| Objective: To investigate the characteristics of paratyphoid fever in children in Chongqing Children’s Hospital in recent 32 years and to provide clinical experiences for diagnosis and treatment.Methods: The clinical data of children with paratyphoid fever who were hospitalized in the Children’s Hospital of Chongqing Medical University from 1988 to 2020 were collected.The epidemiological characteristics,clinical characteristics,changes in antibiotic sensitivity of strains,the complications and related data of paratyphoid fever in children were analyzed retrospectively.Results:(1)A total of 56 cases of paratyphoid fever in children were collected.It could occur in all seasons of the year,with the peak from June to September.The age of onset ranged from 17 days and 7 hours to 16.6years old.It was more common in infants and school-age children.(2)The clinical manifestations of paratyphoid fever in children were varied in this group,mainly including fever(98.2%),digestive symptoms(91.1%),and respiratory symptoms(60.7%).The average duration of fever was 15.1±8.3 days and the average duration of diarrhea was 5.9 ±3.1 days.Apathy,roseola and relatively bradycardia were rare in children and only appeared in older children with paratyphoid fever.(3)Children with paratyphoid fever were easily misdiagnosed.Only 8.9%(5/56)were diagnosed or suspected of being infected with Salmonella enterica at the time of admission in this study.It took an average of 5.0(4.0-7.0)days after admission to the hospital to be diagnosed,and an average of 13.5(9.8-19.2)days from onset to diagnosis.(4)Among children with paratyphoid fever in this research,63.0%(34/54)had normal White blood cell(WBC)count,and 25.9%(14/54)had leukopenia.Anemia was found in 51.0%(26/51),and 73.1%(19/26)of them was mild anemia.The incidence of thrombocytopenia was 18.4%(9/49).The eosinophil count decreased in41.2%(7/17)and disappeared in 23.5%(4/17).The erythrocyte sedimentation rate(ESR)increased in 64.3%(18/28).The total positive rate of bacterial culture was 89.3%(50/56),among which the positive rate of bone marrow culture was 64.7%(11/17).The positive rate of blood culture was slightly lower than that of bone marrow culture,which was62.5%.The positive rates of stool culture and urine culture were 27.3%(9/33)and 0.0%,respectively.The positive rate of Widal test was 18.9%(7/37),of which 6 children had negative bacterial cultures.(5)In this study,the positive bacterial culture strains had a low sensitivity to ampicillin which was 48.8%(20/41).The sensitivity to sulfamethoxazole and trimethoprim,fluoroquinolones was higher than that of ampicillin.They were generally sensitive to the third and fourth generation cephalosporins.The multidrug resistance(MDR)rate was 30.6%(15/49).In the past 32 years,the sensitivity of positive bacterial culture strains isolated in our hospital showed a significant decrease in amikacin and had no significant change in ampicillin,cotrimoxazole,ciprofloxacin,ceftazidime,ceftriaxone and cefepime.After grouping study,it was found that S.Paratyphi A was more sensitive to ampicillin than S.Paratyphi B and S.Paratyphi C,especially in the age group > 3 years old.S.Paratyphi A and S.Paratyphi B were more sensitive to piperacillin or sulfamethoxazole and trimethoprim than S.Paratyphi C.(6)In this study,the combined treatment based on third-generation cephalosporins was effective: 11 cases were treated with third-generation cephalosporins combined with quinolones,5cases were treated with third-generation cephalosporins combined with penicillin,1 case was treated with third-generation cephalosporins combined with aminoglycosides,and 1 case was treated with third-generation cephalosporins combined with imipenem/cilastatin sodium.The average time for abatement of fever was 5.0(3.0-9.0)days,and the average hospitalization time was 10.8 ± 4.5 days.(7)Paratyphoid fever in children in this research was prone to complications,which from high to low were: bronchial pneumonia 19.6%(11/56),bronchitis 14.3%(8/56),and toxic myocarditis 14.3%(8/56),toxic hepatitis 10.7%(6/56).Among them,72.0%(18/25 cases)were single system complications.The occurrence of complications was related to whether the infected strain was a MDR strain(OR: 5.750;95%CI;P: 0.011).Conclusion: The paratyphoid fever among children in this group were sporadic throughout the year,with the peak from June to September.It was more common in infants and school-age children.The clinical manifestations of paratyphoid fever in children were varied,mainly including fever,digestive symptoms.Apathy,roseola and relatively bradycardia were rare in children and only appeared in older children with paratyphoid fever.Respiratory symptoms were more common in infants.Leukopenia was found in small number of children with paratyphoid fever,and more than half of the children had anemia.The decrease of eosinophil count had reference significance for the diagnosis of paratyphoid fever,and the positive rate was higher than leukopenia.In bacterial culture among this study,the positive rate of bone marrow culture was the highest,followed by blood culture.For children with negative bacterial culture,the Widal test was useful for diagnosis.In the past 32 years,the sensitivity of clinical isolates in our hospital to quinolones and cephalosporins did not change significantly.The third-generation cephalosporins were still the first-line drug for the treatment of children with paratyphoid fever.In this group,S.Paratyphi A was more sensitive to ampicillin than S.Paratyphi B and S.Paratyphi C,especially in the age group > 3 years old.S.Paratyphi A and S.Paratyphi B were more sensitive to piperacillin or sulfamethoxazole and trimethoprim than S.Paratyphi C.Children with paratyphoid fever were prone to complications,especially those infected with MDR strains. |
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