title: Factors associated with typhoid relapse in the era of multiple drug resistant strains.
abstract: BACKGROUND
  Typhoid has an estimated global burden of greater than 27 million cases per annum with a clinical relapse rate of 5% to 20%.  Despite the large relapse burden, the factors associated with relapse are largely unknown.
  
  
  METHODS
  We have followed a protocol for the diagnosis and management of pediatric typhoid since 1988.  We report factors associated with relapse of culture-proven enteric fever in 1,650 children presenting to the Aga Khan University Medical Center,  Karachi, Pakistan, over a 15-year period.
  
  
  RESULTS
  In those infected with multiple drug resistant (MDR) strains, factors associated with subsequent relapse include constipation at presentation and presentation within 14 days of fever onset.  Diarrhoea in those children infected with drug sensitive strains had an association with decreased subsequent relapse, as was quinolone therapy.
  
  
  CONCLUSIONS
  Multiple clinical factors at presentation are associated with subsequent typhoid fever relapse.  These factors may be postulated to be associated with subsequent relapse due to alterations in the reticuloendothelial system organism load.  These data will be valuable in developing algorithms for clinical follow-up in children infected with MDR enteric fever.
authors: Pediatrix Medical Group, San Antonio, Texas, USA. kaashif_ahmad@pediatrix.com
authors: Kaashif Aqeeb
authors: KA
authors: Ahmad
authors: Liaqat Hayat
authors: LH
authors: Khan
authors: Bakht
authors: B
authors: Roshan
authors: Zulfiqar Ahmed
authors: ZA
authors: Bhutta
mesh_terms: D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D012008:Recurrence; D012307:Risk Factors; D012485:Salmonella typhi / Q000187:drug effects / Q000302:isolation & purification*; D014435:Typhoid Fever / Q000453:epidemiology*