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Typhoid fever in hospitalized children in Kelantan, Malaysia
K E Choo1, A Razif, W A Ariffin
1Department of Paediatrics, Universiti Sains Malaysia School of Medical Sciences, Kota Bharu, Kelantan, Malaysia.
Insights
This study on pediatric typhoid fever in Kelantan found school-children most affected, with fever and hepatomegaly common. Early diagnosis and appropriate antibiotic use are crucial for managing this infectious disease.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Typhoid fever remains a significant public health concern, particularly in endemic regions.
- Understanding the specific epidemiological and clinical characteristics in pediatric populations is essential for effective disease control.
Purpose of the Study:
- To investigate the epidemiological, clinical, laboratory, and treatment aspects of blood culture-positive typhoid fever in children admitted to Hospital Universiti Sains Malaysia.
- To identify key features and complications of typhoid fever in Kelantanese children.
Main Methods:
- A retrospective study analyzing data from 137 pediatric patients with blood culture-proven typhoid fever.
- Data collection included patient demographics, clinical presentation, laboratory results, and treatment regimens.
Main Results:
- School-children constituted the most affected group, with cases occurring year-round.
- Common symptoms included fever, hepatomegaly, diarrhea, vomiting, and cough; rose spots were rare.
- Complications ranged from gastritis and gastro-intestinal bleeding to encephalopathy and myocarditis. Leucopenia was observed in 46% of patients.
- Blood and stool cultures were positive during the first three weeks of illness. Relying solely on an O titre > 1/160 would miss 50% of cases.
- Chloramphenicol was the primary antibiotic used, and two deaths were recorded.
Conclusions:
- Typhoid fever in Kelantanese children presents with characteristic symptoms and a range of potential complications.
- Diagnostic criteria should consider clinical and laboratory findings beyond a single serological titre threshold.
- Effective management involves prompt diagnosis and appropriate antibiotic therapy to reduce morbidity and mortality.
Abstract:
A retrospective study of 137 patients with blood culture-positive typhoid fever admitted to the paediatric unit of the Hospital Universiti Sains Malaysia was carried out to study epidemiological, clinical, laboratory and treatment aspects of typhoid fever in Kelantanese children in hospital. The male:female ratio was 1:1.1. School-children were the most affected. Cases were seen throughout the year. The five most frequently presenting features were fever, hepatomegaly, diarrhoea, vomiting and cough. Rose spots were seen in only two patients. Complications included gastritis, bronchitis, ileus, psychosis, encephalopathy, gastro-intestinal bleeding and myocarditis. Relative bradycardia was not seen. Blood and stool cultures were positive in the 1st, 2nd and 3rd weeks of illness. There was no significant difference between percentages of elevated O and H titres, whether done during or after the 1st week of illness. A four-fold rise in (O) titres occurred in 50% of cases tested. We would miss 50% of typhoid fever cases if a titre (O) equal to more than 1/160 were relied upon for diagnosis. Altogether, 46% of patients had leucopenia. Chloramphenicol was the most commonly used antibiotic. There were two deaths.