Publication: Enteric fever: Diagnostic value of clinical features
Date
2006
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
Objectives: to evaluate the diagnostic value of clinical symptoms and signs in enteric fever and to propose a clinical
diagnostic criterion.
Design: Prospective observational study
Setting: Kathmandu Medical College, Teaching Hospital, Kathmandu, Nepal
Materials and methods: febrile patients with clinical diagnosis of enteric fever were included in the study with the
aim of confirming diagnosis with blood culture, or bone marrow culture and evaluating the diagnostic accuracy of
various clinical signs and symptoms.
Results: 64% of the clinically diagnosed cases had blood/ bone marrow culture positive. The diagnostic accuracy of
the various symptoms and signs excluding fever was between 42%-75.5%. Majority of the symptom and sign did
not have very high diagnostic accuracy. Hence a diagnostic criterion was proposed and clinical features with
diagnostic accuracy more than 50% were taken into consideration. Major criteria included fever with diagnostic
accuracy of 64%, headache with accuracy of 75.5% and relative bradycardia with an accuracy of 66%. Minor
criteria included vomiting, diarrhoea, Splenomegaly, chills and abdominal pain /discomfort with diagnostic accuracy
of 57%, 55%, 55%, 53% and 51% respectively. Finally after combination of various major and minor criteria a final
diagnostic criterion was proposed having an accuracy of 66% and including both major and minor clinical symptom
and sign.
Conclusion: clinical diagnosis of enteric fever will be very helpful in a country like ours. Though none of the
clinical symptoms and sign have very high diagnostic accuracy a diagnostic criteria may be helpful. Criteria
including both major and minor signs and symptoms would be the most appropriate diagnostic tool as it includes the
important abdominal symptoms and signs of enteric fever.
Key words: enteric fever, clinical features, diagnostic criteria
Description
Neopane A 1, Poudel M 2, Pradhan B3, Dhakal R 2, Karki DB4
1Assist Professor, 2
Medical officer, 3Lecturer, 4Professor, Department of Medicine Kathmandu Medical College,
Sinamangal