Typhoid fever during childhood in South Asia: A review

Kaashif A. Ahmad, Zulfiqar A. Bhutta

Research output: Contribution to journalReview articlepeer-review


Despite considerable advances in the understanding of the pathogenesis and microbiology of typhoid fever, the disease still accounts for an estimated 16 million cases annually globally, with almost 600,000 deaths. While accurate population-based figures of the burden of typhoid fever in developing countries are unavailable, conservative estimates indicate varying incidence rates ranging from 150 per 100,000 population in South America to over 1000 cases per 100,000 population in some Asian countries. Recent data from community-based studies in both Pakistan and India suggest that the incidence of typhoid may be greatest among children under 5 years of age. A major problem in recent years has been the emergence of drug-resistance in strains of Salmonella typhi causing infections, in some recent instances to even second-line antibiotics such as quinolones and third generation cephalosporins. It is recognized that drug resistant typhoid is frequently associated with increased morbidity and toxicity, a fact reaffirmed by the significantly increased mortality with such infections, at times exceeding 10%. This review will focus on the recent advances in our understanding of the pathogenesis, clinical presentation and therapy of typhoid in childhood. Although several alternative strategies are available for the management of typhoid in institutional settings, few protocols have evaluated community-based management. The development of algorithms for rapidly diagnosing typhoid based on clinical and simple laboratory criteria and subsequent triage to appropriate first or second-line therapy would go a long way towards rational management of this disorder, as well as reduce the risk of emergence of further drug resistance.

Original languageEnglish
Pages (from-to)372-380
Number of pages9
JournalJournal of the College of Physicians and Surgeons--Pakistan : JCPSP
Issue number6
Publication statusPublished - 1 Jun 2002


  • Enteric fever
  • Paratyphoid vaccines
  • Typhoid


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