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Abstract Typhoid fever is one of the common fevers endemic in our country, which is caused by Salmonella enterica serovar
typhi. The aim of the present study is to find the recent trends in clinical presentation, laboratory profile, culture and
sensitivity pattern of it as this would give more confidence in the treating physician especially regarding the selection of
antibiotics. This study was done in Chettinad Hospital and Research Institut
Institute,
e, Kelambakkam, Kancheepuram district.
About 40 cases of culture proven typhoid fever were analysed. Males and females were equally affected with mean age
of presentation being 17.4 years with maximum number of cases in <20 years group. Fever(100%) followe followed by
abdominal pain(80%) were the most common symptoms. Among the laboratory profile leucopenia which is considered
common in typhoid occurred only in 10% of the patients in our study. Instead thrombocytopenia(50%) was more
common in our patients. Among th thee antibiotics, Salmonella was most sensitive to ceftriaxone followed by conventional
antibiotics like chloramphenicol, ampicillin and cotrimoxazole but the resistance was more to fluoroquinolones.
Keywords: Antibiotic susceptibility, Ceftriaxone
Ceftriaxone, Thrombocytopenia, Typhoid fever.
*
Address for Correspondence:
Dr. Noorul Ameen. S, A108, Pelican Nest Apartments, No 48, Creek street
street, Okkium Thoraipakkam, Chennai-600097,
600097, Tamil Nadu, INDIA.
Email: mmcsmarty@yahoo.co.in
Received Date: 08/09/2016 Revised Date: 18/100/2016 Accepted Date: 10/11/2016
CLINICAL PRESENTATION
100.00%
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Copyright © 2016, Statperson Publications, MedPulse – International Medical Journal, ISSN: 2348-2516, EISSN: 2348-1897, Volume 3, Issue 11
1 November 2016
S Noorul Ameen
Ameen, Lijo George, D Rajasekaran
HEMATOLOGICAL PROFILE
EOSINOPENIA
BASOPENIA
THROMBOCYTOPENIA
LEUCOCYTOSIS
LEUCOPENIA
Further the antibiotic sensitivity was also studied and the constipation was considered a prominent symptom in
following pattern was noted. Most of the cases were typhoid fever, in our study only 12.5% of patients had
sensitive to the 3rd generation cephalophorin, Ceftriaxone. constipation. The typical rose spots of typhoid fever
Old drugs such as cotrimoxazole and chloramphenicol occurred only in one patient and it occurred on the
were sensitive
tive in 33 and 29 of the patients respectively. seventh day of illness. The occurrence of mesenteric
The resistance was very high among the commonly used adenopathy was 77% in one study15 whereas in our study
drugs such as ciprofloxacin and ofloxacin but sensitivity was found in only 7.5% (3 patients). Thrombocytopenia
was high for ampicillin interestingly. The sensitivity was
as noticed in 50% of patients compared with about 40%
pattern is shown in Table 1 in a study done by Ali Hassan Abro et al16. In our study
there was only 12.5% of multidrug resistant cases who
Table 1: Sensitivity pattern of common antibiotics used in had resistance to first line drugs such as ampicillin,
treatment of typhoid fever
chloramphenicol and cotrimoxazole which wh is in
Sensitive No. of Resistant No. of
Drugs accordance with other studies on enteric fever17,18.
Patients (%) Patients (%)
Tetracycline 37 (92.5) 3 (7.5)
Nalidixic acid resistance was found in 87.5% of the cases.
Ceftriaxone 35 (87.5) 5 (12.5) This trend has also been substanciated by other studies
Cotrimoxazole 33 (82.5) 7 (17.5) which showed about 78.3%19 and 78%17 of Nalidixic acid
Ampicillin 33 (82.5) 7 (17.5) resistance. This is mainly
nly due to indiscriminate use of
Chloramphenicol 29 (72.5) 11 (27.5) ciprofloxacin as the first line drug in treatment of
Cefotaxim 7 (17.5) 33 (82.5) Salmonella typhi cases. Eventhough there had been more
Ciprofloxacin 5 (12.5) 35 (87.5) multidrug resistant cases of enteric fever in 1980s and
Ofloxacin 3 (7.5) 37 (92.5) 90s, change in antibiotic preference for typhoid has
Amikacin 2 (5) 38 (95) changedd the trend of increased susceptibility to
conventional antibiotics such as chloramphenicol,
Out of 40 patients, 38 cases were treated with parenteral
ampiciilin and cotrimoxazole. Most importantly the
ceftriaxone for 14 days. The remaining cases were treated
proportion of ceftriaxone sensitive cases was more in our
with amikacin and ampicillin. Among the 38 patients
study which shows that it could be considered the first
firs
treated with ceftriaxone, fever subsided by 4 days in 24
line treatment in inpatient cases of enteric fever. The
patients (60%).
response to this drug has been good with defervescense of
fever in about 4 days in 60% of cases treated with
DISCUSSION ceftriaxone.
Typhoid fever is a common health problem in India and
Southeast Asia. This infection iff not treated adequately
can lead onto a mortality of about 30% but with
CONCLUSION
Enteric is a common endemic fever in India. Eventhough
appropriate antibiotic treatment the mortality reduces to
the incidence
ence has gone down recently due to improved
0.5%12. In our study the incidence of typhoid fever was
sanitation and heathcare facilities, still it is a major
higher in age group <20 years as in previous researches13.
burden to the society. It mainly affects children and
The common clinical manifestations were fever,
young adults. Community based studies on risk factors,
abdominal pain, vomiting and diarrhoea which is in
clinical presentation and especially culture and
a sensitivity
accordance with the previous study14. Eventhough
pattern are necessary for improved care for these cases. In
our locality, the interesting finding was association of 9. Mehta G, Randhawa VS, Mohapatra NP: Intermediate
many cases with thrombocytopenia and constipation susceptibility to ciprofloxacin in Salmonella typhistrains
in India: Eur J Clin Microbiol Infect Dis. 2001;20:760–1.
which was more common in many studies was less
10. Harish BN, Madhulika U, Parija SC: Isolated high-level
common in our study. Further there has been a trend of ciprofloxacin resistance in Salmonella enterica
improved susceptibility to conventional antibiotics like subsp.enterica serotype Paratyphi A: J Med
chloramphenicol, cotrimoxazole, ampicillin and newer Microbiol. 2004;53:819.
antibiotics like ceftriaxone with increased resistance to 11. Saha SK, Talukder SY, Islam M, Saha S: A highly
quinolones. ceftriaxone-resistant Salmonella typhi in
Bangladesh: Pediatr Infect Dis J. 1999;18:387.
12. Cooke FJ, Wain J: The emergence of antibiotic resistance
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Source of Support: None Declared
Conflict of Interest: None Declared
Copyright © 2016, Statperson Publications, MedPulse – International Medical Journal, ISSN: 2348-2516, EISSN: 2348-1897, Volume 3, Issue 11 November 2016