Skip to content
1887

Abstract

Enteric fever is a significant health concern in endemic countries. While extensive research has been conducted to understand its presentation and outcomes in non-cancer patients, limited data exist on its impact on cancer patients. This descriptive study aims to investigate the clinical presentation and outcome in cancer patients.

This retrospective observational study analysed 90 adult cancer patients from a single centre in Pakistan from January 2017 to December 2022. Inclusion criteria involved documented blood culture infections with or A, B, or C. We examined clinical presentation, laboratory parameters, antimicrobial resistance, complications, and outcomes. Additionally, we explored the effects of chemotherapy, comorbidities, type of malignancy, and patient age on complications and mortality.

was the most prevalent organism (72.2 %), followed by A (22.2 %) and B (5.5 %). Variably-resistant isolates constituted 51.5 %, multi-drug resistant (MDR) isolates accounted for 20 %, extensively drug-resistant (XDR) for 14.4 % and ESBL-producers for 15.5 %, of all enteric fever infections. Enteric fever-associated complications were observed in 21.1 % of cases. Chemotherapy in the preceding month did not affect mortality, nor did age, gender, or malignancy type. However, comorbidities were statistically significant for mortality (-value 0.03). A total of 8.8 % of patients required ICU care, and the all-cause 30 day mortality rate was 13.3 %

Enteric fever remains prevalent in our geographical region. Unlike non-typhoidal (NTS), enteric fever does not behave differently in an immunocompromised population, including cancer patients.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution License. The microbiology society waived the open access fees for this article.
Loading

Article metrics loading...

/content/journal/acmi/10.1099/acmi.0.000719.v3
2024-05-14
2025-06-24
Loading full text...

Full text loading...

/deliver/fulltext/acmi/6/5/acmi000719.v3.html?itemId=/content/journal/acmi/10.1099/acmi.0.000719.v3&mimeType=html&fmt=ahah

References

  1. Carey ME, MacWright WR, Im J, Meiring JE, Gibani MM et al. The Surveillance for Enteric fever in Asia project (SEAP) Severe Typhoid Fever Surveillance in Africa (SETA), Surveillance of Enteric Fever in India (SEFI), and Strategic Typhoid Alliance Across Africa and Asia (STRATAA) population-based enteric fever studies: a review of methodological similarities and differences. Clin Infect Dis 2020; 71:S102–S110 [View Article]
    [Google Scholar]
  2. World Health Organisation. Typhoid fever surveillance, estimated incidence and progress towards introduction of typhoid conjugate vaccine–worldwide, 2018–2022–surveillance de la Fièvre Typhoïde, incidence Estimée et Progrès Réalisés en vue de L’Introduction Du Vaccin Antityphoïdique Conjugué–Echelle Mondiale, 2018-2022. Wkly Epidemiol Record 2023; 98:69–78
    [Google Scholar]
  3. Nizamuddin S, Ching C, Kamal R, Zaman MH, Sultan F. Continued outbreak of ceftriaxone-resistant Salmonella enterica serotype typhi across Pakistan and assessment of knowledge and practices among healthcare workers. Am J Trop Med Hyg 2021; 104:1265–1270 [View Article] [PubMed]
    [Google Scholar]
  4. Bennett JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases E-book: Elsevier health sciences; 2019
    [Google Scholar]
  5. Gordon MA. Salmonella infections in immunocompromised adults. J Infect 2008; 56:413–422 [View Article] [PubMed]
    [Google Scholar]
  6. Khan M, Coovadia Y, Sturm AW. Typhoid fever and asymptomatic human immunodeficiency virus infection. A report of 10 cases. J Clin Gastroenterol 1997; 25:507–512 [View Article] [PubMed]
    [Google Scholar]
  7. Kuijpers LMF, Phe T, Veng CH, Lim K, Ieng S et al. The clinical and microbiological characteristics of enteric fever in Cambodia, 2008-2015. PLoS Negl Trop Dis 2017; 11:e0005964 [View Article] [PubMed]
    [Google Scholar]
  8. Yang C-H, Tseng H-H, Chen K-J, Liu J-D. Salmonella infections: a retrospective 10-year analysis of 134 cases in A regional hospital in Taiwan. Scand J Infect Dis 1996; 28:171–175 [View Article] [PubMed]
    [Google Scholar]
  9. Gerona JG, Navarra SV. Salmonella infections in patients with systemic lupus erythematosus: a case series. Int J Rheum Dis 2009; 12:319–323 [View Article] [PubMed]
    [Google Scholar]
  10. Kwo PY, Cohen SM, Lim JK. ACG clinical guideline: evaluation of abnormal liver chemistries. Am J Gastroenterol 2017; 112:18–35 [View Article] [PubMed]
    [Google Scholar]
  11. Thomas ME, Blaine C, Dawnay A, Devonald MAJ, Ftouh S et al. The definition of acute kidney injury and its use in practice. Kidney Int 2015; 87:62–73 [View Article] [PubMed]
    [Google Scholar]
  12. Harris JB, Brooks WA. Typhoid and paratyphoid (enteric) fever. In Hunter’s Tropical Medicine and Emerging Infectious Diseases Elsevier; 2020 pp 608–616
    [Google Scholar]
  13. Hughes M, Appiah A, Watkins LF. Typhoid & paratyphoid fever; 2023 https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/typhoid-and-paratyphoid-fever
  14. Marchello CS, Carr SD, Crump JA. A systematic review on antimicrobial resistance among Salmonella Typhi worldwide. Am J Trop Med Hyg 2020; 103:2518–2527 [View Article] [PubMed]
    [Google Scholar]
  15. Das JK, Hasan R, Zafar A, Ahmed I, Ikram A et al. Trends, associations, and antimicrobial resistance of Salmonella Typhi and Paratyphi in Pakistan. Am J Trop Med Hyg 2018; 99:48–54 [View Article] [PubMed]
    [Google Scholar]
  16. Butt MH, Saleem A, Javed SO, Ullah I, Rehman MU et al. Rising XDR-typhoid fever cases in Pakistan: are we heading back to the pre-antibiotic era?. Front Public Health 2021; 9:794868 [View Article] [PubMed]
    [Google Scholar]
  17. Kamal R, Ching C, Zaman MH, Sultan F, Abbas S et al. Identification of multiple variant extensively drug-resistant typhoid infections across Pakistan. Am J Trop Med Hyg 2023; 108:278–284 [View Article] [PubMed]
    [Google Scholar]
  18. Kakaria A, Asgaonkar D, Narkhede M. Clinical profile of enteric fever: a prospective study of fifty enteric fever patients. Int J Res Med Sci 2014; 2:1620 [View Article]
    [Google Scholar]
  19. Qamar FN, Yousafzai MT, Dehraj IF, Shakoor S, Irfan S et al. Antimicrobial resistance in Typhoidal Salmonella: surveillance for enteric fever in Asia project, 2016-2019. Clin Infect Dis 2020; 71:S276–S284 [View Article] [PubMed]
    [Google Scholar]
  20. Shaikh AIA, Prabhakar AT. Typhoid fever and its nervous system involvement. In Innate Immunity in Health and Disease Intech Open London; 2021 pp 1–5
    [Google Scholar]
  21. Karambelkar R, Karambelkar G, Babhalgaonkar P. A case report of acute glomerulonephritis associated with typhoid fever. Pediatr Infect Dis 2013; 5:175–177 [View Article]
    [Google Scholar]
  22. Gupta A, Puri S, Aggarwal NP, Randhawa G, Jha PM. Typhoid fever complicated by rhabdomyolysis with acute hepatitis, splenic infarct, pancreatitis, and acute kidney injury. Indian J Nephrol 2023; 33:147–149 [View Article] [PubMed]
    [Google Scholar]
  23. Ray B, Raha A. Typhoid and enteric fevers in intensive care unit. Indian J Crit Care Med 2021; 25:S144–S149 [View Article] [PubMed]
    [Google Scholar]
  24. Mouton F, Ohuoba EI, Evans FM, Desalu I, Wilson C. Typhoid enteric fever–part. Update Anaesthesia 2017; 32:13
    [Google Scholar]
  25. Wang M. Johnson SJICiCP. Enteric Infect 2014237–251 [View Article]
    [Google Scholar]
  26. Longley AT, Hemlock C, Date K, Luby SP, Andrews JR et al. Illness severity and outcomes among enteric fever cases from Bangladesh, Nepal, and Pakistan: data from the surveillance for enteric fever in Asia project, 2016-2019. Clin Infect Dis 2020; 71:S222–S231 [View Article] [PubMed]
    [Google Scholar]
  27. Saad NJ, Lynch VD, Antillón M, Yang C, Crump JA et al. Seasonal dynamics of typhoid and paratyphoid fever. Sci Rep 2018; 8:1–9 [View Article] [PubMed]
    [Google Scholar]
/content/journal/acmi/10.1099/acmi.0.000719.v3
Loading
/content/journal/acmi/10.1099/acmi.0.000719.v3
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error