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[Aspects of typhoid fever in children]
Insights
This study on pediatric typhoid fever highlights diagnostic challenges and treatment responses. Some children with typhoid fever may not respond to standard antibiotics like chloramphenicol or amoxicillin, requiring alternative treatments.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Clinical pharmacology
Context:
- Typhoid fever presents diagnostic challenges in children, with initial misdiagnosis in 38% of cases.
- Common symptoms include fever, abdominal pain, and diarrhea; examination findings can include abdominal tenderness, delirium, and liver enlargement.
- Hematological findings such as anemia and lymphopenia are noted in a significant percentage of pediatric typhoid patients.
Purpose:
- To describe clinical features, treatment outcomes, and diagnostic considerations of typhoid fever in 77 children.
- To evaluate the efficacy of chloramphenicol, amoxicillin, and ampicillin in treating pediatric typhoid fever.
- To identify challenges in diagnosing and managing typhoid fever, particularly in cases with antibiotic resistance.
Summary:
- A cohort of 77 children (48 boys, 29 girls) aged 1 month to 12 years with typhoid fever was treated with chloramphenicol, amoxicillin, or ampicillin.
- The average fever duration was 5.2 days, with one relapse and one fatality in a one-month-old infant.
- Two patients with resistant Salmonella typhi strains successfully responded to co-trimoxazole, underscoring the need for vigilance regarding antibiotic resistance.
Impact:
- Highlights the importance of considering typhoid fever in pediatric patients, especially in certain populations.
- Suggests that milk feeds may exacerbate symptoms like diarrhea and abdominal distension during the acute phase, recommending soya products as an alternative.
- Emphasizes that some typhoid fever cases may exhibit resistance to chloramphenicol and amoxicillin, necessitating alternative therapeutic strategies.
Abstract:
Some aspects of typhoid fever in 77 children are discussed. There were 48 boys and 29 girls and their ages ranged from 1 month to 12 years. The patients were treated with chloramphenicol 100 mg/kg/d during the first 2 weeks and with either amoxycillin (100 mg/kg/d) or ampicillin (200 mg/kg/d) during the third week. The average duration of fever was 5.2 days. There was 1 relapse and 1 child, a baby aged 1 month, died. The correct diagnosis was not suspected by the referring doctor in 38% of the patients. On admission the commonest complaints were fever, abdominal pain, diarrhoea, headache and vomiting. The commonest findings on examination were tenderness or distension of the abdomen, apathy or delirium, rhonchi or crepitations, liver enlargement and meningism. There was anaemia (Hb less than 10 g/dl) in 23% and lymphopenia (less than 1500/microliter) in 43% of the patients. The differential white blood cell count revealed 5% or more unsegmented neutrophils in 32% of the patients, while 25% had 10% or more band cells. Two patients (sisters) failed to respond after 15 and 16 days of therapy with chloramphenicol and ampicillin because of resistant Salmonella typhi and were successfully treated with co-trimoxazole. Practitioners caring for black patients should always be on the alert for typhoid fever; some patients may not respond to chloramphenicol or amoxicillin. During the acute phase milk feeds are best replaced by soya products because of abdominal distension or aggravation of diarrhoea by milk.
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