Typhoid fever in children: Clinical presentation and risk factors

Objective: The diagnosis of typhoid fever based on widal test is on the rise despite its set back. We prospectively reviewed over one year period, cases of typhoid fever admitted in our centre to document the pattern of clinical presentation, risk factors and the reliability of Widal test in its diagnosis. Methods: This was a prospective study carried out in a Nigerian Teaching Hospital. All children, whose parents consented, admitted with a diagnosis of typhoid fever using the Centre for Disease Control and prevention (CDC) case definition for typhoid fever, between 1st January and 31st December 2010, were consecutively reviewed using a structured questionnaire. Results: A total of 42 patients were admitted out of which 35 were analysed, the remaining 7 were excluded because consent was not obtained. The disease was more common in males than females with M: F ratio of 3:2. The study gives the incidence of suspected typhoid of 30.5 per 1000 admission. The age range of the study population was 6 months to 15 years with cases being common among the age group five to nine years 13(37.1%). It has a bimodal peak of occurrence as it occurs commonly in April/May and in August/September. The disease was common in the low socioeconomic classes. All the 35 patients had fever (100%), vomiting 25 (71.4%), typhoid psychosis 3 (8.6%) and 4 (11.4%) had intestinal perforation. Culture was positive in 8 (22.9%) of the patients. Widal test were significant in 20 (57.1%) with a sensitivity of 62.5%, specificity 44.4%, positive predictive value 25%, negative predictive value 80% and the efficiency of the test was 48.6%. Conclusion: The incidence of typhoid fever in this study is 30.5 per 1000 admission, it is common during rainy and harmattan period. The use of Widal test is not too helpful in diagnosis of typhoid fever. Therefore, culture samples should be done in all cases of suspected typhoid fever.