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Research Articles

A descriptive analysis of clinico-demographic features and microbiological results of typhoid fever suspected patients in four large hospitals of Bhutan

Authors:

T Tshokey ,

JDW National Referral Hospital, Thimphu, BT
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N Tshering,

JDW National Referral Hospital, Thimphu, BT
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K Wangchuk,

JDW National Referral Hospital, Thimphu, BT
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R Sharma,

JDW National Referral Hospital, Thimphu, BT
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A Mongar,

JDW National Referral Hospital, Thimphu, BT
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T Dorji,

Phuentsholing Hospital, BT
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S Wangchuk,

Central Regional Referral Hospital, Gelephu, BT
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D Damcho,

Eastern Regional referral Hospital, Mongar, BT
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K Wangdi

Phuentsholing Hospital, BT
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Abstract

Introduction: Bhutan reports about 2000 typhoid fever cases annually. We aimed at understanding the clinico-demographic features and microbiological results of patients with suspected typhoid fever.

 

Methods: A yearlong (2012) study of typhoid fever suspects was conducted to describe and analyse associations of demographic and clinical features with laboratory findings.

 

Results: A total of 457 patients were enrolled. Most patients were from Phuntsholing General Hospital (n=181; 39.6%) followed by Jigme Dorji Wangchuck National Referral Hospital (n=170; 37.2%), Eastern Regional Referral Hospital (n=56; 12.3%) and Central Regional Referral Hospital (n=50; 10.9%). Fever (n=420; 91.9 %) and headache (n=397; 86.9 %) were the commonest symptoms reported by the patients. Only 30% (n=137) and 11.2% (n=51) had diarrhoea and constipation respectively. Mean duration of illness was 11.2 days. Among the 457 Widal tests performed, 76.1% (n=348) were negative, 12.3 % (n=56) positive for O antigen, 8.5% (n=39) for H antigen and 3.1% (n=14) for both. Only 2 of the 109 (1.8%) patients with a positive Widal test had a positive blood culture. Widal test showed a sensitivity of 33.3% and specificity of 76.3%. There was no association of any symptoms to antibody titres. There were three peaks when suspected cases reported to hospitals. More than 97% (n=447) of blood were sterile and Salmonella Typhi was isolated only in 1.3% (n=6). Only one isolate showed resistance to amoxicillin and nalidixic acid.

 

Conclusion: Typhoid fever was not being diagnosed satisfactorily but over-diagnosed and treated clinically. Widal test should be replaced by more sensitive and specific tests or used cautiously with well-defined cut-off titres.

 

How to Cite: Tshokey, T. et al., (2016). A descriptive analysis of clinico-demographic features and microbiological results of typhoid fever suspected patients in four large hospitals of Bhutan. Sri Lankan Journal of Infectious Diseases. 6(2), pp.106–113. DOI: http://doi.org/10.4038/sljid.v6i2.8117
Published on 27 Oct 2016.
Peer Reviewed

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