Age Related Clinical and Laboratory Manifestations of Enteric Fever in Children.

ABSTRACT

Scanty literature is available on age related clinical features in children in Western India. A study was thereby conducted to evaluate the clinical profile of enteric fever patients admitted in our hospital in the year 2007. All patients with fever with Widal positive and/or with culture grown salmonella were included. A retrospective analysis of their clinical features, laboratory parameters and antimicrobial therapy was done. A total of 33 patients were included and divided into two age groups; < 5 years and > 5 years. Mean age of presentation was 5 + 3 years. Male Female ratio was 21. Common clinical features were fever (100%), hepatomegaly (82%), elevated liver enzymes (85%), anemia (88%) and elevated ESR (80%). None of the patients had constipation. In the age group of <5 years, diarrhea was more common in (P = 0.05), whereas relative bradycardia (P = 0.018) and gall bladder sludge on USG (P = 0.04) was seen only in > 5 years age group. Of all the first line antibiotics used, Ceftriaxone was used in 29 (87.88%) patients, Ciprofloxacin in 3 (9.1%) patients, and Cefotaxime in 1 (3%) patient. Failure of first line antibiotics was seen in 10 (30.3%) patients. Complications were seen in 6 (18.18%) patients, of which 2 (33.33%) had serositis, 1 (16.67%) each had osteomyelitis, synovitis, splenic abscess and shock. 31 (93.9%) patients recovered. 1 (3%) died and 1 (3%) was lost to follow-up. Recovery was faster in < 5 years age group (Mean 6.1 ± 2.1 days) as compared to > 5 years old (9.4 ± 4.5 days) (P = 0.01).Fever, hepatomegaly, elevated liver enzymes, anemia and elevated ESR are the common clinical features of enteric fever in children. Diarrhea is more common in younger children whereas relative bradycardia and gall bladder sludge is more common in older children. Constipation is not a feature. Recovery is better in younger children. 30% of our patients had resistance to third generation cephalosporins as first line antibiotics.