A prospective study of the importance of enteric fever as a cause of non-malarial febrile illness in patients admitted to Chittagong Medical College Hospital, Bangladesh.

Abstract

BACKGROUND:

Fever is a common cause of hospital admission in Bangladesh but causative agents, other than malaria, are not routinely investigated. Enteric fever is thought to be common.

METHODS:

Adults and children admitted to Chittagong Medical College Hospital with a temperature of ≥38.0 °C were investigated using a blood smear for malaria, a blood culture, real-time PCR to detect Salmonella Typhi, S. Paratyphi A and other pathogens in blood and CSF and an NS1 antigen dengue ELISA.

RESULTS:

We enrolled 300 febrile patients with a negative malaria smear between January and June 2012: 156 children (aged ≤15 years) and 144 adults with a median (interquartile range) age of 13 (5-31) years and median (IQR) illness duration before admission of five (2-8) days. Clinical enteric fever was diagnosed in 52 patients (17.3 %), lower respiratory tract infection in 48 (16.0 %), non-specific febrile illness in 48 (16.0 %), a CNS infection in 37 patients (12.3 %), urinary sepsis in 23 patients (7.7 %), an upper respiratory tract infection in 21 patients (7.0 %), and diarrhea or dysentery in 21 patients (7.0 %). Malaria was still suspected in seven patients despite a negative microscopy test. S. Typhi was detected in blood by culture or PCR in 34 (11.3 %) of patients. Of note Rickettsia typhi and Orientia tsutsugamushi were detected by PCR in two and one patient respectively. Twenty-nine (9 %) patients died during their hospital admission (15/160 (9.4 %) of children and 14/144 (9.7 %) adults). Two of 52 (3.8 %) patients with enteric fever, 5/48 (10.4 %) patients with lower respiratory tract infections, and 12/37 (32.4 %) patients with CNS infection died.

CONCLUSION:

Enteric fever was confirmed in 11.3 % of patients admitted to this hospital in Bangladesh with non-malaria fever. Lower respiratory tract and CNS infections were also common. CNS infections in this location merit more detailed study due to the high mortality.

• Authors: Rapeephan R Maude, Aniruddha Ghose, Rasheda Samad, Hanna K de Jong, Masako Fukushima, Lalith Wijedoru, Mahtab Uddin Hassan, Md Amir Hossain, Md Rezaul Karim, Abdullah Abu Sayeed, Stannie van den Ende, Sujat Pal, A S M Zahed, Wahid Rahman, Rifat Karnain, Rezina Islam, Dung Thi Ngoc Tran, Tuyen Thanh Ha, Anh Hong Pham, James I Campbell, H Rogier van Doorn, Richard J Maude, Tom van der Poll, W Joost Wiersinga, Nicholas P J Day, Stephen Baker, Arjen M Dondorp, Christopher M Parry, Md Abul Faiz
• Journal: BMC infectious diseases (BMC Infect Dis) Vol. 16 Issue 1 Pg. 567 (10 13 2016) ISSN: 1471-2334 [Electronic] England
• PMID: 27737634 (Publication Type: Journal Article, Observational Study)

Topics

• Adolescent
• Adult
• Aged
• Bangladesh (epidemiology)
• Child
• Child, Preschool
• Female
• Fever (etiology, microbiology)
• Hospitalization (statistics & numerical data)
• Hospitals, University
• Humans
• Infant
• Malaria (complications, epidemiology, microbiology, virology)
• Male
• Middle Aged
• Salmonella typhi (isolation & purification, physiology)
• Typhoid Fever (complications, epidemiology, microbiology)
• Young Adult