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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.
Insights
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.
Abstract:
Typhoid accounts for 8% of pediatric admissions to the Aga Khan University Hospital in Karachi, Pakistan. Over a 4-year period (1986-1989), 355 children had typhoid documented by culture of blood or bone marrow. Strains of Salmonella, resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole accounted for 20% of these cases. Compared with children infected by drug-susceptible strains of Salmonella, children with multiresistant infection were generally sicker at presentation and were more likely to be assessed as appearing "toxic" (P less than .001), as having disseminated intravascular coagulation (P less than .01), and as exhibiting hepatomegaly (P less than .01). The mortality was 4.2% among children with multiresistant infection and 1.4% among those infected with strains susceptible to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole; the higher mortality in the former group was probably due to a longer duration of illness (P less than .05) and to ineffectual oral antimicrobial therapy before hospitalization.