# Early Predictors of Enteric Fever in Children Presenting With Fever Without Focus: A Prospective Study

## TL;DR

This study identifies early clinical and lab signs that can predict enteric fever in children with fever without a clear source, reducing reliance on blood cultures.

## Contribution

The study provides a set of early predictors for enteric fever in children using clinical and basic lab parameters in resource-limited settings.

## Key findings

- Duration of fever >4 days, rising fever trend, coated tongue, and splenomegaly were clinical predictors of enteric fever.
- Elevated CRP (>25 mg/L), SGPT (>40 IU/L), and absolute eosinopenia were lab predictors of enteric fever.
- These predictors can help identify enteric fever without blood culture in resource-limited areas.

## Abstract

Objective

Blood culture is the gold standard for diagnosing enteric fever (EF), but its unavailability in many health facilities often leads to the overuse of antimicrobials. This study aimed to determine whether EF can be predicted early using clinical features and basic laboratory parameters, thus bypassing the need for blood culture.

Methodology

This prospective cohort study, conducted from September 2015 to February 2017 in Delhi, included children (6 months to 15 years old) presenting with "fever without focus" within the first week of onset. Based on the investigation results, children were categorized into either Group I: blood culture positive for EF - Salmonella Typhi/Paratyphi; Group II: blood culture negative for EF but had another diagnosis; or Group III: cases in which the cause could not be established or were treated with empirical antibiotics, considered as the ambiguous group and excluded from the study.

Results

Out of the 350 cases, blood cultures confirmed EF in 73 children; 112 children had another diagnosis subsequently, and 165 cases could be placed in Group III. Blood culture is considered the gold standard. Logistic regression was applied to statistically significant clinical and laboratory parameters in children in Group I to identify independent predictors of EF. Duration of fever >4 days, rising trend of fever, coated tongue, splenomegaly, C-reactive protein (CRP) (>25 mg/L), serum glutamic pyruvic transaminase (SGPT) (>40 IU/L), and absolute eosinopenia were independent predictors of EF in this study.

Conclusion

In resource-limited settings, and short of blood culture, early prediction of EF is possible with clinical features and simple laboratory investigations.