Patterns of resistant Salmonella typhi infection in infants.

Culture-proven cases of enteric fever (182) were studied during the period May 1991 to April 1992; 39 per cent of the children were below 3 years. There was male preponderance. Infants presented within first few days of onset of fever with severe systemic manifestation, such as repeated convulsion, puffiness of face and oedema, massive hepatomegaly, and bleeds due to thrombocytopenia. Only 49-52 per cent of the cultures were sensitive to ampicillin, chloroamphenicol, and cotrimoxazole. The infants were treated with cephalosporin such as cefotaxime or quinolones as ciprofloxacin, since 100 per cent of the cultures were sensitive to this drug. Three infants had meningitis, two interstitial nephritis, and six had marrow hypoplasia. Two children who had been treated prior to admission with ampicillin or chloroamphenicol died within 48 h of admission, one of a liver abcess and peritonitis, and the other due to meningitis. Markedly prolonged hypothermia was seen during recovery in few cases. Forty-six per cent of infants had complications as against 2 per cent in older children. Drug Resistant Salmonella typhi infection seems to have a rapidly progressive severe course with multiple organ involvement such as meningitis, liver abcess, nephritis, and marrow hypoplasia. Initiation of appropriate antibiotics depending on local sensitivity pattern is needed early in the disease to avoid mortality and morbidity.