Frequency of Enteric Fever Among Children Presenting with Acute Febrile Illness
DOI:
https://doi.org/10.47489/szmc.v40i2.933Keywords:
Typhoid Fever, Paratyphoid Fever, Salmonella typhi, Child, Blood Culture, FeverAbstract
Background: Enteric fever is a frequent cause of acute febrile illness in children living in endemic areas. Pakistan carries one of the highest burdens worldwide, but recent culture-confirmed estimates from routine hospital practice that could guide testing in febrile children are limited.
Objective: To determine the frequency of blood culture–positive enteric fever in children presenting with acute febrile illness.
Method: This is a Cross-sectional study. Department of Paediatrics, Punjab Rangers Teaching Hospital, Lahore, from 1 March 2025 to 30 September 2025. After institutional ethical approval, 121 children with acute febrile illness of more than 48 hours’ duration were enrolled and assessed for enteric fever by blood culture. Data were analysed in SPSS version 25. Effect modifiers were addressed by stratification, and the chi-square test was used to test associations, with a p-value of ?0.05 taken as significant.
Results: The mean age was 6.60 ± 3.53 years, and 68 children (56.2%) were male. The mean duration of fever at presentation was 5.45 ± 2.18 days, and the mean axillary temperature was 39.03 ± 0.60 °C. Blood culture was positive in 23 children (19.0%) and negative in 98 (81.0%). Among the positive cultures, S. Typhi accounted for 14 (60.9%) and S. Paratyphi for 9 (39.1%). On stratification, children with a temperature above 39 °C had a significantly higher rate of culture positivity (p = 0.041).
Conclusion: Culture-confirmed enteric fever was common (19.0%) in this group of febrile children and was associated with high-grade fever. The single-centre design and modest sample size limit wider application, and larger multicentre studies with susceptibility testing are needed.
References
Manesh A, Meltzer E, Jin C, Britto C, Deodhar D, Radha S, et al. Typhoid and paratyphoid fever: a clinical seminar. J Travel Med. 2021;28(3). https://doi.org/10.1093/jtm/taab012
Meiring JE, Shakya M, Khanam F, Voysey M, Phillips MT, Tonks S, et al. Burden of enteric fever at three urban sites in Africa and Asia: a multicentre population-based study. Lancet Glob Health. 2021;9(12):e1688-e96. https://doi.org/10.1016/S2214-109X(21)00370-3
Pathak A, Upadhayay R, Mathur A, Rathi S, Lundborg CS. Incidence, clinical profile, and risk factors for serious bacterial infections in children hospitalized with fever in Ujjain, India. BMC Infect Dis. 2020;20(1):162. https://doi.org/10.1186/s12879-020-4890-6
Garrett DO, Longley AT, Aiemjoy K, Yousafzai MT, Hemlock C, Yu AT, et al. Incidence of typhoid and paratyphoid fever in Bangladesh, Nepal, and Pakistan: results of the Surveillance for Enteric Fever in Asia Project. Lancet Glob Health. 2022;10(7):e978-e88. https://doi.org/10.1016/S2214-109X(22)00119-X
Sinha B, Rongsen-Chandola T, Goyal N, Arya A, Kumar CM, Chakravarty A, et al. Incidence of Enteric Fever in a Pediatric Cohort in North India: Comparison with Estimates from 20 Years Earlier. J Infect Dis. 2021;224(Suppl 5):S558-S67. https://doi.org/10.1093/infdis/jiab046
Yousafzai MT, Irfan S, Thobani RS, Kazi AM, Hotwani A, Memon AM, et al. Burden of Culture Confirmed Enteric Fever Cases in Karachi, Pakistan: Surveillance For Enteric Fever in Asia Project (SEAP), 2016-2019. Clin Infect Dis. 2020;71(Suppl 3):S214-S21. https://doi.org/10.1093/cid/ciaa1308
Baig U, Mehdi SM, Iftikhar N. A pattern of antibiotic drug resistance of Salmonella Typhi and Salmonella Paratyphi among children with enteric fever in a tertiary care hospital in Lahore, Pakistan. Croat Med J. 2023;64(4):256-64. https://doi.org/10.3325/cmj.2023.64.256
Andrews JR, Vaidya K, Saha S, Yousafzai MT, Hemlock C, Longley A, et al. Healthcare Utilization Patterns for Acute Febrile Illness in Bangladesh, Nepal, and Pakistan: Results from the Surveillance for Enteric Fever in Asia Project. Clin Infect Dis. 2020;71(Suppl 3):S248-S56. https://doi.org/10.1093/cid/ciaa1321
McAteer J, Derado G, Hughes M, Bhatnagar A, Medalla F, Chatham-Stevens K, et al. Typhoid Fever in the US Pediatric Population, 1999-2015: Opportunities for Improvement. Clin Infect Dis. 2021;73(11):e4581-e89. https://doi.org/10.1093/cid/ciaa914
Nusrat N, Islam MR, Paul N, Rahman N, Krishnapillai A, Haq MA, Haque M. Clinical and Laboratory Features of Enteric Fever in Children and Antibiotic Sensitivity Pattern in a Tertiary Care Hospital of a Low- and Middle-Income Country. Cureus. 2022;14(10):e30784. https://doi.org/10.7759/cureus.30784
Ahmad M, Shah N, Siddiqui MA. Frequency and Antibiotics Sensitivity Pattern of Culture-Positive Salmonella Typhi in Children. J Coll Physicians Surg Pak. 2023;33(3):303-07. https://doi.org/10.29271/jcpsp.2023.03.303
Deksissa T, Gebremedhin EZ. A cross-sectional study of enteric fever among febrile patients at Ambo hospital: prevalence, risk factors, comparison of Widal test and stool culture and antimicrobials susceptibility pattern of isolates. BMC Infect Dis. 2019;19(1):288. https://doi.org/10.1186/s12879-019-3917-3
Chapagain RH, Adhikari S, Bhattarai T, Basaula Y, Bhattarai S. Burden of enteric fever and antibiotic sensitivity in Nepalese Children Prior to Typhoid Vaccine in National Immunization Program. J Nepal Health Res Counc. 2023;21(2):297-302. https://doi.org/10.33314/jnhrc.v21i02.4728
Qamar FN, Yousafzai MT, Sultana S, Baig A, Shakoor S, Hirani F, et al. A Retrospective Study of Laboratory-Based Enteric Fever Surveillance, Pakistan, 2012-2014. J Infect Dis. 2018;218(suppl_4):S201-S05. https://doi.org/10.1093/infdis/jiy205
Jayaprasad N, Borhade P, LeBoa C, Date K, Joshi S, Shimpi R, et al. Retrospective Review of Blood Culture-Confirmed Cases of Enteric Fever in Navi Mumbai, India: 2014-2018. Am J Trop Med Hyg. 2023;109(3):571-74. https://doi.org/10.4269/ajtmh.23-0102
Memon H, Saeed F, Iqbal M, Saboohi E, Hanif S, Mallick AHH. Association of extensively drug resistant salmonella infection in children with typhoid fever. Pak J Med Sci. 2022;38(7):1864-69. https://doi.org/10.12669/pjms.38.7.5868
Srinivasan M, Sindhu KN, Ramanujam K, Ramasamy RK, Subramaniam S, Ganesan SK, et al. Factors Predicting Blood Culture Positivity in Children With Enteric Fever. J Infect Dis. 2021;224(Suppl 5):S484-S93. https://doi.org/10.1093/infdis/jiab357
Bibi S, Hussain Gilani SY, Siddiqui TS, Syed F, Arif MA, Haider N. Extensively Drug-Resistant Enteric Fever In Children: Surging Threats Of Antimicrobial Resistance And Possible Solutions. J Ayub Med Coll Abbottabad. 2023;35(3):424-27. https://doi.org/10.55519/JAMC-03-11769
This work is licensed under a 