A study on the clinical spectrum, prescription pattern and diagnosis of enteric fever in a tertiary care hospital of North India


  • Soumyadip Chatterji Department of Infectious Diseases, Tata Medical Center, Kolkata, West Bengal, India http://orcid.org/0000-0002-5291-1901
  • Priyanka Sharma Department of Microbiology, AIIMS, New Delhi, India
  • Avinash Kaur Department of Biomedical Engineering, IIT, New Delhi, India
  • Dinesh Kalyanasundaram Department of Biomedical Engineering, IIT, New Delhi, India
  • Ashutosh Biswas Department of Medicine, AIIMS, New Delhi, India
  • Naveet Wig Department of Medicine, AIIMS, New Delhi, India
  • Arti Kapil Department of Microbiology, AIIMS, New Delhi, India




Enteric fever, Typhoid, Salmonella, Loop mediated isothermal amplification, Multi-drug resistance


Background: Enteric fever is a major public health concern in developing countries. Lack of good diagnostic tests and antimicrobial resistance are challenges in treatment of enteric fever. Timely diagnosis and proper management of fever are essential to reduce the complications and emergence antibiotic resistance.

Methods: A prospective observational study was conducted on 71 subjects between February 2018 and December 2019. Spectrum of the disease, antimicrobial resistance and prescription pattern were observed and performances of various diagnostic methods (like culture, serology and loop mediated isothermal amplification) were determined.

Results: The most commonly observed clinical features included gastrointestinal complaints, anaemia, leukopenia, splenomegaly and hepatitis. Blood culture was positive for 49.3% (35/71) of the cases using conventional culture method. All samples positive by LAMP were also culture positive. Among the culture positive samples 80% (28/35) were S. typhi and 20% (7/35) were S. paratyphi A. Antimicrobial susceptibility to ciprofloxacin was 39.3% and 28.6% and ampicillin susceptibility was 32.1 and 28.6% in S. typhi and S. paratyphi A respectively. Only one multidrug resistant isolate was noted, while none was resistant to ceftriaxone or azithromycin. Cefixime and azithromycin combination therapy led to the earliest defervescence of fever.

Conclusions: Oral combination therapy may be a good option to treat enteric fever and oral combination therapy may be a good option to treat enteric fever and performance of LAMP seem to be as good as culture with a shorter turnaround time. LAMP can be used to obviate the need of culture in resource limited settings.

Author Biography

Soumyadip Chatterji, Department of Infectious Diseases, Tata Medical Center, Kolkata, West Bengal, India


Department of Infectious Diseases


Antillón M, Warren JL, Crawford FW, Weinberger DM, Kurum E, Pak GD et al. The burden of typhoid fever in low- and middle-income countries: A meta-regression approach. PLoS Negl Trop Dis. 2017;11(2):1-21.

Marchello CS, Hong CY, Crump JA. Global typhoid fever incidence: A systematic review and meta-analysis. Clin Infect Dis. 2019;68(2):S105-16.

Parry CM, Ribeiro I, Walia K, Rupali P, Baker S, Basnyat B. Multidrug resistant enteric fever in South Asia: Unmet medical needs and opportunities. BMJ. 2019;364:1-4.

Bhutta ZA. Current concepts in the diagnosis and treatment of typhoid fever. Br Med J. 2006;333(7558):78-82.

Kaur A, Kapil A, Elangovan R, Jha S, Kalyanasundaram D. Highly-sensitive detection of Salmonella typhi in clinical blood samples by magnetic nanoparticle-based enrichment and in-situ measurement of isothermal amplification of nucleic acids. PLoS One. 2018;13(3):45-9.

Kaur A, Ruhela A, Sharma P, Khariwal H, Sesth S, Kumar A, et al. Simultaneous and high sensitive detection of Salmonella typhi and Salmonella paratyphi a in human clinical blood samples using an affordable and portable device. Biomed Microdevices. 2019.

Joshi S. Antibiogram of S. enterica serovar Typhi and S. enterica serovar Paratyphi A: a multi-centre study from India. WHO South-East Asia J Public Heal. 2012;1(2):182.

Sharma P, Dahiya S, Kumari B, Balaji B, Sood S, Das BK, et al. Pefloxacin as a surrogate marker for quinolone susceptibility in Salmonella enterica serovars typhi & paratyphi a in India. Indian J Med Res. 2017;145:43-8.

Sharma P, Dahiya S, Manral N, Kumari B, Kumar S, Pandey S, et al. Changing Trends of Culture-positive Typhoid Fever and Antimicrobial Susceptibility in a Tertiary Care North Indian Hospital over the Last Decade. Indian J Med Microbiol. 2018;36(1):70-6.

Kumar S, Rizvi M, Berry N. Rising prevalence of enteric fever due to multidrug-resistant Salmonella: An epidemiological study. J Med Microbiol. 2008;57(10):1247-50.

Narasanna R, Chavadi M, Kelmani C. Prevalence of multidrug-resistant Salmonella typhi in typhoid patients and detection of blaCTX-M2 and blaCTX-M9 genes in cefetoxime-mediated extended spectrum β-lactamase-producing Salmonella typhi isolates. Biomed Res. 2018;29(14):3015-21.

Klemm EJ, Shakoor S, Page AJ, Qamar FN, Judge K, Saeed DK, et al. Emergence of an extensively drug-resistant Salmonella enterica serovar typhi clone harboring a promiscuous plasmid encoding resistance to fluoroquinolones and third-generation cephalo-sporins. MBio. 2018;9(1):1-10.

Rai S, Prasad K, Dhole T, Jain S, Ghoshal U. Rationale of azithromycin prescribing practices for enteric fever in India. Indian J Med Microbiol. 2012;30(1):30.

Capoor MR, Rawat D, Nair D, Hasan AS, Deb M, Aggarwal P, et al. In vitro activity of azithromycin, newer quinolones and cephalosporins in ciprofloxacin-resistant Salmonella causing enteric fever. J Med Microbiol. 2007;56(11):1490-4.

Katiyar A, Sharma P, Dahiya S, Singh H, Kapil A, Kaur P. Genomic profiling of antimicrobial resistance genes in clinical isolates of Salmonella Typhi from patients infected with Typhoid fever in India. Sci Rep. 2020;10(1):56-9.

Sharma P, Dahiya S, Balaji V, Kanga A, Panda P, Das R, et al. Typhoidal salmonellae: Use of multi-locus sequence typing to determine population structure. PLoS One. 2016;11(9):45-9.

Collee JG, Duguid J.P, Fraser AG. In: Collee JG, Fraser AG, Marmion BP SA eds. Mackie and Mc Cartney Practical Medical Microbiology. United States: Elsevier; 2014.

Performance standards for antimicrobial susceptibility testing. Available at: https://silo.pub/performance-standards-for-antimicrobial-susceptibility-testing. Accessed on 20 November 2021.

Habte L, Tadesse E, Ferede G, Amsalu A. Typhoid fever: Clinical presentation and associated factors in febrile patients visiting shashemene referral hospital, southern Ethiopia. BMC Res Notes. 2018;11(1):1-6.

Britto CD, Wong VK, Dougan G, Pollard AJ. A systematic review of antimicrobial resistance in Salmonella enterica serovar typhi, the etiological agent of typhoid. PLoS Negl Trop Dis. 2018;12(10):e0006779.

Manesh A, Balaji V, Kumar DRN, Rupali P. A case of clinical and microbiological failure of azithromycin therapy in Salmonella enterica serotype Typhi despite low azithromycin MIC. Int J Infect Dis. 2017;54:62-3.

Paul UK. Typhoid Fever Recent Management. API-Med Updat. 2017:64-7.

Crump JA, Sjölund-Karlsson M, Gordon MA, Parry CM. Epidemiology, clinical presentation, laboratory diagnosis, antimicrobial resistance, and antimicrobial management of invasive Salmonella infections. Clin Microbiol Rev. 2015;28(4):901-37.

Krishna S, Desai S, Anjana VK, Paranthaaman RG. Typhidot (IgM) as a reliable and rapid diagnostic test for typhoid fever. Ann Trop Med Public Heal. 2011;4(1):42-4.

Balakrishna TP, Sumathi S, Anuradha K, Venkatesh D, Krishna S. A Comparative Study of Typhidot and Widal Test in the Diagnosis of Typhoid Fever. J Evol Med Dent Sci. 2013;2(21):3720-5.

Balaji V, Kapil A, Shastri J, Pragasam AK, Gole G, Choudhari S, et al. Longitudinal typhoid fever trends in India from 2000 to 2015. Am J Trop Med Hyg. 2018;99(3):34-40.

Rathod P, Patil P, Choure B, Patil A. Study of current prescribing pattern of antimicrobial drugs in indoor cases of enteric fever in a tertiary care hospital. Int J Basic Clin Pharmacol. 2016:159-62.




How to Cite

Chatterji, S., Sharma, P., Kaur, A., Kalyanasundaram, D., Biswas, A., Wig, N., & Kapil, A. (2022). A study on the clinical spectrum, prescription pattern and diagnosis of enteric fever in a tertiary care hospital of North India. International Journal Of Community Medicine And Public Health, 9(6), 2633–2638. https://doi.org/10.18203/2394-6040.ijcmph20221546



Original Research Articles