A descriptive analysis of clinico-demographic features and microbiological results of typhoid fever suspected patients in four large hospitals of Bhutan

<p><strong>Introduction:</strong> Bhutan reports about 2000 typhoid fever cases annually. We aimed at understanding the clinico-demographic features and microbiological results of patients with suspected typhoid fever.</p><p><strong> </strong></p><p...

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Bibliographic Details
Main Authors: T Tshokey, N Tshering, K Wangchuk, R Sharma, A Mongar, T Dorji, S Wangchuk, D Damcho, K Wangdi
Format: Article
Language:English
Published: Sri Lankan Society for Microbiology 2016-10-01
Series:Sri Lankan Journal of Infectious Diseases
Subjects:
Online Access:https://sljid.sljol.info/articles/8117
Description
Summary:<p><strong>Introduction:</strong> Bhutan reports about 2000 typhoid fever cases annually. We aimed at understanding the clinico-demographic features and microbiological results of patients with suspected typhoid fever.</p><p><strong> </strong></p><p><strong>Methods:</strong> A yearlong (2012) study of typhoid fever suspects was conducted to describe and analyse associations of demographic and clinical features with laboratory findings.</p><p><strong> </strong></p><p><strong>Results:</strong> A total of 457 patients were enrolled. Most patients were from Phuntsholing General Hospital (n=181; 39.6%) followed by Jigme Dorji Wangchuck National Referral Hospital (n=170; 37.2%), Eastern Regional Referral Hospital (n=56; 12.3%) and Central Regional Referral Hospital (n=50; 10.9%). Fever (n=420; 91.9 %) and headache (n=397; 86.9 %) were the commonest symptoms reported by the patients. Only 30% (n=137) and 11.2% (n=51) had diarrhoea and constipation respectively. Mean duration of illness was 11.2 days. Among the 457 Widal tests performed, 76.1% (n=348) were negative, 12.3 % (n=56) positive for O antigen, 8.5% (n=39) for H antigen and 3.1% (n=14) for both. Only 2 of the 109 (1.8%) patients with a positive Widal test had a positive blood culture. Widal test showed a sensitivity of 33.3% and specificity of 76.3%. There was no association of any symptoms to antibody titres. There were three peaks when suspected cases reported to hospitals. More than 97% (n=447) of blood were sterile and <em>Salmonella </em>Typhi was isolated only in<em> </em>1.3% (n=6). Only one isolate showed resistance to amoxicillin and nalidixic acid.</p><p><strong> </strong></p><p><strong>Conclusion: </strong>Typhoid fever was not being diagnosed satisfactorily but over-diagnosed and treated clinically. Widal test should be replaced by more sensitive and specific tests or used cautiously with well-defined cut-off titres.</p><p> </p>
ISSN:2012-8169
2448-9654