PRESENTATION OF TYPHOID FEVER PATIENTS IN HAZARA DIVISION AND RESPONSE TO DIFFERENT TREATMENT REGIMENS

Authors

  • Hassan Shahzad Nazar
  • Aftab Rabbani
  • Adeel Riaz
  • Jasim Anwar

Abstract

Background: Response to treatment can vary in patients with typhoid fever. This study was carried out on a group of typhoid patients who were treated in Medical B ward of Ayub Teaching Hospital. Resistance to antibiotic is commonly acquired by Salmonella typhi and is widely reported. Objective of study was to identify such resistance in patients coming from parts of Hazara Division. Methods: All patients who presented with typhoid fever and admitted to Medical B Unit from 1st July to 30th September 2002 were included in study. Out of 76 patients 46 (60%) were male. Epidemiological date, presenting symptoms, finding on physical examination, laboratory investigation and radiological examination were recorded. Then one of six commonly used treatment regimens were started. Response to treatment was studied. Results: Common presenting symptoms and signs were recorded. Headache and fever were seen in 100% of patients. Cough and hypotension were among presenting features in 65% of patients. Leucocyte count of Less than 4x103/dl was seen in 11% of samples. Liver functions and Renal function were found alterd in 30% of patients. Study of response pattern to different regimens suggested relatively poor response to flouroquinolones. Fever of those patients who were treated with chloamphenicol and cefexime ,settled early as compared to patients on other regimens. Conclusions.  In addition to well known presenting features of typhoid like headache, fever, cough, hypotension and leucopenia abnormalities of renal and liver functions were commonly seen. Response to quinolone was poor suggesting emergence of resistance of salmonella typhi in this area.Key Words: Tyhpoid, Multiresistance in salmonella, Hazara, Quinolones, Chloroamphenicol.

References

Rabbani MW, Iqbal I, Malik MS. A comparative study of cefixime and chloramphenicol in children with typhoid fever. J.Pak Med Assoc 1998;48(6):163-4.

Fjaerli HO, Heger B, Gundersen SG, Hoel T, Espinoza R. Outbreak of typhoid in family. Tidsskr Nor Leageforen.1993;113(24):3022-4.

Oslen SJ, Bleasdale SC, Magnano AR, Landrigan C, Holland BH, Taux RV, et al. Outbreak of typhoid fever in United States,1960-99. Epidemiology infect 2003;130(1):13-21.

Ruiz M, Rodriguez JC, Sirvent E, Escribano I, Cebrian L, Royo G. Usefulness of different Techniques in the study of the epidemiology of salmonellosis. APMIS 2003;111(9):848-56.

Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ. Typhoid fever. N Engl J Med 2002;347(22):1770-82.

Ranju C, Pais P, Ravindran GD, Sing G. Changing pattern of antibiotic sensitivity of salmonella typhi. Natl Med J India.1998;11(6):266-7.

Parry CM. The treatment of multidrug resistant and Nalidixic acid resistant typhoid fever in Vietnam. Trans R Soc Trop Med Hyg 2004;98(7): 413-22.

Lec CY, Chin CH, Chuang YY, Su LH, Wu TL, Chang LY, et al. Multidrug resistant nontyphoid salmonella infection in a medical center. J Microbiol immunol Infect 2002;35(2):78-84.

Dutta TK, Beeresha Ghotekar LH. Atypical manifestations of typhoid fever.J Postgrad Med 2001;47(4):248-51.

Asperilla MO, Smego RA Jr, Scott LK. Quinolone antibiotics in treatment of salmonella infection. Rev Infect Dis 1990;12(5):873-89.

Kumar P, Clark M. Infectious diseases 4th Ed. Edinburgh, WB Saunders, 1998:34-5.

Girgis NI, Butler T, Frenck RW, Sultan Y, Brown FM, Tribble D, et al. Azithromycin versus ciprofloxacin for treatment of uncomplicated typhoid fever in a randomized trial in Egypt that included multi drug resistance. Antimicrob Agents Chemother1999;43(6):1441-4.

Sharma A, Gathwala G. Clinical Profile and outcome in enteric fever.Indian Pediatr.1993;30(1):47-50.

Memon LA, Billoo AG, Memon HI. Cefixime:an oral option for the treatment of multi drug resistant enteric fever in children. South Med J. 1997;90(12):1204-7.

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