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Indian Journal of Community Medicine

Enteric Fever in Infancy. Two Cases in an Orphanage Out Break

Author(s): Mohit Sahni, Shubhangi Bedi*

Vol. 30, No. 4 (2005-10 - 2005-12)

Enteric fever is infrequent under three years of age1. It is even rarer under one year of age. We here discuss two cases of Enteric fever, one in a six days old neonate, and the other in a three months old infant. They were infected within one month of each other, from the same orphanage. Both had the same Salmonella group C1 organism, suggesting horizontal transmission within the orphanage. This is arguably the first such report of salmonella infection in infancy in an orphanage.

Case 1: A six days old female neonate with a cyanotic heart disease (VSD, absent pulmonary valve, PDA with bi-directional shunt and right sided failure) was brought from an orphanage with two days history of respiratory distress, fever and loose mucod stools. Blood culture grew Salmonella group C1. She was started on Cefotaxime and Amikacin as per the sensitivity report. Her fever responded to the treatment but she died ten days after admission, due to intractable heart failure.

Case 2: Another female infant three months old was admitted from the same orphanage one month after the first case. This patient was admitted to our ICU in shock with seizures, pneumonia and respiratory arrest. The infant was put on a ventilator and started on Cefotaxime and Amikacin for sepsis. On the third day of admission, blood culture report showed growth of Salmonella group C1. She was given full course of antibiotics for fourteen days and was discharged in a satisfactory condition.

Discussion:

Enteric fever in infancy is known to present with shock and distress2 but Salmonella infection is not often considered, because of the rarity of the condition. A high index of suspicion is needed in areas where Enteric fever is common. The first case we have reported probably got the infection vertically, from the mother. The baby was abandoned to the orphanage and the mother could not be traced. Vertical transmission of typhoid has been reported previously3. She had stayed in the orphanage for a week before being admitted with us in the hospital. We suspect, the second case inthe orphanage may have contacted the disease from the index case, either directly or through a carrier. Both of our cases cultured the same strain of Salmonella. This suggests the index case who spent the first week of it's life in the orphanage may have spread the infection to the second case. Measures to prevent further spread in orphanage including meticulous hand washing by the carriers probably prevented further spread. To our knowledge this is the first report of Enteric fever outbreak in infancy from an orphanage setting.

References:

  1. Sinha A, Sazawal S, Kumar R, Sood S, Reddaiah VP, Singh B et al. Typhoid fever in children aged less than five years. Lancet 1999; 354 : 734-37.
  2. Pandey KK, Srinivasan S, Mahadevan S, Nalini P, Rao RS. Typhoid fever below five years. Indian Pediatrics 1990; 27: 153-56.
  3. Chin KC, Simmonds, Tarlow MJ. Neonatal typhoid fever. Arch Dis Child 1986;61:1228-30.

Mohit Sahni, Shubhangi Bedi*
Department of Pediatrics and * Microbiology,
St. Stephen's Hospital, Tis Hazari, India
E-mail: [email protected]

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