© JAPI • VOL. 56 • APRIL 2008 www.japi.org 237 Original Article# Enteric Fever in Mumbai – Clinical Profle, Sensitivity Patterns and Response to Antimicrobials S Jog*, R Soman**, T Singhal***, C Rodrigues+, A Mehta+, FD Dastur** Abstract Aims : Enteric fever is endemic in Mumbai and its diagnosis poses several problems. Our main aim was to study the clinical profle, haematological features of culture proven typhoid cases, the antimicrobial susceptibility pattern of the isolates and the time to defervescence with the treatment received. Material and Methods : This was a retospective chart review of all cases of culture proven enteric fever carried out at a tertiary care private hospital in Mumbai over the period January 2003 to September 2005. Results : Culture positivity in our study was 52.6%. Sixty one percent of the isolates were Salmonella typhi while 39% were Salmonella paratyphi A. An absolute eosinopenia was seen in 76.9% of the patients. Before being admitted to the hospital, 46.2% received antibiotics. The mean time to defervescence in patients who received prior antibiotics was 4.5 days while that in those who did not receive prior antibiotics was 5.1 days. Conclusions : A high culture positivity despite prior or ongoing antibiotic treatment was seen. Absolute eosinophil count of 0% could be an important marker of typhoid. High prevalence of nalidixic acid resistance, a marker of resistance to fuoroquinolones was observed. Combination treatment was not found to be superior to treatment with a single antibiotic. © INTRODUCTION E nteric fever is a systemic illness caused by Salmonella enterica serotype typhi or paratyphi A/B. In India the disease is endemic with an incidence ranging from 102 to 2219 per 100,000 population. 1 It results in considerable morbidity, absenteeism and resource utilization. Diagnosis of enteric fever is fraught with problems. History, physical findings and fever pattern are suggestive but can neither confrm nor exclude typhoid. Blood culture is the ‘gold standard’ for diagnosis and also gives information about antibiotic sensitivity of the isolate; however the cost of cultures, lack of “culture of cultures” and administration of prior antibiotics are impediments in this diagnostic approach. The Widal test is very commonly used in Indian set up but has very variable sensitivity and specifcity and problems in interpretation. Therapy of enteric fever is becoming more complicated and expensive with time. By the end of 1990s, Salmonella enterica developed resistance simultaneously to all frst line drugs like chloramphenicol, cotrimoxazole and ampicillin. *Fellow, Dept. of Infectious Diseases; **Consultant Physician; ***Consultant Paediatrician; +Consultant Microbiologist, P.D.Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai 400016, India. Received : 2.1.2007; Revised : 18.2.2008; Accepted : 3.3.2008 #Rapid Publication Fluoroquinolones when frst introduced in early 1990’s were very effective but the past decade has seen a progressive increase in the MICs of ciprofoxacin and high incidence of clinical failure to quinolones. The beta lactams such as cefxime and ceftriaxone are now being increasingly used but these are expensive drugs and are associated with a long time to defervescence and high rates of relapse. There have also been sporadic reports of high-level resistance to ceftriaxone in S. typhi and S. paratyphi. 2 Experience with new drugs such as azithromycin is at present scanty. 5-7 To sum up, enteric fever raises several issues of diagnosis and treatment. There is a scarcity of studies in literature addressing these issues. Hence a retrospective review of patients of enteric fever at our hospital was carried out to solve some of these pertinent clinical problems. Aims and Objectives The primary aim of the study was to study the sensitivity patterns of S. enteritica and response to antimicrobial therapy. The secondary aims were to study the clinical and laboratory profle of patients with culture proven enteric fever. MATERIAL AND METHODS This was a retrospective chart review of all cases of enteric fever carried out at a tertiary care private