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Multidrug-resistant typhoid in children: presentation and clinical features
Z A Bhutta1, S H Naqvi, R A Razzaq
1Department of Pediatrics, Faculty of Health Sciences, Aga Khan University, Karachi, Pakistan.
Reviews of Infectious Diseases
|September 1, 1991
Summary
Multidrug-resistant typhoid in children is a growing concern, leading to more severe illness and higher mortality rates. Early diagnosis and effective treatment are crucial for combating this public health challenge.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Resistance
- Clinical Microbiology
Background:
- Typhoid fever is a significant cause of pediatric hospital admissions in Karachi, Pakistan.
- A notable percentage of typhoid cases are caused by multidrug-resistant Salmonella strains.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of pediatric typhoid infections.
- To compare outcomes between infections caused by drug-susceptible and multidrug-resistant Salmonella strains.
Main Methods:
- Retrospective analysis of 355 pediatric typhoid cases documented by blood or bone marrow culture.
- Comparison of clinical presentation, severity markers, and mortality between susceptible and resistant infection groups.
Main Results:
- Twenty percent of Salmonella strains were resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole.
- Children with multidrug-resistant infections presented as sicker, with higher rates of "toxic" appearance, disseminated intravascular coagulation, and hepatomegaly.
- Mortality was significantly higher in children with multidrug-resistant typhoid (4.2%) compared to drug-susceptible cases (1.4%).
Conclusions:
- Multidrug-resistant typhoid is associated with increased clinical severity and mortality in children.
- Ineffectual pre-hospitalization antimicrobial therapy may contribute to poorer outcomes in multidrug-resistant cases.
- The findings underscore the need for vigilant monitoring of antimicrobial resistance patterns and prompt, appropriate treatment for pediatric typhoid.