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Objective: To determine the frequency of enteric fever in children presenting with acute febrile illness in Islamabad, Pakistan.
Methods: This was a cross-sectional study, conducted in the department of Paediatrics, Islamabad Medical Complex, Islamabad, from 1st of October 2024 to 30th of April 2025. After obtaining ethical approval, this study included 179 children with acute febrile illness. After a thorough clinical evaluation, venous samples from all patients were sent for diagnosis of enteric fever via blood culture. Data were analysed using SPSS version 22. The data were stratified according to the effect modifiers. Statistical significance was set at p ≤0.05.
Results: The ages ranged from 1-12 years (median = 7, IQR = 4–10), and weights ranged from 8–48 kg (median = 27, IQR = 16–39). The duration of fever varied between 5 and 14 days (median = 10, IQR = 8–12), and the recorded temperature ranged from 38.6°C to 40.0°C (median = 39.2°C, IQR = 38.8–39.5°C). Of the 179 patients, 21 (11.7%; 95% CI: 7.4–17.4%) had enteric fever confirmed by blood culture. The data were stratified according to the effect modifiers (Table I). There was no difference between subgroups of age, sex, area of residence, maternal educational status, weight, and fever duration (p = 0.903, 0.967, 0.418, 0.383, 0.359, and 0.321, respectively). Enteric fever was significantly higher in the low socioeconomic status group (p = 0.015).
Conclusion: Our study suggests that enteric fever is a high-burden disease in the paediatric population in Islamabad, responsible for 11.7% (95% CI: 7.4–17.4%) of acute febrile illnesses, with a significantly high impact on those from low socioeconomic status. Studies incorporating multiple centres and areas would provide more comprehensive data.
Keywords: Typhoid Fever; Paratyphoid Fever; Fever; Cross-Sectional Studies; Socioeconomic Factors.
References
Ali N, Khan NU, Waheed S, Mustahsan S. Etiology of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care center in Karachi, Pakistan. Pak J Med Sci. 2020;36(6):1285-90. https://doi.org/10.12669/pjms.36.6.2334
Le-Viet N, Le VN, Chung H, Phan DT, Phan QD, Cao TV, et al. Prospective case-control analysis of the aetiologies of acute undifferentiated fever in Vietnam. Emerg Microbes Infect. 2019;8(1):339-52. https://doi.org/10.1080/22221751.2019.1580539
Deksissa T, Gebremedhin EZ. A cross-sectional study of enteric fever among febrile patients at Ambo hospital: prevalence, risk factors, comparison of Widal test and stool culture, and antimicrobials susceptibility pattern of isolates. BMC Infect Dis. 2019;19(1):288. https://doi.org/10.1186/s12879-019-3917-3
Ryan ET, Hill DR, Solomon T, Endy TP, Aronson N. Hunter's Tropical Medicine and Emerging Infectious Diseases. 10 ed: Elsevier; 2020.
Memon A, Ahmed M, Iqbal K. Frequency and Antimicrobial Resistance Pattern of Extensive-Drug Resistance Salmonella typhi Isolates. Journal of Microbiology and Infectious Diseases. 2020;10:68-74. https://doi.org/10.5799/jmid.748642
Chanthavilay P, Mayxay M, Xongmixay P, Roberts T, Rattanavong S, Vongsouvath M, et al. Estimation of Incidence of Typhoid and Paratyphoid Fever in Vientiane, Lao People's Democratic Republic. Am J Trop Med Hyg. 2020;102(4):744-48. https://doi.org/10.4269/ajtmh.19-0634
Voysey M, Pant D, Shakya M, Liu X, Colin-Jones R, Theiss-Nyland K, et al. Under-detection of blood culture-positive enteric fever cases: The impact of missing data and methods for adjusting incidence estimates. PLoS Negl Trop Dis. 2020;14(1):e0007805. https://doi.org/10.1371/journal.pntd.0007805
Singh R, Singh SP, Ahmad N. A Study of Etiological Pattern in an Epidemic of Acute Febrile Illness during Monsoon in a Tertiary Health Care Institute of Uttarakhand, India. J Clin Diagn Res. 2014;8(6):MC01-3. https://doi.org/10.7860/JCDR/2014/8965.4435
Garrett DO, Longley AT, Aiemjoy K, Yousafzai MT, Hemlock C, Yu AT, et al. Incidence of typhoid and paratyphoid fever in Bangladesh, Nepal, and Pakistan: results of the Surveillance for Enteric Fever in Asia Project. Lancet Glob Health. 2022;10(7):e978-e88. https://doi.org/10.1016/S2214-109X(22)00119-X
John J, Bavdekar A, Rongsen-Chandola T, Dutta S, Gupta M, Kanungo S, et al. Burden of Typhoid and Paratyphoid Fever in India. N Engl J Med. 2023;388(16):1491-500. https://doi.org/10.1056/NEJMoa2209449
Andrews JR, Vaidya K, Saha S, Yousafzai MT, Hemlock C, Longley A, et al. Healthcare Utilization Patterns for Acute Febrile Illness in Bangladesh, Nepal, and Pakistan: Results from the Surveillance for Enteric Fever in Asia Project. Clin Infect Dis. 2020;71(Suppl 3):S248-S56. https://doi.org/10.1093/cid/ciaa1321
Nakisuyi J, Bernis M, Ndamira A, Kayini V, Mulumba R, Theophilus P, et al. Prevalence and factors associated with malaria, typhoid, and co-infection among febrile children aged six months to twelve years at kampala international university teaching hospital in western Uganda. Heliyon. 2023;9(9):e19588. https://doi.org/10.1016/j.heliyon.2023.e19588
Das P, Rahman MZ, Banu S, Rahman M, Chisti MJ, Chowdhury F, et al. Acute febrile illness among outpatients seeking health care in Bangladeshi hospitals prior to the COVID-19 pandemic. PLoS One. 2022;17(9):e0273902. https://doi.org/10.1371/journal.pone.0273902
Marks F, Liu J, Soura AB, Gasmelseed N, Operario DJ, Grundy B, et al. Pathogens That Cause Acute Febrile Illness Among Children and Adolescents in Burkina Faso, Madagascar, and Sudan. Clin Infect Dis. 2021;73(8):1338-45. https://doi.org/10.1093/cid/ciab289
Teferi M, Desta M, Yeshitela B, Beyene T, Cruz Espinoza LM, Im J, et al. Acute Febrile Illness Among Children in Butajira, South-Central Ethiopia During the Typhoid Fever Surveillance in Africa Program. Clin Infect Dis. 2019;69(Suppl 6):S483-S91. https://doi.org/10.1093/cid/ciz620
Karthikeyan AS, Srinivasan M, Kanungo S, Sinha B, Shrivastava A, Ramanujam K, et al. Antibiotics for Fever Among Children: Findings From the Surveillance for Enteric Fever in India Cohorts. J Infect Dis. 2021;224(Supple 5):S494-S501. https://doi.org/10.1093/infdis/jiab115
Chapagain RH, Adhikari S, Bhattarai T, Basaula Y, Bhattarai S. Burden of enteric fever and antibiotic sensitivity in Nepalese Children Prior to Typhoid Vaccine in the National Immunization Program. J Nepal Health Res Counc. 2023;21(2):297-302. https://doi.org/10.33314/jnhrc.v21i02.4728
Azhar M, Zamir N, Shaikh M, Ullah I. Enteric Fever Complicated by Intestinal Perforation in Children: A Persistent Health Problem Requiring Surgical Management. Pak J Med Sci. 2020;36(5):890-93. https://doi.org/10.12669/pjms.36.5.2270
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