%), and azithromycin (7.3%). Multi-drug resistance was observed only in S. Typhi (3.4%). Among NA R strains, 61.8% were sensitive, 11.1% were moderately sensitive, and 23.9% were resistant to ciprofloxacin (0.8%, 57.4%, and 37.9% respectively according to revised CLSI breakpoint criteria for ciprofloxacin). Resistance to third-generation cephalosporin was found in seven (2%) strains of S. enterica. Conclusion: Increasing rates of nalidixic acid, fluoroquinolone and azithromycin resistance among S. enterica, particularly in S. Paratyphi A strains, is of concern, as S. Paratyphi A infection is becoming increasingly common and is not prevented by current vaccinations. Our results favour use of cefexime or possibly chloramphenicol as first choice for uncomplicated enteric fever. MICs for third-generation cephalosporins and susceptibility pattern must be closely monitored in view of its emerging resistance among Salmonella enterica.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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Antimicrobial resistance among blood culture isolates of Salmonella enterica in New Delhi

Jain

Chugh

2013

J Infect Dev Ctries

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“…The fact that we found no statistical difference in response to ceftriaxone between the two groups suggests that NAR is only class specific. This is at variance from a study by Walia et al [4] who found a significant difference in the time to defervescence in nalidixic acid resistant salmonella and those which were sensitive possibly due to the fact that their groups were treated with fluoroquinolones. Due to the small group of patients who were treated only with fluoroquinolones a sub group analysis of response to that antibiotic in NAR and NAS group could not be done.…”

Section: Discussioncontrasting

confidence: 55%

Profile of Culture Positive Enteric Fever from Bangalore

Gupta

Handa

Chadha

et al. 2009

Medical Journal Armed Forces India

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Background: Enteric fever is endemic in India. The aim of this study was to analyse the clinical, laboratory, antibiotic sensitivity profile and response to antibiotics of culture positive enteric fever patients from Bangalore. Methods: In this retrospective study only culture positive enteric fever patients were taken and their clinical, laboratory, antibiotic sensitivity profile and the clinical response to antibiotics studied. Result: Eighty one culture positive enteric fever patients were taken into the study. Presenting symptoms included fever, pain abdomen (18.5%), loose stools (25%), vomiting (33%) and headache (30%). Absolute bradycardia at admission was not found in any of our patients. Normal or low total leucocyte count was seen in 97.5%. Typhoid hepatitis was seen in 8.5%. Salmonella enterica subspecies enterica serovar typhi (S typhi) were isolated in 80% of cases; 83% of all cases showed nalidixic acid resistance. All isolates were sensitive to chloramphenicol and third generation cephalosporins. Ciprofloxacin resistance was found in 19% cases. The time to defervescence in patients treated with ceftriaxone was 4.3 days. There was no statistical difference in time to defervescence in nalidixic acid resistant and sensitive strains. Complications included gastro intestinal bleed and encephalopathy. Conclusion: Prevalence of nalidixic acid resistance is high, while clinical resistance to quinolones may be higher than that found in the laboratory which requires detailed study. Chloramphenicol sensitivity has returned and nalidixic acid resistant and sensitive isolates are uniformly sensitive to third generation cephalosporins with no difference in time to defervescence. MJAFI 2009; 65 : 328-331

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“…Other large series include those by Chowta et al, S. jog et al and Walia et al 2,12,13 Most of the clinical symptoms and signs reported by us are similar to those reported earlier. [14][15][16] Children in this study commonly presented with fever, headache and gastrointestinal symptoms and diarrhea was more common than constipation.…”

Section: Discussionsupporting

confidence: 77%

Clinical profile of enteric fever in tertiary care hospital of Kashmir

Mushtaq

Bhat

Rather

et al. 2017

Int J Contemp Pediatr

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Background: Enteric fever is common cause of pyrexia in children and its diagnosis poses several problems, the diagnosis most often remains either as an unsubstantiated clinical impression or a serological diagnosis and occasionally confirmed by blood culture. Typhoid fever is a commonly encountered systemic disease caused by the gram-negative bacteria Salmonella enterica serovar typhi. It is a major public health problem in India. The incidence of enteric fever can be regarded as an index of sanitary measure practiced in our country. Aim of our study was to know the clinical profile, hematological features of clinically and serologically suspected typhoid cases, antibiotic pattern in use, the time to defervescence with the treatment received and over all hospital stay days. Methods: This was a retrospective record file review of all admitted children for pyrexia under evaluation who were clinically suspected as cases of enteric fever and serologically proven by significant titres of O and H antigen and few were culture proven cases of enteric fever carried out at a tertiary care children hospital in Kashmir valley over the period January 2012 to January 2016. Results: During this period, a total of 129 children with typhoid fever were admitted to Pediatric ward. Of the 129 children, 69 (53.5%) were boys and 60 (46.5%) were girls. The age range of the study population was 1 year to 15 years. The predominant symptoms of typhoid fever were fever 123 (95.3%), anorexia/weakness 58 (45.0%), abdominal pain 53 (41.1%), pallor 47 (36.4%), coated tongue 42 (32.6%), headache 30 (23.3%) and gastrointestinal symptoms/ dysentry 9 (7.0%). Diarrhea 25 (19.4%) was more common than constipation 5 (3.9%) in this study. Hepatomegaly 26 (20.2%) and splenomegaly 67 (51.9%), lymphadenopathy 24 (19.4%) and seizure in 5 cases (3.9%) were other major physical findings. Typhoid complications were seen in the form of jaundice (deranged LFTs) 25 (19.4%), abdominal distention 20 (15.5%) and tenderness 14 (10.9%), encephalopathy 5 (3.9%), shock 3 (2.3%) and UTI 4 (3.1%). Blood culture was positive in 36 (27.9%), 20 (15.5%) percent of the isolates were Salmonella typhi, while 16 (12.4%) were Salmonella paratyphi A. low yield was attributed to oral antibiotics received outside hospital setting. Ceftriaxone was used to treat all the patients diagnosed with enteric fever. Oral Azithromycin was added to treatment regime in those patients who were persistently febrile after 6 days. Those patients who were discharged before 14 days, therapy was completed with oral cefixime. The mean duration of hospital stay was 9.6 days for uncomplicated cases. Leukopenia was seen in majority of the patients with mean cell count of 6492.7cubic/mm. The mean time to defervescence in patients who received prior antibiotics was 4 days while that in those who did not receive prior antibiotics was 5 days. Conclusions: Atypical presentations are seen in typhoid fever patients so we need to be cautious about it, clinical symptoms and signs can vary with different ...

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Current perspectives of enteric fever: a hospital-based study from India

Cited by 56 publications

References 35 publications

Antimicrobial resistance among blood culture isolates of Salmonella enterica in New Delhi

Antimicrobial resistance among blood culture isolates of Salmonella enterica in New Delhi

Profile of Culture Positive Enteric Fever from Bangalore

Clinical profile of enteric fever in tertiary care hospital of Kashmir

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