Patterns of resistant Salmonella typhi infection in infants
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Published on: August 11, 2014
S Rajajee1, T B Anandi, S Subha
1Childs Trust Hospital & Medical Research Foundation Madras, India.
Insights
Drug-resistant enteric fever in infants presents severely with multiple organ issues. Early, appropriate antibiotics based on local sensitivity are crucial to prevent infant mortality and morbidity.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Enteric fever, particularly Salmonella typhi infections, poses a significant health challenge, especially in young children.
- Antibiotic resistance in Salmonella typhi is a growing concern, complicating treatment strategies.
Purpose of the Study:
- To investigate the clinical presentation, complications, and antibiotic sensitivity patterns of culture-proven enteric fever in children.
- To evaluate treatment outcomes and identify risk factors for severe disease and mortality in infants.
Main Methods:
- A retrospective study of 182 culture-proven enteric fever cases from May 1991 to April 1992.
- Analysis of patient demographics, clinical manifestations, laboratory findings, antibiotic sensitivity, and treatment outcomes.
Main Results:
- 39% of affected children were under 3 years old, with male preponderance.
- Infants exhibited severe systemic manifestations including convulsions, edema, hepatomegaly, and thrombocytopenia.
- Antibiotic sensitivity to ampicillin, chloramphenicol, and cotrimoxazole was low (49-52%), while cephalosporins and quinolones showed 100% sensitivity.
- Complications were more frequent in infants (46%) than older children (2%), including meningitis, nephritis, and marrow hypoplasia.
- Mortality occurred in two children treated with older antibiotics prior to admission.
Conclusions:
- Drug-resistant Salmonella typhi infections in infants follow a severe, progressive course with multi-organ involvement.
- Prompt initiation of antibiotics guided by local sensitivity patterns is essential for reducing mortality and morbidity in pediatric enteric fever.
Abstract:
Culture-proven cases of enteric fever (182) were studied during the period May 1991 to April 1992; 39 per cent of the children were below 3 years. There was male preponderance. Infants presented within first few days of onset of fever with severe systemic manifestation, such as repeated convulsion, puffiness of face and oedema, massive hepatomegaly, and bleeds due to thrombocytopenia. Only 49-52 per cent of the cultures were sensitive to ampicillin, chloroamphenicol, and cotrimoxazole. The infants were treated with cephalosporin such as cefotaxime or quinolones as ciprofloxacin, since 100 per cent of the cultures were sensitive to this drug. Three infants had meningitis, two interstitial nephritis, and six had marrow hypoplasia. Two children who had been treated prior to admission with ampicillin or chloroamphenicol died within 48 h of admission, one of a liver abcess and peritonitis, and the other due to meningitis. Markedly prolonged hypothermia was seen during recovery in few cases. Forty-six per cent of infants had complications as against 2 per cent in older children. Drug Resistant Salmonella typhi infection seems to have a rapidly progressive severe course with multiple organ involvement such as meningitis, liver abcess, nephritis, and marrow hypoplasia. Initiation of appropriate antibiotics depending on local sensitivity pattern is needed early in the disease to avoid mortality and morbidity.
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