A Hospital Based Cross-Sectional Study on Enteric Fever – Evolving Clinical Features, Basic Laboratory Parameters And Serological Profiles

Enteric fever still remains a cause of significant morbidity and mortality, particularly in children. In countries with poor resources and inadequate access to basic health care system, like ours, where widespread antibiotic availability and prescribing leads to low sensitivity of blood cultures and where bone marrow cultures are difficult to perform, early detection of suggestive clinical features and initial changes in simple blood tests and relatively cheaper and non-invasive serological tests may have significant value in diagnosis and management of this condition. We conducted a cross-sectional study over a period of one year involving 170 clinically suggestive enteric fever cases. Out of 170 under 12 years children, confirmed typhoid were 98(57.64%) cases, clinical typhoid 72(42.35%) cases, culture proven 14(8.23%) cases, serology proven (Widal test and Typhidot M positive) 86(50.58%) cases. In our study fever and splenomegaly were present in 100% cases. Constipation, abdominal distension or pain, pallor, coated tongue and hepatomegaly were the other major findings. Significant number of children had anemia, eosinopenia, elevated liver enzymes without much hepatic derangements. Widal test had a good negative predictive value(94.87%) whereas the sensitivity(100%), specificity(74.35%) and negative predictive value(100%) were much higher for Typhidot test. Utilizing these parameters we could establish a referral guideline resulting in rapid clinical diagnosis, start of early presumptive treatment and rapid diagnostic confirmation so as to minimize complications.