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Published on: August 11, 2014
Clinical Profile of Children With Typhoid and Paratyphoid Fever and Antimicrobial Susceptibility Testing Patterns of
Chinmay Kumar Behera1, Mukesh K Jain1, Anupama Singh1
1Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, IND.
Insights
This study found that most children admitted with fever had typhoid fever, caused by Salmonella typhi. Salmonella paratyphi A was responsible for paratyphoid fever. Effective treatments for Salmonella typhi include azithromycin and chloramphenicol, while Salmonella paratyphi A responded well to meropenem and chloramphenicol.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Antimicrobial Resistance
Background:
- Typhoid and paratyphoid fevers pose global health challenges in children due to rising antimicrobial resistance (AMR).
- Understanding the clinical presentation and antimicrobial susceptibility patterns of Salmonella typhi and Salmonella paratyphi is crucial for effective treatment.
Purpose of the Study:
- To determine the common symptoms of typhoid and paratyphoid fevers in pediatric patients.
- To assess the antimicrobial susceptibility testing (AST) patterns of Salmonella typhi and Salmonella paratyphi isolates.
Main Methods:
- A cross-sectional study was conducted at Kalinga Institute of Medical Sciences, India, involving pediatric patients with positive blood cultures for Salmonella.
- Data on patient demographics, symptoms, and hospitalization duration were collected.
- Antimicrobial susceptibility testing (AST) was performed using the VITEK 2 system, with data analyzed using R software.
Main Results:
- The study included 328 pediatric patients; 80.49% had typhoid fever (Salmonella typhi) and 19.51% had paratyphoid fever (Salmonella paratyphi A).
- Common symptoms included fever (100%), cough (47.87%), altered bowel movements (38.41%), and abdominal pain (27.13%).
- Salmonella typhi showed high sensitivity to chloramphenicol and azithromycin, while Salmonella paratyphi A was most sensitive to meropenem and chloramphenicol. Both pathogens exhibited significant resistance to quinolones like ciprofloxacin and levofloxacin.
Conclusions:
- Typhoid fever is prevalent among children presenting with fever, with Salmonella typhi being the primary causative agent.
- Fever, cough, and gastrointestinal disturbances are key symptoms requiring attention.
- Effective treatment options for Salmonella typhi include azithromycin and chloramphenicol, while Salmonella paratyphi A is best treated with meropenem and chloramphenicol, underscoring the need for targeted antimicrobial therapy based on AST results.
Abstract:
Background and objectives Typhoid and paratyphoid fevers in children are global health concerns due to antimicrobial resistance (AMR) among their pathogens (i.e., Salmonella typhi and Salmonella paratyphi). We conducted this study to determine the symptoms of typhoid and paratyphoid fevers in children and assess the antimicrobial susceptibility testing (AST) patterns of S. typhi and S. paratyphi isolates in our hospital. Methods This cross-sectional study was conducted from July 2023 to June 2025 at Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, India. All pediatric patients (under 18 years) admitted during the indicated timeframe with fever were screened. The study included participants with a positive blood culture for S. typhi or S. paratyphi. Patients who reported having any additional bacteria were not included. We noted the participants' age, sex, symptoms, and length of hospitalization. Blood samples were collected to determine AST results for the bacterial isolates. We presented our findings using an upset plot, jitter plots, and chord diagrams. We used the VITEK 2 system to perform AST. We used R software (version 4.6.1) for data analysis. Results Our study population comprised 328 participants (men: 171, 52.13%; women: 157, 47.87%). The median age of the participants was 8.63 (5.98-11.52) years. Typhoid and paratyphoid fevers were seen in 264 (80.49%) and 64 (19.51%) patients, respectively. The causative organisms were S. typhi and S. paratyphi A, respectively. The median hospitalization length was 7.5 (5.0-10.3) days. The most common symptoms were fever (328, 100%), followed by cough (157, 47.87%), followed by altered bowel movements (126, 38.41%), abdominal pain (89, 27.13%), coated tongue (71, 21.65%), vomiting (66, 20.12%), and loss of appetite (47, 14.33%). The S. typhi isolates demonstrated the highest sensitivity to chloramphenicol (261, 98.86%), followed by azithromycin (256, 96.97%), imipenem (241, 91.29%), cotrimoxazole (251, 95.08%), and meropenem (249, 94.32%). Levofloxacin (177, 67.05%) was the most resistant drug, followed by ciprofloxacin (161, 60.98%) and ofloxacin (127, 48.11%) for the 264 S. typhi isolates. None of the isolates showed resistance to azithromycin or chloramphenicol. The S. paratyphi A isolates demonstrated maximum sensitivity towards meropenem (57, 89.06%), followed by imipenem (55, 85.94%), chloramphenicol (54, 84.38%), and cotrimoxazole (51, 79.69%). Ciprofloxacin (47, 73.44%), followed by ofloxacin (42, 65.63%) and levofloxacin (41, 64.06%), were the most resistant drugs among the 64 S. paratyphi A isolates. Conclusion Most participants had typhoid fever. S. paratyphi A was the causative organism of paratyphoid fever in the remaining 64 participants. Fever, cough, abnormal bowel motions, abdominal pain, coated tongue, vomiting, and appetite loss were the most prevalent symptoms. For the S. typhi isolates, azithromycin, cotrimoxazole, imipenem, meropenem, and chloramphenicol were the most effective treatment options. Similarly, the best therapies for the S. paratyphi A isolates were imipenem, meropenem, cotrimoxazole, and chloramphenicol. Both isolates exhibited the highest level of resistance to quinolones, including levofloxacin, ciprofloxacin, and ofloxacin.
