Drug resistant typhoid fever; its clinical spectrum and management in different age groups.

Abstract

Objective: To describe the clinical spectrum of MDR and XDR typhoid fever in different age groups of pediatric population as the disease is generally more common in children with higher rates of complications and mortality. Study Design: Prospective Cross-sectional study. Setting: Department of Pediatric, Government Teaching Hospital Shahdara, Lahore. Period: July 2020 to July 2021. Material & Methods: 211 patients with suspected/confirmed enteric fever between 6 months to 5 years were initially enrolled. Blood culture was performed in all cases. Only culture confirmed cases (143/211) were included. Data was entered and analyzed using SPSS version 23. Quantitative variables like age group, fever defervescence time and duration of hospital stay were calculated as mean and standard deviations while qualitative variables like gender, clinical symptoms and signs, types of typhoid and response to antibiotics were calculated as percentages. Chi-square test was used taking P value <0.05 as statistically significant. Results: Mean age of study population was 6.8 ± 3.1 years. Majority (44.1%) of patients belonged to age group >5-10 years and were males (54.5%). Anorexia, coated tongue and hepatomegaly was prevalent among all age groups. High grade fever, loose motions and splenomegaly were common in children <5 years as were anemia, leukocytosis and enteric hepatitis. Children >5-10 years of age had more frequency of abdominal pain (P value <0.03), toxic look (P value <0.04) and leucopenia. While vomiting and thrombocytopenia were common in children >10-15 years of age. MDR typhoid was common in young children (<5 years) while XDR typhoid was common in children of >5-15 years. All MDR patients responded to ceftriaxone while XDR patients responded to either monotherapy or a combination of drugs. Age and gender did not affect antibiotic resistance in both MDR and XDR typhoid (P value >0.05). Fever defervescence time (FDT) was 3-5 days in both MDR and XDR typhoid and it was not significantly different with either monotherapy or a combination of drugs (P value 0.40). Conclusion: There are age related differences in clinical spectrum and lab parameters of drug resistant typhoid fever (MDR & XDR). Resistance to antibiotics in both MDR and XDR typhoid was not significantly affected by age and gender.