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Arch Dis Child. 1996 September; 75(3): 214–217.
PMCID: PMC1511710

Impact of age and drug resistance on mortality in typhoid fever.


The risk factors for mortality were analysed in a consecutive group of 1158 children presenting to the Aga Khan University Medical Center, Karachi, with multidrug resistant typhoid fever that had been proved on culture. There were 19 deaths, representing an overall case fatality rate of 1.6%. Multidrug resistant typhoid was associated with a more severe clinical illness and higher rates of toxicity, hepatomegaly, hypotensive shock, and death. Irrespective of drug resistance status, typhoid fever was found to be a more severe illness in young infants with significantly higher rates of diarrhoea, hypotensive shock, and mortality. Univariate analysis of admission characteristics associated with increased risk for mortality revealed significant association with younger age (p < 0.05), hypotensive shock or hypothermia (p < 0.001), obtundation (p < 0.001), seizures (p < 0.05), anaemia at admission (p < 0.005), and leucocytosis (p < 0.001). Logistic regression analysis of risk factors for mortality showed persistent association of hypothermia, toxicity, and anaemia with mortality. The data provides evidence that multidrug resistant typhoid in childhood is associated with increased risk of mortality, especially in infancy and closer attention to several risk factors for increased morbidity and case fatality rates may lead to improved outcome of treatment.

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  • Ivanoff B, Levine MM, Lambert PH. Vaccination against typhoid fever: present status. Bull World Health Organ. 1994;72(6):957–971. [PubMed]
  • Rowe B, Threlfall EJ, Ward LR. Does chloramphenicol remain the drug of choice for typhoid? Epidemiol Infect. 1987 Jun;98(3):379–383. [PMC free article] [PubMed]
  • Ellis ME, Moosa A, Hillier V. A review of typhoid fever in South African black children. Postgrad Med J. 1990 Dec;66(782):1032–1036. [PMC free article] [PubMed]
  • Butler T, Islam A, Kabir I, Jones PK. Patterns of morbidity and mortality in typhoid fever dependent on age and gender: review of 552 hospitalized patients with diarrhea. Rev Infect Dis. 1991 Jan-Feb;13(1):85–90. [PubMed]
  • RAO PT, RAO KV. Typhoid fever in children. Indian J Pediatr. 1959 Jul;26:258–264. [PubMed]
  • Kagwa-NYanzi JA. Typhoid fever in African children. J Trop Pediatr Environ Child Health. 1971 Sep;17(3):105–109. [PubMed]
  • Coovadia YM, Gathiram V, Bhamjee A, Garratt RM, Mlisana K, Pillay N, Madlalose T, Short M. An outbreak of multiresistant Salmonella typhi in South Africa. Q J Med. 1992 Feb;82(298):91–100. [PubMed]
  • Topley JM. Mild typhoid fever. Arch Dis Child. 1986 Feb;61(2):164–167. [PMC free article] [PubMed]
  • Mahle WT, Levine MM. Salmonella typhi infection in children younger than five years of age. Pediatr Infect Dis J. 1993 Aug;12(8):627–631. [PubMed]
  • Scragg J, Rubidge C, Wallace HL. Typhoid fever in African and Indian children in Durban. Arch Dis Child. 1969 Feb;44(233):18–28. [PMC free article] [PubMed]
  • Bhutta ZA, Naqvi SH, Razzaq RA, Farooqui BJ. Multidrug-resistant typhoid in children: presentation and clinical features. Rev Infect Dis. 1991 Sep-Oct;13(5):832–836. [PubMed]
  • Mishra S, Patwari AK, Anand VK, Pillai PK, Aneja S, Chandra J, Sharma D. A clinical profile of multidrug resistant typhoid fever. Indian Pediatr. 1991 Oct;28(10):1171–1174. [PubMed]
  • Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol. 1966 Apr;45(4):493–496. [PubMed]
  • Riley LW, Cohen ML, Seals JE, Blaser MJ, Birkness KA, Hargrett NT, Martin SM, Feldman RA. Importance of host factors in human salmonellosis caused by multiresistant strains of Salmonella. J Infect Dis. 1984 Jun;149(6):878–883. [PubMed]
  • Holmberg SD, Solomon SL, Blake PA. Health and economic impacts of antimicrobial resistance. Rev Infect Dis. 1987 Nov-Dec;9(6):1065–1078. [PubMed]
  • Olarte J, Galindo E. Salmonella typhi resistant to chloramphenicol, ampicillin, and other antimicrobial agents: strains isolated during an extensive typhoid fever epidemic in Mexico. Antimicrob Agents Chemother. 1973 Dec;4(6):597–601. [PMC free article] [PubMed]
  • Mukherjee P, Mukherjee S, Dalal BK, Haldar KK, Ghosh E, Pal TK. Some prospective observations on recent outbreak of typhoid fever in West Bengal. J Assoc Physicians India. 1991 Jun;39(6):445–448. [PubMed]
  • Gupta A. Multidrug-resistant typhoid fever in children: epidemiology and therapeutic approach. Pediatr Infect Dis J. 1994 Feb;13(2):134–140. [PubMed]
  • Ferreccio C, Levine MM, Manterola A, Rodriguez G, Rivara I, Prenzel I, Black RE, Mancuso T, Bulas D. Benign bacteremia caused by Salmonella typhi and paratyphi in children younger than 2 years. J Pediatr. 1984 Jun;104(6):899–901. [PubMed]
  • Rajajee S, Anandi TB, Subha S, Vatsala BR. Patterns of resistant Salmonella typhi infection in infants. J Trop Pediatr. 1995 Feb;41(1):52–54. [PubMed]
  • van Basten JP, Stockenbrügger R. Typhoid perforation. A review of the literature since 1960. Trop Geogr Med. 1994;46(6):336–339. [PubMed]
  • Johnson AO, Aderele WI. Enteric fever in childhood. J Trop Med Hyg. 1981 Feb;84(1):29–35. [PubMed]
  • Gupta V, Gupta SK, Shukla VK, Gupta S. Perforated typhoid enteritis in children. Postgrad Med J. 1994 Jan;70(819):19–22. [PMC free article] [PubMed]
  • Biswal N, Mathai B, Bhatia BD, Srinivasan S, Nalini P. Enteric fever: a changing perspective. Indian Pediatr. 1994 Jul;31(7):813–819. [PubMed]
  • Carmeli Y, Raz R, Schapiro JM, Alkan M. Typhoid fever in Ethiopian immigrants to Israel and native-born Israelis: a comparative study. Clin Infect Dis. 1993 Feb;16(2):213–215. [PubMed]
  • Mathieu JJ, Henning KJ, Bell E, Frieden TR. Typhoid fever in New York City, 1980 through 1990. Arch Intern Med. 1994 Aug 8;154(15):1713–1718. [PubMed]
  • Smith IF, Taiwo O, Golden MH. Plant protein rehabilitation diets and iron supplementation of the protein-energy malnourished child. Eur J Clin Nutr. 1989 Nov;43(11):763–768. [PubMed]
  • Lackritz EM, Campbell CC, Ruebush TK, 2nd, Hightower AW, Wakube W, Steketee RW, Were JB. Effect of blood transfusion on survival among children in a Kenyan hospital. Lancet. 1992 Aug 29;340(8818):524–528. [PubMed]
  • Hoffman SL, Punjabi NH, Kumala S, Moechtar MA, Pulungsih SP, Rivai AR, Rockhill RC, Woodward TE, Loedin AA. Reduction of mortality in chloramphenicol-treated severe typhoid fever by high-dose dexamethasone. N Engl J Med. 1984 Jan 12;310(2):82–88. [PubMed]
  • Rogerson SJ, Spooner VJ, Smith TA, Richens J. Hydrocortisone in chloramphenicol-treated severe typhoid fever in Papua New Guinea. Trans R Soc Trop Med Hyg. 1991 Jan-Feb;85(1):113–116. [PubMed]
  • Butler T, Ho M, Acharya G, Tiwari M, Gallati H. Interleukin-6, gamma interferon, and tumor necrosis factor receptors in typhoid fever related to outcome of antimicrobial therapy. Antimicrob Agents Chemother. 1993 Nov;37(11):2418–2421. [PMC free article] [PubMed]

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