Risk factors for the development of severe typhoid fever in Vietnam

Abstract

BackgroundTyphoid fever is a systemic infection caused by the bacterium Salmonella enterica serovar Typhi. Age, sex, prolonged duration of illness, and infection with an antimicrobial resistant organism have been proposed risk factors for the development of severe disease or fatality in typhoid fever.MethodsWe analysed clinical data from 581 patients consecutively admitted with culture confirmed typhoid fever to two hospitals in Vietnam during two periods in 1993–1995 and 1997–1999. These periods spanned a change in the antimicrobial resistance phenotypes of the infecting organisms i.e. fully susceptible to standard antimicrobials, resistance to chloramphenicol, ampicillin and trimethoprim-sulphamethoxazole (multidrug resistant, MDR), and intermediate susceptibility to ciprofloxacin (nalidixic acid resistant). Age, sex, duration of illness prior to admission, hospital location and the presence of MDR or intermediate ciprofloxacin susceptibility in the infecting organism were examined by logistic regression analysis to identify factors independently associated with severe typhoid at the time of hospital admission.ResultsThe prevalence of severe typhoid was 15.5% (90/581) and included: gastrointestinal bleeding (43; 7.4%); hepatitis (29; 5.0%); encephalopathy (16; 2.8%); myocarditis (12; 2.1%); intestinal perforation (6; 1.0%); haemodynamic shock (5; 0.9%), and death (3; 0.5%). Severe disease was more common with increasing age, in those with a longer duration of illness and in patients infected with an organism exhibiting intermediate susceptibility to ciprofloxacin. Notably an MDR phenotype was not associated with severe disease. Severe disease was independently associated with infection with an organism with an intermediate susceptibility to ciprofloxacin (AOR 1.90; 95% CI 1.18-3.07; p = 0.009) and male sex (AOR 1.61 (1.00-2.57; p = 0.035).ConclusionsIn this group of patients hospitalised with typhoid fever infection with an organism with intermediate susceptibility to ciprofloxacin was independently associated with disease severity. During this period many patients were being treated with fluoroquinolones prior to hospital admission. Ciprofloxacin and ofloxacin should be used with caution in patients infected with S. Typhi that have intermediate susceptibility to ciprofloxacin.

Case Series of Imported Enteric Fever at a Referral Center in Tokyo, Japan: Antibiotic Susceptibility and Risk Factors for Relapse

“…[15][16][17] The rates of occurrence of relative bradycardia and splenomegaly were also similar to those in a previous study. 15 However, the rate for rose spots is reported to vary widely, from 2.6-4% 5,17 up to 49%, 15 and it was only 6% (2/35 patients) in the present study. We speculate that this wide variation could be the result of differences in time from disease onset to treatment initiation, because rose spots generally develop 1-2 weeks after onset.…”

“…Although decreased fluoroquinolone susceptibility has been considered as a risk factor for relapse, 17,26 no largescale study has analyzed the risk factors for relapse with ceftriaxone treatment. In the present study, the relapse group showed longer times from disease onset to treatment initiation (P = 0.035) and time to defervescence (> 7 days) after treatment initiation (P = 0.022) compared with the cure group.…”

“…9 The increase in strains with decreased susceptibility to fluoroquinolones, especially in the endemic areas, is a serious problem that leads to treatment failure and severe or fatal outcomes such as intestinal perforation, encephalopathy, and hemodynamic shock. 17 Accordingly, recent articles have recommended intravenous ceftriaxone or oral azithromycin for empiric treatment of enteric fever in returning travellers. 21 In fact, in our study, the isolates showed excellent susceptibility to ceftriaxone (97%) and azithromycin (97%).…”

Fiebre, ictericia y hepatitis: no siempre es infección viral

“…La hepatomegalia se encuentra en todos los pacientes con hepatitis por Salmonella (18)(19)(20), así como pueden cursar con esplenomegalia; estas visceromegalias pueden ser evidentes en el examen físico o por ecografía abdominal (20). Además de las manifestaciones sistémicas que pueden apoyar el diagnóstico como miocarditis, insuficiencia renal, y alteraciones hemorrágicas y cutáneas (como la presencia de exantema [30%]) (7,9,15,17), también es frecuente encontrar bradicardia, a pesar de la fiebre, y esta situación es una característica clásica de la entidad (1, 2, 4, 7). Las manifestaciones neuropsiquiátricas se presentan en 10%-40% de los casos y son complicaciones importantes y discapacitantes, dado que se asocian con severidad en la presentación clínica; estas incluyen delirio, estupor, coma, meningitis por tifoidea, encefalomielitis, síndrome de Guillan-Barré, psicosis, manía o apatía.…”

Typhoid Fever Complicated by Hemophagocytic Lymphohistiocytosis and Rhabdomyolysis

“…DISCUSSION TF by S. typhi can result in severe disease with complications in 10-15% of patients, including gastrointestinal bleeding, intestinal perforation, hepatitis, pancreatitis, typhoid encephalopathy, disseminated intravascular coagulation, hemolytic uremic syndrome, endocarditis, pneumonia, and rarely, reactive HLH and rhabdomyolysis such as in our patient. 2,3 Host factors associated with severe disease have been reported in younger individuals (birth through 1 year of age), the immunosuppressed, females, and those infected with resistant S. typhi.…”