Introduction: Enteric Fever is endemic in South East Asia and poses a significant health problem in developing countries including India. Though treatable, enteric fever is known to cause potentially life threatening complications such as encephalopathy and enteric perforations. Diagnosis and management of enteric fever in pediatric age group pose several problems because of non- specific symptomatology. We conducted this prospective study to analyze clinical presentation, lab parameters, Sensitivity pattern and Complications in pediatric patients admitted with the diagnosis of enteric fever.

Materials and Methods: This was a prospective cohort study in which pediatric patients having enteric fever were included on the basis of a predefined inclusion and exclusion criteria. The study was conducted in a tertiary care medical college situated in a rural area. Informed consent was obtained from the guardians of the cases. Detailed history and demographic details were noted and thorough clinical examination was done in all the cases. Complete blood count, blood culture and sensitivity and Widal test was done in all the cases. Complications during hospital stay were also noted down. SSPE 16 version software was used for statistical analysis. P value less than 0.05 was taken as statistically significant.

Results: Out of 80 studied cases there were 46 (57.50%) males and 34 (42.50%) females with a M:F ratio of 1: 0.73. The most common sign was fever which was present in all (100%) the cases. The other signs and symptoms were headache (33.75%), high grade fever (28.75%), vomiting (28.75%) abdominal pain (21.25%) and chills (16.25%). On clinical examination isolated hepatomegaly and splenomegaly was present in 16 (20.00%) and 7 (8.75%) patients respectively whereas hepatosplenomegaly was present in 14 (17.50%) patients. Leukopenia was seen in 26 (32.50%) patients whereas leukocytosis was present in 7 (8.75%) patients. thrombocytopenia and deranged hepatic function tests were seen in 13 (16.25%) and 7 (8.75%) patients respectively. Blood culture was positive in 39 (48.75%) patients. Widal test was found to be positive in 41 (51.25%) patients.75 (93.75%) patients responded well to administration of antibiotics. 5 (6.25%) patients developed complications such as meningeal signs (3.75%), bleeding diathesis (1.25%)and enteric perforation (1.25%).

Conclusion: Enteric fever is endemic in developing countries including India. Varied symptomatology makes its diagnosis difficult particularly in pediatric age group. Delayed diagnosis may lead to complications such as encephalopathy, bleeding diathesis and enteric perforation.

Keywords: Enteric Fever, Encephalopathy, Enteric perforation, Culture and Sensitivity.

1. Date KA, Bentsi-Enchill AD, Fox KK, Abeysinghe N, Mintz ED, Khan MI, Sahastrabuddhe S, Hyde TB; Centers for Disease Control and Prevention (CDC). Typhoid Fever surveillance and vaccine use - South-East Asia and Western Pacific regions, 2009-2013.
2. Bhan MK, Bahl R, Bhatnagar S. Typhoid and paratyphoid fever. Lancet. 2005 Aug 27-Sep 2;366(9487):749-62.

3. Sejvar J, Lutterloh E, Naiene J, et al. Neurologic manifestations associated with an outbreak of typhoid fever, Malawi--Mozambique, 2009: an epidemiologic investigation. PLoS One. 2012;7(12): e46099.
4. Dance D, Richens JE, Ho M, Acharya G, Pokhrel B, Tuladhar NR. Blood and bone marrow cultures in enteric fever. J Clin Pathol. 1991;44(12):1038.
5. Willke A, Ergonul O, Bayar B. Widal test in diagnosis of typhoid fever in Turkey. Clin Diagn Lab Immunol. 2002;9(4):938-41.
6. Choo KE, Davis TM, Ismail A, Tuan Ibrahim TA, Ghazali WN. Rapid and reliable serological diagnosis of enteric fever: comparative sensitivity and specificity of Typhidot and Typhidot-M tests in febrile Malaysian children. Acta Trop. 1999 Mar 15;72(2):175-83.
7. Butler T, Bell WR, Levin J, Linh NN, Arnold K. Typhoid fever. Studies of blood coagulation, bacteremia, and endotoxemia. Arch Intern Med. 1978 Mar;138(3):407-10.
8. Thompson CN, Karkey A, Dongol S, et al. Treatment Response in Enteric Fever in an Era of Increasing Antimicrobial Resistance: An Individual Patient Data Analysis of 2092 Participants Enrolled into 4 Randomized, Controlled Trials in Nepal. Clin Infect Dis. 2017;64(11):1522-1531.
9. Maheshwari V, Kaore NM, Ramnani VK, Sarda S. A Comparative Evaluation of Different Diagnostic Modalities in the Diagnosis of Typhoid Fever Using a Composite Reference Standard: A Tertiary Hospital Based Study in Central India. J Clin Diagn Res. 2016;10(10):DC01-DC04.
10. Malik GM. Enteric Fever in asir region, southern of saudi arabia. J Family Community Med. 1994;1(1):35-9.
11. Mathura KC, Gurubacharya DL, Shrestha A, Pant S, Basnet P, Karki DB. Clinical profile of typhoid patients. Kathmandu Univ Med J (KUMJ). 2003Apr-Jun;1(2):135-7.
12. Khan M. A plausible explanation for male dominance in typhoid ileal perforation. Clin Exp Gastroenterol. 2012;5:213-7.
13. Iftikhar A, Bari A, Jabeen U, Bano I. Spectrum of complications in childhood Enteric Fever as reported in a Tertiary Care Hospital. Pak J Med Sci. 2018;34(5):1115-1119.
14. Akullian A, Ng'eno E, Matheson AI, et al. Environmental Transmission of Typhoid Fever in an Urban Slum. PLoS Negl Trop Dis. 2015;9(12):e0004212. Published 2015 Dec 3.
15. Comeau JL, Tran TH, Moore DL, Phi CM, Quach C. Salmonella enterica serotype Typhi infections in a Canadian pediatric hospital: a retrospective case series. CMAJ Open. 2013;1(1):E56-61. Published 2013 May 2.
16. Dheer G, Kundra S, Singh T. Clinical and laboratory profile of enteric feverin children in northern India. Trop Doct. 2012 Jul;42(3):154-6.
17. Mweu E, English M. Typhoid fever in children in Africa. Trop Med Int Health. 2008;13(4):532-40.
18. Khosla SN, Anand A, Singh U, Khosla A. Haematological profile in typhoidfever. Trop Doct. 1995 Oct;25(4):156-8.
19. Gidvani CH, Chandar V, Raghunath D, Puri RD, Wilson CG, Nagendra A. Enteric fever - culture and sensitivity pattern and treatment outcome. Med J Armed Forces India. 2017;51(2):83-86.
20. Chiu CH, Tsai JR, Ou JT, Lin TY. Typhoid fever in children: a fourteen-yearexperience. Acta Paediatr Taiwan. 2000 Jan-Feb;41(1):28-32.

Dr Bhagyashri Ahirrao

Assistant Professor, Department of Pathology ACPM Medical College Dhule, India