Typhoid fever in Dhulikhel hospital, Nepal
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Kathmandu University Medical Journal (2003) Vol. 2, No. 3, Issue 7, 188-192
Original Article
Typhoid fever in Dhulikhel hospital, Nepal
Sharma N, Koju R, Karmacharya B, Tamang MD, Makaju R, Nepali N, Shrestha P, Adhikari D
Abstract
One hundred and twelve cases of typhoid fever presenting in outpatient and emergency department of Dhulikhel
Hospital in Nepal were studied. In this study, it was found that 71% typhoid fever cases were less than 30 years of
age group with male to female ratio of 3:1. Fever over 5 days followed by headache and chills were major
presenting symptoms. Widal test and blood culture for Salmonella typhi were positive in 59% and 49% cases
respectively. Two third of our study population had total leucocyte count of normal range. The fever clearance time
was significantly better with ofloxacin compared to ciprofloxacin (pMaterials and methods
This study was undertaken in Dhulikhel Hospital to Further incubation was done in case it was indicated.
have base line information on typhoid fever as Regular subculture was done on day 1 i.e. after
regards to its demographic distribution, clinical overnight incubation and after 5 days of incubation
features, laboratory findings and antibiotic response on solid media namely Blood Agar (BA),
to help clinicians in future. MacConkey Agar (MA) and Chocolate Agar (CA).
Subculture was also done when there was obvious
Total 112 cases of suspected typhoid fever attending turbidity in the broth on any day. Subcultures on BA
to Dhulikhel Hospital were studied from November and CA were incubated in the candle jar where as
2001 till October 2002. The diagnostic criteria of those on MA were incubated at ambient atmosphere.
typhoid fever were based on clinical and laboratory
findings. The clinical findings were – high grade Serological test: When the biochemical test of the
fever over 5 days with headache, relative isolate was characteristics of salmonella, serological
bradycardia, dry coated tongue and spleenomegaly. agglutination test on a suspension of about 1010
The laboratory findings were – no leucocytosis, bacteria per millilitre were carried out, first using
blood culture positive for Salmonella and serotyping. polyvalent sera and if positive using monovalent sera
as well, in the following order:
The febrile illness of other causes like pneumonia, • Salmonella polyvalent O sera
malaria, deep abscesses, tuberculosis, amoebic liver • Individual salmonella O group sera
abscess, encephalitis, influenza, endocarditis, visceral • Single factor H sera
leishmaniasis, and connective-tissue diseases were
excluded with necessary investigations. The Antibiotic sensitivities were carried out on all
demographic data, clinical parameter, laboratory positive blood isolates using Kirby-Bauer disc
findings and antibiotics and their response was diffusion method.
analyzed.
The statistical analysis was done with SPSS 11.5 for
Fever Clearance Time (FCT) was defined as the time Microsoft windows. Mean values ± standard
from onset of treatment to the first time axillary deviations were calculated for continuous variables.
temperature fell below 37˚C and remained below The statistical significance of differences between
37˚C for 48 hours. groups was analyzed by T – test for continuous
variables.
Widal test: The slide test type of widal test was done
to detect antibodies against O and H antigens of S. Results
typhi and H antigens of S. paratyphi A and S. All 112 patients with typhoid fever had undergone
paratyphi B. The samples which showed routine blood test with widal test and blood culture.
agglutination (clumping) with the antigenic reagents The age of the study population ranged from 6 years
were considered positive and those that do not to 75 with mean ± standard deviation of 28.33±15.2.
agglutinated were considered negative. The male female ratio of study population was 3:1.
Seventy one percent of the patients were of below 30
Blood Culture: The blood culture bottles were years of age.
immediately incubated at 37˚ C for at least 5 days.
Table 1: Age and Sex wise distribution of study population
Age group Male Female Total
< 10 8 2 10
11 – 20 19 9 28
21 – 30 31 11 42
31 – 40 2 8 10
41 – 50 9 3 12
51 – 60 3 3 6
61 – 70 2 - 2
71 – 80 - 2 2
Total 74 38 112
189Headache, chills, cough and pain were the common at the time of admission significantly present along
presenting symptoms with fever.
Table 2: Symptom wise distribution of study population
Symptoms No of Patient Percentage
Fever 112 100
Headache 49 43.8
Chills 46 41.1
Vomiting 7 6.3
Cough 17 15.2
Pain Abdomen 12 10.7
Diarrhoea 9 8
Constipation 6 5.4
Disorientation 0 0
The widal test of 97 patients revealed that 59% were culture done in 112 patients, 49.2% were positive and
positive and 38% were negative. Regarding blood rest were negative.
Table 3: Blood culture, widal test and spleenomegaly in study population
Positive Negative Positive %
Widal 59 38 52.7
Blood Culture 55 57 49.2
Spleenomegaly 3 109 2.7
Spleenomegaly was found in 3 patients out of 112 patients.
Table 4: Total leucocyte count in study population
WBC count No of patient Percentage
< 4000 36 32.1
4000 - 11000 70 62.5
> 11000 6 5.3
Two third of the patients have total leucocyte count leucocyte counts. Only 5.3% have raised leucocyte
of normal range i.e. 4000 – 11000/cmm. Thirty two count.
percent of the study populations have below normal
Table 5: Response to different drugs
No of patient Fever clearance time Release from treatment
Ciprofloxacin 57 (50.9%) 4.6±1.15 9.7±3.17
Ofloxacin 21 (18.8%) 3.7±0.91 9.7±2.88
Ceftriaxone 17 (15.2%) 4.1±0.89 6.6±1.23
Chloramphenicol 5 (4.5%) 5.4±0.89 10.4±1.14
Cefotaxime 4 (3.6%) 4.5±0.82 8±0.82
Amoxicillin 8 (7.1%) 6.2±1.03 6.8±2.6
The average fever clearance time was shortest with
Ofloxacin - 3.7±0.91 (mean ± standard deviation) The fever clearance time had no significant
whereas longest with Amoxicillin group – 6.2±1.03. difference between ciprofloxacin and ceftriaxone (p -
The release from treatment was shorter - 4.1±2.6with > 0.05), ofloxacin and ceftriaxone (p - > 0.05),
Amoxicillin whereas longest - with Chloramphenicol ciprofloxacin and chloramphenicol (p - > 0.05). This
- 10.4±1.14. was significantly better in ofloxacin compared to
190ciprofloxacin (p - 0.05), ofloxacin and ceftriaxone (p - > 0.05), typhoid fever in Dhulikhel Hospital. Similarly thirty ciprofloxacin and chloramphenicol (p - > 0.05). The percent of study population presented with chloramphenicol had similar fever clearance time gastrointestinal problems including abdominal pain with ciprofloxacin which could be due to few and diarrhoea, which is similar to symptoms numbers of cases. Fever clearance time was described in most of the textbooks and research significantly better in ofloxacin compared to articles2,9. ciprofloxacin (p -
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ofloxacin compared to ciprofloxacin (pYou can also read
