| Objective:To analyze the epidemiological characteristics and clinical features of typhoid fever and paratyphoid fever patients in Department of Infectious Diseases in the past 5 years,and provide scientific basis for early detection,early diagnosis and early treatment of the disease.Methods:This is a retrospective descriptive study(from January 2013 to December 2017),the subject of which are composed of 150 patients(form Department of Infectious Diseases of the first affiliated hospital of Kunming medical university,Yunnan,China),in order to study epidemiological characteristics and clinical features of typhoid fever and paratyphoid fever patients.Using SPSS22.0 statistical software for statistical analysis.Results:1.150 strains of Salmonella were isolated among the 1243 clinically diagnosed cases in 5 years in our hospital,the positive rate of clinically diagnosed cases was 12.1%.12 strains of salmonella typhi,134 strains of salmonella paratyphi A,1 strain of salmonella paratyphi B,1 strain of salmonella paratyphi C2.the epidemiological characteristics:Time distribution:2013-2017 The number of cases were admitted:71 cases,27 cases,25 cases,16 cases,and 11 cases;the number of cases from January to December was:8 cases,3 cases,4 Cases,6 cases,25 cases,23 cases,21cases,20 cases,15 cases,13 cases,7 cases,5 cases,are popular throughout the year,concentrated in 5-10 months.Triple distribution:91males and 59 females,male:female was 1.54:1;0 to 6 years old 4 cases,7 to 17 years old 18 cases,18 to 40 years old 98 cases,41 to 65 years old 29 cases,1 case after 66 years old,all ages have onset,the maximum age of 69 years,the minimum age of 1 year,the average age of 30.24 × 13.10 years,the onset age is concentrated in 18 to 40 years old.office clerk 48 cases(32%),tudents 36 cases(24%),unemployed 33 cases(22%),farmers 16 cases(10.7%),individuals workers 7 cases(4.7%),the workers 6 cases(4%),the children 4 cases(2.7%).Spatial distribution:112 cases of Kunming City,15 cases of Qujing City,6 cases of Honghe Prefecture,4 cases of Zhaotong City,3 cases of Chuxiong Prefecture,2 cases of Yuxi City,2 cases of Pu’er City,2 cases of in other provinces,1case of Baoshan City,1 case of Dali City,1 case of Ruili City,1 case of Lijinag City.3.Clinical Features:main symptoms:fever 150 cases(100%),accompany headache 51 cases(34%),accompany gastrointestinal symptoms 50 cases(33.3%),accompany muscle soreness 27 cases(18%),accompany cough and sputum 12 cases(8%),accompany dizziness 5 casess(3.3%);main signs:the most common is splenomegaly in 82 cases(54.7%),followed by typhoid tongue 14 cases(9.3%)and hepatomegaly 10 cases(6.7%),facial indifference just 2 cases(1.3%).The fever is given priority to with hight fever,80.6%of patients,temperature peak is above 39℃.irregular fever is the main hot type.laboratory features:EO disappeared in 102 cases(68%),EO reduce the 31 cases(20.7%),ALT and/or AST elevated in 98 cases.(65.3%),urine protein positive in 43 cases(28.7%),faecal OB test positive in 59 cases(39.3%);CRP elevated<100mg/L 115 cases(86.7%),PCT elevated in 28 cases(22.8%),ESR elevated in 75 cases(81.5%),WBC lower 42 cases(28%),WBC normal in 107cases(71.35%),WBC Increased 1 cases(0.7%);patients(27.7%)who widal test positive in 130 cases were tested.The sensitivity of the widal test was 25.5%at the first week,26.5%at the second week,27.8%at the third week,66.7%at the fourth week,28.6%at the fifth week,detect 1 at the sixth week case was negative,100%at the seventh week.4.Pathogen Isolation and Drug Sensitivity Results:12 strains of salmonella typhi,134 strains of salmonella paratyphi A,1 strain of salmonella paratyphi B,1 strain of salmonella paratyphi C;drug sensitivity results analysis:The top five sensitive antibiotics were ceftriaxone,ampicillin,compound sulfamethoxazole,chloramphenicol,ampicillin/sulbactam.The first ranked intermediate antibiotic was ciprofloxac:in.The top five were nalidixic acid,ciprofloxacin,gentamycin,amikacin,cefazolin.Multidrug resistance rate was 3.3%(5/150).The multidrug resistance combination was aminoglycosides + first-generation cephalosporins +quinolones 2 cases,aminoglycosides + first or second generation cephalosporins +furans 1 case,penicillin + Sulfonamide + chloramphenicol 1 case,penicillins +Sulfonamides + 3rd generation cephalosporins 1 case.5.Complications:Complications occurred in 105patients,98 cases were complicated with toxic hepatitis,6 cases were complicated with acute bronchitis,1 case was complicated with intestinal hemorrhage.6.Treatment:The most commonly used empirical anti-infection programs are cefoperazone sodium and tazobactam,cephalosporin.Patients with ineffective anti-infective treatment and multidrug resistance cases were 100%effective after diagnosis based on drug sensitivity.Conclusions:1.From 2013 to 2017,the case of typhoid fever and paratyphoid fever patients in Department of Infectious Diseases the number of cases was downtrend.2.May to October was the peak season,male patients is given priority,the onset age mainly concentrated in 18 to 40 years old,the office clerk and students were the main infected people.3.Fever,headache,gastrointestinal is the main symptoms of typhoid fever and paratyphoid fever in Department of Infectious Diseases.The signs were mainly fever,with half of the patients having splenomegaly,some with typhoid tongue,and hepatomegaly.The main complications are toxic hepatitis,rare acute bronchitis,severe complications of intestinal hemorrhage is infrequent.4.Unlike other gram-negative bacterial infections,elevation of CRP and PCT were mild-moderatethe main laboratory features.5.The positive rate of typhoid fever and paratyphoid fever test confirmed in this group was not high,only 27.7%.6.Salmonella paratyphi A was the most common group in this study.7.The top five sensitive antibiotics were ceftriaxone,ampicillin,compound sulfamethoxazole,chloramphenicol,ampicillin/sulbactam.And compound sulfamethoxazole,chloramphenicol,ampicillin/sulbactam provided more drug choices when empiric anti-infective treatments for typhoid and paratyphoid occurred in this region. |
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