Abstract:

Typhoid fever is a major public health problem globally; the greater burden however occurs in the developing countries because of lack of potable water and proper waste management. The disease is associated with a high mortality rate especially in those with enteric perforation or intestinal hemorrhage. The goal of this study was to identify the clinical and laboratory factors that predict the development of enteric perforation in children with typhoid fever.

This study was a retrospective case control analysis of children admitted for typhoid fever without or without enteric perforation over a three year period in a newly established teaching hospital in Kannur. Forty seven children with typhoid fever and enteric perforation (cases) were compared with 94 controls (those without typhoid fever but without enteric perforation). Multivariate analysis using logistic regression was applied to all the factors that were initially significantly associated with enteric perforation. Male sex (Odd Ratio, OR=3.10, p=0.003); inadequate treatment (OR=3.03,P< 0.001); short duration of illness (OR=2.36,P=0.030); neutrophilia (OR=2.92,p=0.013) and elevated ESR (OR=1.07, P=0.041) were found to have independently contributed to development of perforation in children with typhoid fever. This study has attempted to outline the factors that may predict typhoid ideal perforation in children, thereby helping in recognition of high risk cases and drawing up of screening tool to facilitate effective and prompt management.

References:

[1.] Adesunkanmi, A., R., Ajao, O., G (1997) .The Prognostic Factors in Typhoid Ileal Perforation; A Prospective Study of 50 Patients. JR Coll Surg Edinb, 42, 395-399.

[2.] Ameh, E., A.Typhoid Ileal Perforation in Children; A Scourge in developing countries. Ann Trop Paediatr, 19(3), 267-272.

[3.] Butler, T., Knight, J., Nath, S., K., Speelman, P., Roy, S., K, Azad, M., A (1985). Typhoid Fever Complicated by Intestinal Perforation: A Persisting Fatal Disease Requiring Surgical Management. Rev Infect Dis, 7(2), 244-256.

[4.] Chao, H., C., Chiu, C., H., Kong, M., S. , Chang, L., Y., Huang, Y., C., L in TY, e..t al (2000). Factors Associated with Intestinal Perforation in Children’s Non-typhi Salmonella Toxic Megacolon. Pediatr Infect Dis J, 19, 1158-1162.

[5.] Everest, P., Wain, J., Roberts, M., Rock, G., Duogon, G (2001). The Molecular Mechanism of Severe Typhoid Fever. Trend Microbiol, 9(7), 316-320.

[6.] Hosoglu, S., Aldemir, M., Akalin, S., Geyik, M., F., Tacyildiz, I., H., and Leob, M (2004). Risk Factors For Enteric Perforation in Patients with Typhoid Fever. Am J Epidemiol, 160(1), 46-50.

[7.] Khan, M., Coovadia, Y., M., Connolly, C., Sturm, A., W(1999). Influence of Gender on Clinical Features, Laboratory Findings, and Complications of Typhoid Fever. Am J Trop Med Hyg, 61(1), 41-46.

[8.] Meier, D., E., Tarpley, J., L (1998). Typhoid Intestinal Perforation in Children. World J Surg, 22(3), 319-323.

[9.] Mock, C., N., Amaral, J., Visser, L., E (1992). Improvement In Survival from Typhoid Ileal Perforation: Results of 221 Operative Cases. Ann Surg,;215(3), 244-249.

[10.]   Ogunlesi, T., Runsewe-Abiodun, I., Olanrewa, D(2010) . Health Care Seeking Behaviour For Childhood Illness in a Resource Poor Setting. J Paediatr Child Health, 46, 238-242 doi:10.111/j.1440-1754.2009.01677.x.

[11.]   Row, B., Ward, L., R(1990). Threl-Fall EJ. Spread of Multiresistant Salmonella Typhi. Lancet, 334, 1065.

[12.]   Thomas, B(2000). Typhoid Fever. In; Goldman L, Bennet JC, Editors. Cecil Text Book of Medicine Vol.2 (21st edition).USA:WB Saunders, 1681-1683.

[13.]   Van der Zee, H (2008) .Media For the Isolation of Salmonella.In: Corry JEL, Curtis GDW, Baird RM Editors. Handbook of culture media for Microbiology. Oxford, UK: Elsevvier, 34, 195-446.

[14.]   World Health Organisation (2008). Typhoid vaccines: World Health Organisation position paper. Weekly Epidemiol Rec, 83(6), 49-60.

[15.]   Yap, F., Y., Puthucheary, S., D. Typhoid Fever in Children. A Retrospective Study of 54 Cases from Malaysia. Singapore Med J, 39(6), 260-262.