| Objective: To summarize the clinical characteristics of typhoid fever in children through retrospective analysis of children with typhoid fever in Chongqing and to provide the clinical experiences for early diagnosis and treatment.Methods: A retrospective analysis of 125 children with typhoid fever diagnosed and treated at the Children's Hospital of Chongqing University of Medical Science from 1993 to 2008 was conducted to review the epidemiological characteristics, clinical manifestations, complications, laboratory examinations, treatments and prognosis.Results:1. The disease occurred sporadically every year from 1993 to 2008. The age of onset ranged from three months to 14 years old, and 76/125 (60.8%) were from 5 to 12 years old. The disease could be seen throughout the year, but 77/125 (61.6%) occurred in summer or autumn.2. Fifty-two patients (52/125, 41.6%) were admitted to hospital with fever of unknown. Twenty-three patients (23/125, 18.4%) were diagnosed as typhoid fever and 10/125 (8.0%) were diagnosed as salmonella infection. Forty patients (40/125, 32.0%) were misdiagnosed as other diseases. 3. The common clinical features were fever (124/125, 99.2%), hepatomegaly (91/125, 72.8%), splenomegaly (65/125, 52.0%), gastrointestinal manifestations (103/125, 82.4%) and respiratory manifestations (71/125, 56.8%). Diarrhea and cough were common in infants and toddlers, while hepatomegaly was common in children over three years old. Indifferent expression, relative bradycardia and rose spots occurred in 36/125 (28.8%), 8/125 (6.4%) and 8/125 (6.4%), respectively. They were just found in children over three years old.4. Complications were found in 80/125 (64.0%). Toxic hepatitis (49/125, 39.2%) and toxic myocarditis (28/125, 22.4%) happened in relatively high frequencies. Pneumonia and toxic myocarditis were common in infants and toddlers, while toxic hepatitis was common in children over three years old.5. WBC was in the normal range in 97/125 (77.6%), and only 16/125 (12.8%) presented leucopenia. Eosinophils reduced or disappeared in 28/33 (84.8%). Anemia were found in 85/125 (68.0%), and 84/85 (98.8%) of them presented mild or moderate anemia. The overall positive rate of bacterial cultures was 77.0% (94/122). The positive rate of blood cultures was high (75/110, 68.2%). It was 86.7% (39/45), 54.7% (29/53) and 32.0% (8/25) in the first week, the second week, and the third week of the illness, respectively. The positive rate of bone marrow cultures and stool cultures was 55.0% (22/40) and 7.4% (5/68). The positive rate of Widal test was 42.7% (50/117), and it was positive in 27 cases with negative bacterial cultures.6. Antimicrobial susceptibility testings were carried out in 91/125. All cases were proved susceptible to tienam (31/31), cefepime (26/26), ceftazidime (33/33), levofloxacin (6/6) and ciprofloxacin (49/49). The susceptibilities to ceftriaxone, cefotaxime and cefoperazone were 14/15 (93.3%), 62/64 (96.9%) and 10/15 (66.7%), respectively. The susceptibilities to amikacin, norfloxacin, chloramphenicol and ampicillin were 36/60 (60.0%), 29/43 (67.4%), 27/36 (75.0%) and 43/58 (74.1%), respectively. The susceptibilities to cefoperazone, amikacin and norfloxacin decreased from 2000 to 2008 compared with 1990's, while the susceptibilities to chloramphenicol and ampicillin increased.7. In the clinical treatment, ceftriaxone and ciprofloxacin were proved efficacious in 8/8 (100%). Cefotaxime and ciprofloxacin were efficacious in 10/12 (83.3%). Cefotaxime and amikacin were efficacious in 3/8 (37.5%). Ciprofloxacin and amikacin were efficacious in 17/20 (85.0%). Ciprofloxacin was efficacious in 23/25 (92.0%). Ofloxacin was efficacious in 4/4 (100%). Chloramphenicol was efficacious in 2/3 (66.7%). Basing on the results of antimicrobial susceptibility testing, the patients with poor therapeutic effect initially were treated by sensitive antibiotic and the curative effect were prominent.8. The hospitalization time ranged from one day to 25 days. One hundred and one patients (101/125, 80.8%) were cured, 22/125 (17.6%) were improved and 2/125(1.6%) died in this study.Conclusions:1. Children with typhoid fever are minor and sporadic in Chongqing. The peak age of onset rang from five to twelve years old. Summer and autumn are more common seasons.2. The clinical manifestations of children with typhoid fever are atypical. The common clinical features are fever, hepatomegaly, splenomegaly, gastrointestinal manifestations and respiratory manifestations. Gastrointestinal and respiratory manifestations are common in infants and toddlers, while hepatomegaly is common in children over three years old. Indifferent expression is atypical and relative bradycardia and rose spots are rare. They could be seen only in children over three years old.3. The incidence of complications is high in children with typhoid fever. Toxic hepatitis and toxic myocarditis happen in relatively high frequencies. Pneumonia and toxic myocarditis are common in infants and toddlers, while toxic hepatitis is common in children over three years old.4. WBC of children with typhoid fever is mostly in the normal range. Eosinophils reducing or disappearing is an important feature. Anemia is common and mostly mild or moderate. Blood culture remains the gold standard diagnostic method for diagnosis of typhoid fever. The positive rate of Widal test is low, but it is still of great significance for the cases with negative bacterial culture.5. The third-generation cephalosporins and quinolones remain susceptible for the treatment of children with typhoid fever in Chongqing, which should be used as first-line drugs. The susceptibility to chloramphenicol from 2000 to 2008 is higher than that of 1990's, so it can be used as one of second-line drugs.
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