A Frequency of Enteric Fever Among Children Presenting with Acute Febrile Illness at Capital Development Authority Hospital Islamabad

Abstract

Background: Enteric (typhoid/paratyphoid) fever is a common cause of acute febrile illness (AFI) in children in South Asia. The emergence of widely drug-resistant Salmonella Typhi in Pakistan makes empiric therapy more difficult, highlighting the importance of local, culture-based estimates .

Objectives: To identify the prevalence of culture-confirmed enteric fever in children who present with AFI at a tertiary hospital in Islamabad and to evaluate the correlation with age, sex, length of fever, and weight.

Methods: Methods: A cross sectional study was carried out in a period of six months in the Department of Paediatrics, Capital Development Authority (CDA) Hospital, Islamabad. After obtaining ethical approval and parental consent, consecutive children aged 1 8 years with AFI (recorded temperature over 101 F during the last four days) and no antibiotic use in the last two weeks were enrolled (n=150). About 5 mL of the venous blood was cultured according to the hospital protocol (Wilson and Blair bismuth sulphite agar).  Associations were tested with χ² (α=0.05).

Results: Mean age was 4.6 ± 2.1 years; 54.0% were boys. Median fever duration at presentation was 5 days (IQR 4–6). Blood culture yielded S. Typhi in 18/150 children (12.0%; 95% CI 7.3–18.3); no S. Paratyphi was isolated. Culture positivity did not differ by sex (boys 12.3% vs girls 11.6%; χ²=0.03, p=0.86) or weight tertiles (χ²=0.39, p=0.82). By age, positivity was 7.7% (6/78) in 1–4 years versus 16.7% (12/72) in 5–8 years (χ²=3.01, p=0.083). Fever ≥5 days was significantly associated with culture positivity (17.9% [15/84] vs 4.5% [3/66]; χ²=6.09, p=0.014). Median time (IQR 30–44) was calculated.

Conclusions: Culture-confirmed typhoid accounted for 12% of pediatric AFI presentations at a tertiary center in Islamabad. Prolonged fever (≥5 days) significantly increased the likelihood of a positive blood culture.

Keywords: enteric fever; typhoid; acute febrile illness; children; blood culture; Salmonella Typhi.