Diagnosis of enteric fever in the emergency department: a retrospective study from Pakistan

BACKGROUND Enteric fever is one of the top differential diagnoses of fever in many parts of the world. Generally, the diagnosis is suspected and treatment is initiated based on clinical and basic laboratory parameters. AIMS The present study identifies the clinical and laboratory parameters predicting enteric fever in patients visiting the emergency department of a tertiary care hospital in Pakistan. METHODS This is a retrospective chart review of all adult patients with clinically suspected enteric fever admitted to the hospital through the emergency department during a 5-year period (2000-2005). RESULTS A total of 421 emergency department patients were admitted to the hospital with suspected enteric fever. There were 53 cases of blood culture-positive enteric fever and 296 disease-negative cases on culture. The mean age in the blood culture-positive group was 27 years (SD: 10) and in the group with negative blood culture for enteric fever, 35 years (SD: 15) with a male to female ratio of 1:0.6 in both groups. Less than half (48%) of all patients admitted with suspected enteric fever had the discharge diagnosis of enteric fever, of which only 13% of the patients had blood culture/serologically confirmed enteric fever. None of the common clinical and laboratory parameters differed between enteric fever-positive patients and those without it. CONCLUSION Commonly cited clinical and laboratory parameters were not able to predict enteric fever.