Section of Pediatric Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan.
Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
Clin Infect Dis. 2020 Dec 1;71(Suppl 3):S232-S238. doi: 10.1093/cid/ciaa1309.
Typhoid fever is caused by Salmonella enterica subspecies enterica serovar Typhi (S. Typhi) and can lead to systemic illness and complications. We aimed to characterize typhoid-related ileal perforation in the context of the population-based Surveillance of Enteric Fever in Asia Project (SEAP) in Bangladesh, Nepal and Pakistan.
Between September 2016 and September 2019, all cases of nontraumatic ileal perforation with a clinical diagnosis of typhoid were enrolled from 4 tertiary care hospitals in Karachi, 2 pediatric hospitals in Bangladesh, and 2 hospitals in Nepal. Sociodemographic data were collected from patients or their caregivers, and clinical and outcome data were retrieved from medical records. Tissue samples were collected for histopathology and blood cultures where available.
Of the 249 enrolled cases, 2 from Bangladesh, 5 from Nepal and 242 from Pakistan. In Pakistan, most of the cases were in the 0-15 (117/242; 48%) and 16-30 (89/242; 37%) age groups. In all countries, males were most affected: Pakistan 74.9% (180/242), Nepal 80% (4/5), and Bangladesh 100% (2/2). Blood culture was done on 76 cases; 8 (11%) were positive for S. Typhi, and all were extensively drug resistant (XDR) S. Typhi. Tissue cultures was done on 86 patients; 3 (3%) were positive for S. Typhi, and all were XDR S. Typhi, out of 86 samples tested for histopathology 4 (5%) revealed ileal perforation with necrosis. Culture or histopathology confirmed total 15 (11%) enteric fever cases with ileal perforation are similar to the clinically diagnosed cases. There were 16/242 (7%) deaths from Pakistan. Cases of ileal perforation who survived were more likely to have sought care before visiting the sentinel hospital (P = .009), visited any hospital for treatment (P = .013) compared to those who survived.
Although surveillance differed substantially by country, one reason for the higher number of ileal perforation cases in Pakistan could be the circulation of XDR strain of S. Typhi in Karachi.
伤寒是由肠沙门氏菌亚种肠亚种伤寒血清型（S. Typhi）引起的，可导致全身疾病和并发症。我们旨在描述孟加拉国、尼泊尔和巴基斯坦基于人群的肠热病监测项目（SEAP）中与伤寒相关的回肠穿孔情况。
2016 年 9 月至 2019 年 9 月，从卡拉奇的 4 家三级护理医院、孟加拉国的 2 家儿科医院和尼泊尔的 2 家医院，招募了所有具有临床诊断伤寒的非创伤性回肠穿孔病例。从患者或其护理人员收集社会人口统计学数据，并从病历中检索临床和结局数据。在有组织样本的情况下，收集组织样本进行组织病理学和血液培养。
249 例入组病例中，来自孟加拉国的 2 例，尼泊尔的 5 例，巴基斯坦的 242 例。在巴基斯坦，大多数病例发生在 0-15 岁（117/242；48%）和 16-30 岁（89/242；37%）年龄组。在所有国家中，男性受影响最大：巴基斯坦 74.9%（180/242），尼泊尔 80%（4/5），孟加拉国 100%（2/2）。对 76 例进行了血液培养；8 例（11%）为伤寒沙门氏菌阳性，均为广泛耐药（XDR）伤寒沙门氏菌。对 86 例患者进行了组织培养；3 例（3%）为伤寒沙门氏菌阳性，均为 XDR 伤寒沙门氏菌，在 86 例送检组织病理学检查的样本中，4 例（5%）显示回肠穿孔伴坏死。培养或组织病理学检查共证实 15 例（11%）经肠道发热并发回肠穿孔的病例与临床诊断病例相似。巴基斯坦有 16/242（7%）例死亡。存活的回肠穿孔病例更有可能在就诊前先去了哨点医院就诊（P=.009），也更有可能去了任何医院接受治疗（P=.013）。
尽管各国的监测情况有很大差异，但巴基斯坦回肠穿孔病例较多的一个原因可能是卡拉奇 XDR 伤寒血清型的流行。
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