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Enteric fever: a changing perspective

N Biswal1, B Mathai, B D Bhatia

  • 1Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry.

Indian Pediatrics
|July 1, 1994
PubMed
Summary
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Enteric fever cases and complications increased from 1988-1992, with rising multidrug resistance (MDRT). Despite increased resistance to common drugs and ciprofloxacin, it remains the preferred treatment for complicated MDRT enteric fever.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Clinical Medicine

Background:

  • Enteric fever, caused by Salmonella Typhi, presents a significant global health challenge.
  • Increasing antimicrobial resistance, particularly multidrug resistance (MDRT), complicates treatment and increases morbidity and mortality.
  • Monitoring trends in enteric fever incidence, complications, and antimicrobial susceptibility is crucial for effective public health strategies.

Purpose of the Study:

  • To analyze trends in enteric fever admissions, complications, and antimicrobial resistance patterns between 1988 and 1992.
  • To evaluate the efficacy of different antimicrobial agents, including ciprofloxacin, in treating enteric fever, especially MDRT cases.
  • To identify changes in the susceptibility of Salmonella Typhi to commonly used antibiotics over the study period.

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Main Methods:

  • Retrospective analysis of all enteric fever cases admitted between 1988 and 1992.
  • Documentation of patient demographics, clinical presentations, complications, treatment regimens, and outcomes.
  • Microbiological culture and sensitivity testing to determine Salmonella Typhi susceptibility to various antibiotics.

Main Results:

  • A gradual increase in enteric fever admissions was observed during the study period.
  • Central nervous system (CNS) complications (encephalopathy, meningitis, seizures, cerebellitis) and other complications (myocarditis, hepatitis, gastrointestinal bleeding) showed an increasing trend, particularly in 1991-1992.
  • Multidrug-resistant enteric fever (MDRT) cases constituted 46.3% in 1991 and 33.5% in 1992. Resistance to ampicillin, chloramphenicol, and cotrimoxazole increased, with Salmonella Typhi resistant to ciprofloxacin identified in 2 cases each from 1990-1992. The time for defervescence with ciprofloxacin also increased from 3.5 days in 1990 to 6.2 days in 1992.
  • Deaths occurred exclusively in 1991 and 1992 among MDRT cases with complications.

Conclusions:

  • There has been a concerning rise in enteric fever admissions and associated complications, alongside increasing antimicrobial resistance.
  • While resistance to ciprofloxacin is emerging, it remains the drug of choice for complicated MDRT enteric fever cases.
  • Continuous surveillance of antimicrobial resistance patterns and clinical outcomes is essential for guiding treatment protocols and combating enteric fever effectively.