Clinical specificities of typhoid fever in children of the Kyrgyz Republic
The objective. To reveal current specificities of the clinical course of typhoid fever in children of the Kyrgyz Republic. Patients and methods. 63 medical histories of children aged 9 months to 14 years, who were treated in infectious units of the Osh and Jalalabad regions of the Kyrgyz Republic, were analyzed for the 2000–2010 period. The diagnosis of typhoid fever in all patients was based on epidemiological anamnesis, complex clinical observation and laboratory examinations. Results. The work presents clinical specificities of typhoid fever in children of the Kyrgyz Republic for the 2000–2010 period. As was found, most frequently disease had an acute onset (86.2% of children) with the body temperature rising above 38°С (of them in 74.6% – 39°С and higher), headache (83.0%), decrease of appetite up to anorexia (55.8%), weakness (91.9%). Some patients had chil s, and also nausea or vomiting (23.8 and 4.76%, respectively), sleep disorders (36.5%), sluggishness (31.7%). Disease occurred mainly in the moderate and severe forms, with wave-like fever (83.6% of patients), tachycardia (50.7%), persistent diarrhoea and marked hepatolienal syndrome (hepatomegaly and splenomegaly were found in 81 and 19% of patients). Abdominal syndrome was manifested by pains in the abdomen (81.0% of cases) and in the right hypochondrium (15.9%) lasting for more than 2 wks (23.8%), meteorism (74.6%). Also, the positive Padalka symptom (42.3% of patients), white or dirty-grey coating on the tongue (85.7%) with teeth marks (27.7%), not frequent (not more than 3–4 times a day) loose stools without pathological admixtures (67.0%) lasting for more than 3 wks (57.4%) were found. Conditions with multiple (more than 10–12 times a day) watery yel ow-green stools without mucus lasting for more than 9 days and development of exicosis grades 1–2 was noted in 2 children (aged 9 months and 2.5 years). Delayed stools were noted in 4 adolescents (6.3%). A complicated course (perforated ulcer of the smal intestine and bleeding) and a relapse of typhoid fever were rare (1 and 2 children, respectively). Characteristical y, early diagnosis of typhoid fever in children meets with certain difficulties, which conditions late hospitalization of the majority of patients: almost a half of the patients (44.4%) in this study were hospitalized to an infectious unit at the 5–9th days of disease, 39.8% – at the 12–16th days, and the rest (7.9%) – later than 3 wks. As a rule, they were transferred from other hospitals, where they received treatment for other diagnoses (enteritis, ARVI, pyelonephritis, sepsis, fever of unknown genesis). Clinical recovery in the outcome of disease was stated in 96.8% of cases. Conclusion. The necessary condition for early and successful treatment of typhoid fever is a correct interpretation of clinical symptoms taking into consideration the premorbid background and concomitant diseases, performance of differential diagnosis with respect to other pathology (under the conditions of Kyrgyzstan – AEI) and early detection of the causative agents of disease.