Enteric Fever in Adults: Clinical Diversity and Laboratory Patterns
DOI:
https://doi.org/10.71000/rcvc0995Keywords:
Adult; Blood Culture; Pakistan; Paratyphoid Fever; Risk Factors; Thrombocytopenia; Typhoid Fever.Abstract
Background: Enteric fever remains a major cause of community-acquired febrile illness in South Asia. Its presentation in adults is variable, while routine haematological and biochemical abnormalities are supportive but not diagnostic. Delayed recognition may increase the risk of complications, particularly in settings affected by antimicrobial resistance. A structured assessment of clinical diversity, laboratory findings and factors associated with complicated disease may support earlier triage and guide the design of future prospective hospital-based investigations in endemic regions.
Objective: To describe the demographic, clinical and laboratory profile of enteric fever in adults and identify factors associated with complications.
Methods: A descriptive cross-sectional analysis used 280 adult records structured through a 24-item clinical proforma for a tertiary-care setting in Peshawar, Pakistan. Demographic, clinical, laboratory and outcome variables were analysed using descriptive statistics, chi-square tests, Mann–Whitney U tests and multivariable binary logistic regression. Statistical significance was set at p<0.05.
Results: The mean age was 28.3±8.6 years, and 178 (63.6%) records represented male patients. Fever occurred in 280 (100%) cases, malaise or fatigue in 220 (78.6%), headache in 211 (75.4%) and anorexia in 197 (70.4%). Blood culture was positive in 124 (44.3%) cases, including S. Typhi in 97 (34.6%) and S. Paratyphi in 27 (9.6%). Anaemia, leukopenia, thrombocytopenia and abnormal liver-function tests occurred in 68 (24.3%), 58 (20.7%), 63 (22.5%) and 89 (31.8%) cases, respectively. Complications occurred in 66 (23.6%). Culture positivity (aOR 3.95; 95% CI 2.12–7.37), thrombocytopenia (aOR 3.29; 95% CI 1.71–6.32) and longer fever duration (aOR 1.08 per day; 95% CI 1.00–1.17) independently predicted complications.
Conclusion: Enteric fever showed a broad, non-specific clinical profile with frequent haematological and hepatic abnormalities. Culture positivity, thrombocytopenia and prolonged fever marked a greater probability of complications. The analytical framework requires validation in prospectively collected adult cohorts.
Keywords: Adult; Blood Culture; Pakistan; Paratyphoid Fever; Risk Factors; Thrombocytopenia; Typhoid Fever.
References
Aiemjoy K, Tamrakar D, Saha S, et al. Diagnostic value of clinical features to distinguish enteric fever from other febrile illnesses in Bangladesh, Nepal, and Pakistan. Clin Infect Dis. 2020;71(Suppl 3):S257-S265. doi:10.1093/cid/ciaa1320
Chatham-Stephens K, Medalla F, Hughes M, et al. Emergence of extensively drug-resistant Salmonella Typhi infections among travelers to or from Pakistan - United States, 2016-2018. MMWR Morb Mortal Wkly Rep. 2019;68(1):11-13. doi:10.15585/mmwr.mm6801a3
Browne AJ, Kashef Hamadani BH, Kumaran EAP, et al. Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis. BMC Med. 2020;18(1):1. doi:10.1186/s12916-019-1443-1
Mahmood A, Khan S, Khan MA, et al. Extensively drug-resistant Salmonella typhi infection in adults: experience from a tertiary care hospital. Pak J Med Sci. 2024.
Basnyat B, Qamar FN, Rupali P, Ahmed T, Parry CM. Enteric fever. BMJ. 2021;372:n437. doi:10.1136/bmj.n437
Yousafzai MT, Karim S, Qureshi S, et al. Burden of culture-confirmed enteric fever cases in Karachi, Pakistan. Am J Trop Med Hyg. 2020;102(5):1059-1062.
Aslam S, Nasir N, Iffat W, et al. Clinical presentation and outcome of enteric fever in adult patients with cancer: a perspective from Pakistan. Access Microbiol. 2024.
Dessai R, Bhat KG, Shenoy S, et al. Clinico-microbiological profile of adults with enteric fever. Curr Med Res Pract. 2023.
Lail A, Memon AR, Memon SU, et al. Clinical spectrum and diagnosis of enteric fever: a cross-sectional study. Pak J Med Health Sci. 2023.
Diwaker A, Tiwari A, Jain A, et al. Enteric fever and the diagnostic tools: defining the accuracy. Front Bacteriol. 2024;3:1332180. doi:10.3389/fbrio.2024.1332180
Sapkota J, Roberts T, Basnyat B, et al. Diagnostics for typhoid fever: current perspectives. Open Forum Infect Dis. 2023.
Gajjar H, Patel B, Vegad MM, et al. Comparative study of haematological parameters in typhoid fever. Trends Clin Med Sci. 2023.
Batool R, Qamar ZH, Salam RA, et al. Risk factors associated with extensively drug-resistant typhoid in an outbreak setting of Lyari Town Karachi, Pakistan. Am J Trop Med Hyg. 2022;106(5):1379-1386.
Jabeen K, Saleem S, Jahan S, et al. Molecular characterization of extensively drug resistant Salmonella enterica serovar Typhi clinical isolates from Lahore, Pakistan. Infect Drug Resist. 2023;16:2987-2999.
Chidambaram Y, Antonisamy B, Gunasekaran K, et al. Tracking the shift in enteric fever trends and evolving antibiotic sensitivity patterns. Ghana Med J. 2024;58(?):?.
Hooda Y, Sajib MSI, Rahman H, et al. Molecular mechanism of azithromycin resistance among typhoidal Salmonella strains in Bangladesh identified through passive pediatric surveillance. PLoS Negl Trop Dis. 2019;13(11):e0007868. doi:10.1371/journal.pntd.0007868
Shakya M, Colin-Jones R, Theiss-Nyland K, et al. Phase 3 efficacy analysis of a typhoid conjugate vaccine trial in Nepal. N Engl J Med. 2019;381(23):2209-2218. doi:10.1056/NEJMoa1905047
Patel PD, Patel P, Liang Y, et al. Safety and efficacy of a typhoid conjugate vaccine in Malawian children. N Engl J Med. 2021;385(12):1104-1115. doi:10.1056/NEJMoa2035916
Qadri F, Khanam F, Liu X, et al. Protection by vaccination of children against typhoid fever with a Vi-tetanus toxoid conjugate vaccine in urban Bangladesh: a cluster-randomised trial. Lancet. 2021;398(10301):675-684. doi:10.1016/S0140-6736(21)01124-7
Kulkarni PS, Kulkarni P, Pandey A, et al. A bivalent typhoid-paratyphoid conjugate vaccine candidate in adults: a randomised trial. Lancet. 2024.
Behera JR, Rup AR, Dash AK, Sahu SK, Gaurav A, Gupta A. Clinical and laboratory profile of enteric fever in children from a tertiary care centre in Odisha, eastern India. Cureus. 2021;13(1):e12826. doi:10.7759/cureus.12826
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Rizwanullah, Usman Khan, Muhammad Usman Bari, Zarafshan Hameed Khattak, Faizan Ahmad (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
