Clinical Characteristics and Factors Associated with Blood Culture Positivity Among Children with Suspected Enteric Fever

Open Access

Abstract

Background: Blood culture is the diagnostic gold standard for enteric fever, but its yield in routine paediatric practice in Bangladesh is low, and the laboratory diagnosis of the disease therefore rests heavily on serology. The proportion of confirmed paediatric cases in which the organism is actually recovered, and the extent to which culture, and the Widal test identify the same children, have not been well quantified in this setting. Aim of the study: The aim of the study was to describe the clinical characteristics of children admitted with enteric fever, and to determine the blood culture positivity rate, and the complementary diagnostic yield of blood culture, and the Widal test in this population. Methods & Materials: This analysis was conducted using data from a randomized controlled trial at the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from July 2007 to January 2008. Fifty children aged ≤18 years with serologically and/or culturally confirmed enteric fever were included in the study. Clinical findings, habitat, habits, Widal test results, and blood culture results were recorded. Data were analyzed using SPSS version 13, and a P value <0.05 was considered statistically significant. Result: The patients ranged from 2 to 13 years of age, and the mean (±SD) age was 7.96±3.208 years, and 6.20±3.34 years in the two treatment arms respectively. In total, 24 (48.0%) patients were male, and 26 (52.0%) were female. Fever was present in all 50 (100.0%) patients, followed by pain in 19 (38.0%), loose stool in 15 (30.0%), anorexia in 12 (24.0%), and vomiting in 12 (24.0%) patients. Hepatomegaly was found in 39 (78.0%), splenomegaly in 34 (68.0%), and anaemia in 32 (64.0%) patients. Blood culture was positive in 14 (28.0%) patients, and the Widal test was positive in 42 (84.0%) patients. Both tests were positive in 6 (12.0%) patients, the Widal test alone was positive in 36 (72.0%), and blood culture alone was positive in 8 (16.0%) patients. So, blood culture identified 8 (16.0%) children who would not have been detected by serology alone, whereas serology identified 36 (72.0%) children in whom the organism was not recovered. Conclusion: Blood culture found than one third of the confirmed cases of enteric fever. This shows that using blood culture is not enough, for diagnosis. Because the Widal test and blood culture picked up cases they should be used together not as substitutes, when testing Bangladeshi children who may have enteric fever.