IMPACT OF AGE AND DRUG-RESISTANCE ON MORTALITY IN TYPHOID-FEVER

The risk factors for mortality were analysed in a consecutive group of 1158 children presenting to the Aga Khan University Medical Center, K arachi, with multidrug resistant typhoid fever that had been proved on culture. There were 19 deaths, representing an overall case fatality rate of 1.6%. Multidrug resistant typhoid was associated with a more s evere clinical illness and higher rates of toxicity, hepatomegaly, hyp otensive shock, and death. Irrespective of drug resistance status, typ hoid fever was found to be a more severe illness in young infants with significantly higher rates of diarrhoea, hypotensive shock, and morta lity. Univariate analysis of admission characteristics associated with increased risk for mortality revealed significant association with yo unger age (p < 0.05), hypotensive shock or hypothermia (p < 0.001), ob tundation (p < 0.001), seizures (p < 0.05), anaemia at admission (p < 0.005), and leucocytosis (p < 0.001). Logistic regression analysis of risk factors for mortality showed persistent association of hypothermi a, toxicity, and anaemia with mortality. The data provides evidence th at multidrug resistant typhoid in childhood is associated with increas ed risk of mortality, especially in infancy and closer attention to se veral risk factors for increased morbidity and case fatality rates may lead to improved outcome of treatment.