Int. J. Curr. Res. Med. Sci. (2017).

3(7): 24-29

International Journal of Current Research in

Medical Sciences
ISSN: 2454-5716
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Original Research Article Volume 3, Issue 7 -2017

DOI: http://dx.doi.org/10.22192/ijcrms.2017.03.07.004

To study haematological profile of Enteric fever patients.

Dr SPS Dhillon1, Dr Neeraj Lata2, Dr Sehajpreet Singh3, Dr Vijay Gotwal4,

Dr Tanushree Joshi5, Dr Narinder Singh6
1
Assistant Professor, Department of Pediatrics, Government College Amritsar, Punjab
2
Senior Resident, Department of Pediatrics, Government Medical College, Amritsar, Punjab
3
Intern, Vardhman Mahavir Medical College , and Safdarjung Hospital, New Delhi
4
Junior Resident, Department of Chest and Tuberculosis, Government Medical College, Amritsar, Punjab
5
SeniorDMO, Northern Railway Central Hospital, New Delhi
6
Assistant Professor, Department of Pediatrics, Government College Amritsar, Punjab
Corresponding author: Dr Neeraj Lata
Senior Resident, Department of Pediatrics, Government Medical College, Amritsar
E- mail id:neerajlatavijay@gmail.com

Abstract

Introduction: Typhoid fever is a major health problem in developing countries. It is caused by Salmonella typhi and
S. paratyphi .In India annual incidence is nearly 1%.Blood culture for Salmonella is the gold standard to diagnose
typhoid fever. Hematological profile of these patients is affected by this infection. We took this study to establish the
significance of hematological profile in blood culture proven Typhoid fever patients.
Material and Methods : We did a cross sectional study on 100 patients attending OPD and IPD of Department of
Pediatrics ,with history of fever of >380Cfor 3 days aged 1-14 years. Previously antibiotic treated patients and patients
with proven localised infection were excluded .Panel of tests including blood culture and haematological profile
(Hemoglobin , TLC ,DLC, Platelet count, ESR) were done on these patients .
Results: In our study 46% of our patients were blood culture proven typhoid fever patients. Male children of school
going age group were most commonly affected by typhoid fever. We found anemia, leucopenia, thrombocytopenia in
47.8%,6.5%and 21.5% of patients. Lymphocytosis was seen in 10.9 % of patients.ESR was high in 52.2% of patients.
Results were comparable to studies done in past but we found that out of all these parameters only ESR was
significantly associated with blood culture positivity.
Conclusion : Anemia in typhoid fever patients is not because of the salmonella infection .It can be because of other
reasons for which detailed blood indices are required to be investigated .Total leucocyte count, eosinophil count and
platelet count are also not contributory to diagnosis of enteric fever. High ESR is associated with typhoid fever.
Further studies are needed to study the blood indices in detail in patients with typhoid fever in India.

Keywords: Typhoid fever , Hematological profile, leucopenia

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Introduction Study design

The term enteric fever includes typhoid fever The present study was a hospital based cross-
caused by S.typhi and paratyphoid fever caused sectional study. 100 Patients with fever were
by S.paratyphi A, B and C. Detailed study of evaluated by doing a panel of tests for typhoid
enteric fever was presented by Bretonneau (1826) fever and complete blood count of these patients
who identified intestinal lesions .The name were done.
typhoid fever was given by Louis (1829) to
distinguish it from typhus fever. Eberth (1880) Inclusion criteria
described typhoid bacillus .1 According to WHO
Confirmed case of typhoid fever is defined, as a 1. Age:1-14yrs
patient with fever (> 38°C) that has lasted for at 2. Both sexes
least three days, with a laboratory confirmed 3. Both Indoor and outdoor patients
positive culture of S. typhi. 2 Probable case of 4. Duration of fever of more >3days.
typhoid fever is a patient with fever (> 38°C) that 5. Fever>380C
has lasted for > 3 days, with a positive
serodiagnosis or antigen detection test but without Exclusion criteria
S. typhi isolation. 2 The world sees approximately
22 million new typhoid cases occur each year6. In 1. Previously antibiotic treated patients.
India in disease-endemic areas, the annual 2. Proven localized infection.
incidence of enteric fever is about 1%.3 Complete
blood counts in enteric fever are found to be Materials and Methods
unremarkable. The hemoglobin is normal in the
initial stages but drops with progressing illness. 100 patients from opd and indoor admission with
Severe anemia is unusual and should make one fever of greater than 3 days duration were
suspect intestinal hemorrhage or hemolysis or an included in the study. Complete blood count
alternative diagnosis like malaria. The WBC ,blood culture for typhoid fever and other tests to
count is normal in most cases and leucocytosis rule out other causes of fever were done .Blood
makes the diagnosis less probable. Leukopenia is culture of these patients was done by
perceived to be an important feature of typhoid BacT/ALERT Microbial Detection System.
fever and has been reported in only 20-25% cases. Hemoglobin, TLC, DLC, Eosinophil Count,
4
The differential count is usually unremarkable Platelet count, and ESR samples were sent to the
except for eosinopenia. Eosinopenia often biochemistry department .
absolute may be present in 70-80% cases. 5
Presence of absolute eosinopenia offers a clue to
diagnosis but does not differentiate enteric fever Results
from other acute bacterial or viral infections. A
normal eosinophil count does make typhoid fever Total of 100 Patients with fever for more than 3
a less likely possibility. Platelet counts are normal days attending OPD and IPD were evaluated by
to begin with and fall in some cases by the second doing blood culture and blood counts
week of illness. Overall prevalence of (Hemoglobin, TLC, DLC, Eosinophil count,
thrombocytopenia is around 10-15% 4. We did Platelet count, ESR) .
this study to evaluate the blood indices in culture
proven enteric fever patients. Demographic, clinical data, laboratory Parameter
details were noted and analysed using SPSS
Aims and objectives software version 17(SPSS Inc., Chicago, IL,
USA).
To study haematological profile of Typhoid fever
patients.

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 Int. J. Curr. Res. Med. Sci. (2017). 3(7): 24-29

Table1:Gender distribution of patients

Cumulative
Frequency Percent Valid Percent Percent
Valid FEMALE 43 43.0 43.0 43.0
MALE 57 57.0 57.0 100.0
Total 100 100.0 100.0
SEX

Fig 1:Age wise distribution of patients

In our study age ranged from 1.5 yrs to14 yrs with
mean age of 8.2 yrs +/-3.3SD. In this age group males were affected more than
the females.Blood culture positivity ranged from
Patients in age group 5-8yrs were maximally 1.5 yrs to 14 yrs with mean age 7.880+-3.24SD
affected by typhoid fever followed by 9-12 yr age and its association with age distribution is found
group. to be statistically not significant(p>0.05).

Table2 : Frequency table for Blood culture test.

Frequency Percent Valid Percent Cumulative Percent

Valid POSITIVE 46 46.0 46.0 46.0
NEGATIV
54 54.0 54.0 100.0
E
Total 100 100.0 100.0

When we compared blood culture results in both genders then blood culture positivity in male gender was
found to be statistically significant(p<0.05)

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 Int. J. Curr. Res. Med. Sci. (2017). 3(7): 24-29

Table 3:Hematological test results in Blood culture Positive and negative patients

Blood tests Blood culture Blood culture P value

positive negative
Hb<11gm% 22(47.8%) 29(53.7%) .558
Leucopenia(TLC<40 3(6.5%) 3(5.6%) .598
00)
Lymphocytosis 5(10.9%) 3(5.6%) .598
(TLC>11000)
Eosinophil 3(6.5%) 2(3.7%) .763
count(<1%)
Thrombocytopenia 10(21.7%) 10(18.55) .688
(Platelet
count<1.5lac)
ESR>20 24(52.2%) 39(72.2%) .038

Fig 2: Graph showing the haematological indices

Discussion <5yrs, with range of 1.5-14 yrs and mean age of

presentation 8.2+/-3.3SD.
A total of 100 patients of age group1-14 years of
both gender were studied , who attended OPD and Amongst the definitive cases of typhoid fever i.e.
IPD with 3 or more days of fever of >38 C as per Blood culture positive for S.typhi, 39% belonged
inclusion criteria .Previously antibiotic treated to 5-8yr age group followed by 37% in 9-12 yr
patients and patients with localised infection were and 15.2% in <5year age group . Age distribution
excluded from the study. This study was carried of definite and probable cases of typhoid fever
out for a period of one year. Out of 100 patients was maximum in 5-8 yrs followed by 9-12 yrs
57patients were male and 43 were female. In our .Similar results are seen in earlier studies that
study group Male to female ratio is 1.3:1 i.e. typhoid fever is prevalent in 2-5 and school going
males are more affected than females. children aged 5-15 yrs 6,7. In our study, 15.2% of
40%patients belonged to age group5-8 years all patients with typhoid fever were under 5 years,
followed by 35% in 9-12 yrs and 14% were which is close to the figure in other studies.9,10,18
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 Int. J. Curr. Res. Med. Sci. (2017). 3(7): 24-29

Blood culture was positive in 46% of cases which in their trial.8Our results were comparable to these
was comparable to other studies by Bhutta et al 11, studies but it was not statistically significant.
Dheer et al 13 and Sanjeev et al.15 Krishna et aL
showed 64%blood culture positivity in their ESR was high in 52.2% of blood culture positive
trials.16 and 72.2% in blood culture negative patients and
it is statistically significantly associated with
Hemoglobin is normal in the initial stages but blood culture positivity. Darton and Cames et al
drops with progressing illness. Kakaria et al had shown significant association of raised ESR
reported Anemia in 42.9% in their prospective in typhoid fever patients.3,20
study. Shilpa et al observed anemia in 34% of
their enteric fever patients.12Our results of anemia Conclusion
were comparable to these studies. Severe anemia
Anemia in typhoid fever patients is not because of
is unusual in typhoid fever and should make one
the salmonella infection .It can be because of
suspect intestinal haemorrhage or hemolysis or an
other reasons for which detailed blood indices are
alternative diagnosis like malaria. 17,18 our
required to be investigated. Total leucocyte count,
Results for anemia were comparable to these
eosinophil count and platelet count are also not
studies but they were statistically not significant.
contributory to diagnosis of enteric fever. High
It has been attributed to the maturational arrest of
ESR is associated with typhoid fever. Further
the cell lines in salmonella infection in bone
studies are needed to study the blood indices in
marrow.
patients with typhoid fever in India.
6.5% of our blood culture positive patients had Abbreviations
leucopenia. Kakaria et al reported leucopenia in
10 %of their patients with typhoid fever.19Dheer TLC: Total Leucocyte Count
et al also reported leucopenia in 7.5% of typhoid DLC: Differential Leucocyte Count
fever patients.13 Most of our cases had normal ESR: Erythrocyte Sedimentation Rate
total leucocyte counts similar to earlier reports. Hb:Hemoglobin
11,17,18.

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How to cite this article:

SPS Dhillon, Neeraj Lata, Sehajpreet Singh, Vijay Gotwal, Tanushree Joshi, Narinder Singh. (2017).
To study haematological profile of Enteric fever patients. Int. J. Curr. Res. Med. Sci. 3(7): 24-29.
DOI: http://dx.doi.org/10.22192/ijcrms.2017.03.07.004

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