Clinical analysis of 125 children with typhoid fever from 1993 to 2008 in Chongqing area

Objective To summarize the clinical characteristics of typhoid fever in children and to provide the clinical experiences for early diagnosis and treatment. Methods A retrospective analysis was made on the clinical data of 125 children with typhoid fever in Chongqing from 1993 to 2008. Results 110 cases(88.0%) were from 5 to 14 years old. The cases were more common in summer or autumn (77,61.6%). The common clinical features were fever (124,99.2%),hepatomegaly (91,72.8%),splenomegaly (65,52.0%),gastrointestinal manifestations (103,82.4%) and respiratory manifestations (71,56.8%). WBC was in the normal range in 97(77.6%),and only 16(12.8%) presented leucopenia. Eosinophils reduced or disappeared in 28/33 (84.8%). Anemia existed in 85(68.0%),84/85(98.8%) of whom presented mild or moderate. The overall positive rate of bacterial cultures was 77.0%. The positive rate of blood cultures,marrow cultures,stool cultures and Widal test were 68.2% (75/110),55.0% (22/40),7.4% (5/68) and 42.7% (50/117),respectively. Widal test was positive in 27 cases with negative bacterial cultures. The susceptibilities of clinical strains to ceftazidime,cefepime,ceftriaxone,cefotaxime,cefoperazone,levofloxacin (6/6) and ciprofloxacin were 100%(26/26)、100%(33/33)、93.3%(14/15)、96.9%(62/64)、66.7%(10/15),100% and 100%,respectively. Basing on the results of antimicrobial susceptibility testing,the patients with poor therapeutic effect initially were treated by sensitive antibiotic and the curative effect were prominent:123 children cured while 2 died because of misdiagnosis. Conclusions Typhoid fever is sporadic in Chongqing. The peak age of onset ranges from 5 to 14 years old. It is more common in summer and autumn. The clinical manifestations of typhoid fever in children are atypical. The positive rate of Widal test is low,but it is still of great significance to the cases with negative bacterial culture. The third-generation cephalosporins and quinolones remain susceptible to the treatment for children with typhoid fever in Chongqing.