Indian Journal of Community Medicine Vol. 30, No.
4, October-December, 2005
Enteric Fever in Infancy. Two Cases in an Orphanage Out Break
Enteric fever is infrequent under three years of age1. It is
even rarer under one year of age. We here discuss two cases
of Enteric fever, one in a six days old neonate, and the other
in a three months old infant. They were infected within one
month of each other, from the same orphanage. Both had the
same Salmonella group C1 organism, suggesting horizontal
transmission within the orphanage. This is arguably the first
such report of salmonella infection in infancy in an orphanage
Case 1 : A six days old female neonate with a cyanotic heart
disease (VSD, absent pulmonary valve, PDA with bi-directional
shunt and right sided failure) was brought from an orphanage
with two days history of respiratory distress, fever and loose
mucod stools. Blood culture grew Salmonella group C1. She
was started on Cefotaxime and Amikacin as per the sensitivity
report. Her fever responded to the treatment but she died ten
days after admission, due to intractable heart failure.
Case 2 : Another female infant three months old was admitted
from the same orphanage one month after the first case. This
patient was admitted to our ICU in shock with seizures,
pneumonia and respiratory arrest. The infant was put on a
ventilator and started on Cefotaxime and Amikacin for sepsis.
On the third day of admission, blood culture report showed
growth of Salmonella group C1. She was given full course of
antibiotics for fourteen days and was discharged in a
satisfactory condition.
Discussion
Enteric fever in infancy is known to present with shock and
distress2 but Salmonella infection is not often considered,
because of the rarity of the condition. A high index of suspicion
Bottlenecks to Breast Feeding in Rural Rajasthan
In Tonk district of Rajasthan, 699 mother’s of 0-3 year old
children were surveyed for KAP about breast feeding on a
pre-tested questionnaire.
The mothers often believed that their milk was not sufficient
for their infants and made addition of top milk in their diet,
which disminished the intensity of breast feeding, there by
directly predisposing mothers to the risk of pregnancy as the
period of lactational amenorrhea got shortened due to reduction
of breastfeeding and its replacement by bottle feeding.
In rural areas, feeding was started only after a ritual performed
on the third day after childbirth. A common belief was that
only after second-third day, mother was capable of secreting
sufficient quantity of milk to feed the baby. Such practice
made the mother more vulnerable to postpartum haemorrhage.
An account of this practice in the study area can be estimated
as 60% of the population started breast feeding their children
from 2nd to 3rd day. However initiation of breast feeding after
3rd day was particularly high in low socio-economic class
and the same within 0-12 hours was maximum among upper
socio-economic class.
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is needed in areas where Enteric fever is common. The first
case we have reported probably got the infection vertically,
from the mother. The baby was abandoned to the orphanage
and the mother could not be traced. Vertical transmission of
typhoid has been reported previously3. She had stayed in the
orphanage for a week before being admitted with us in the
hospital. We suspect, the second case inthe orphanage may
have contacted the disease from the index case, either directly
or through a carrier. Both of our cases cultured the same strain
of Salmonella. This suggests the index case who spent the
first week of it’s life in the orphanage may have spread the
infection to the second case. Measures to prevent further
spread in orphanage including meticulous hand washing by
the carriers probably prevented further spread. To our
knowledge this is the first report of Enteric fever outbreak in
infancy from an orphanage setting.
References
1. Sinha A, Sazawal S, Kumar R, Sood S, Reddaiah VP, Singh
B et al. Typhoid fever in children aged less than five years.
Lancet 1999; 354 : 734-37.
2. Pandey KK, Srinivasan S, Mahadevan S, Nalini P, Rao RS.
Typhoid fever below five years. Indian Pediatrics 1990; 27:
153-56.
3. Chin KC, Simmonds, Tarlow MJ. Neonatal typhoid fever. Arch
Dis Child 1986;61:1228-30.
Mohit Sahni, Shubhangi Bedi*
Department of Pediatrics and * Microbiology,
St. Stephen’s Hospital, Tis Hazari, India
E-mail : mohitsahnil23@rediffmail.com
Mothers of this rural area had to go to fields to work as
agricultural labourers and thus their children had to be
supplemented by top milk early in life. Due to poverty, in many
cases, top milk was not available at home and mothers usually
fed the children breast mlk supplemented with inadequate
quantity of complementary foods for economic reasons. 60%
of the population has been found following par tial
breastfeeding for more than 24 months, and a significant
proportion of male children in comparison to their female
counterparts got breastfeeding for this duration.
There was a common belief in this rural area that the first
milk (colostrum) has some unusual ocnstituents in it, which
could be hazardous for the newborn infant and the breast
needs to be squeezed free of this. Thus the baby was put to
the breast only after 3 days and most of the times, first feed
to the infant had been other than breast milk.
To mitigate the hunger of newborn child for 3-5 days, prelecteal
feed was a very common practice in this area. However, giving
this to the child was the responsibility and prerogative of
Enteric Fever in Infancy, Bottlenecks to Breast Feeding