Ileal Perforation and Enteric Fever: Implications for Burden of Disease Estimation

Abstract

Background Ileal perforation occurs in about 1% of enteric fevers as a complication, with a case fatality risk (CFR) of 20%–30% in the early 1990s that decreased to 15.4% in 2011 in South East Asia. We report nontraumatic ileal perforations and its associated CFR from a 2-year prospective enteric fever surveillance across India. Methods The Surveillance for Enteric Fever in India (SEFI) project established a multitiered surveillance system for enteric fever between December 2017 and March 2020. Nontraumatic ileal perforations were surveilled at 8 tertiary care and 6 secondary care hospitals and classified according to etiology. Results Of the 158 nontraumatic ileal perforation cases identified,126 were consented and enrolled. Enteric fever (34.7%), tuberculosis (19.0%), malignancy (5.8%), and perforation of Meckel diverticulum (4.9%) were the common etiology. In those with enteric fever ileal perforation, the CFR was 7.1%. Conclusions Enteric fever remains the most common cause of nontraumatic ileal perforation in India, followed by tuberculosis. Better modalities of establishing etiology are required to classify the illness, and frame management guidelines and preventive measures. CFR data are critical for comprehensive disease burden estimation and policymaking.

Clinical Epidemiology and Surgical Treatment of Spontaneous Perforations of the Terminal Ileum: A Multicentre Study in Cameroon

“…Added to this is the delay in diagnosis already mentioned above, which is constant in most authors on the continent [14] [15] [18] [20]. This significant morbidity is responsible for an often lengthy hospital stay, as observed in this series and in many others [5] [15] [16] [17] [20], with significant financial consequences for patients and their families. The overall postoperative mortality rate varies from 13.8% to 28.3% in African authors [5] [14] [15] [18] [20].…”

“…Serological and bacteriological data, which can be very useful, are usually negative [1] [16] [19]. Other aetiologies such as tuberculosis, tumours or non-specific causes are frequently suggested [1] [2] [16].…”

Fiebre Tifoidea

“…En la mayor parte del mundo, la tasa de pacientes con esta complicación oscila entre 0,6 % y 4,9 % de los casos de fiebre entérica, mientras que en África occidental se han notificado tasas más altas, de 10 a 33 %. (11) Dicha perforación ocurre generalmente entre los 5 y 30 años de edad, cuando el sistema inmunológico está completamente desarrollado; la gravedad de la enfermedad y la mortalidad aumenta abruptamente lejos de este grupo etario. En un 42-89 % de los pacientes la contaminación peritoneal es grave, la peritonitis está mal localizada y el epiplón está lejos del sitio de perforación.…”

Prevalence, Anatomic-pathologic Findings, and Associated Factors of Nontraumatic Ileal Perforations Among Patients with Gut Perforation: A Multicenter Cross-sectional Study

“…The situation is slightly different in LMICs, such as Asia, sub-Saharan Africa, and Latin America, where the causes of ileal perforation are predominantly of infectious origin (10). The infections that have contributed largely to ileal perforation are typhoid, tuberculosis, Taenia, ascaemia, and Entamoebia histolytica, which are precipitated by the burden of HIV in the region (11). Currently, there is no single diagnostic modality that can accurately identify the site of ileal perforation, as most cases are identi ed intraoperatively (12).…”