Frequency and associated factors of typhoid carrier on duoenal fluid culture in a tertiary care hospital, Pakistan : a crossectional study

Typhoid fever is a serious public health problem and remains a major cause of morbidity and mortality worldwide. Typhoid carriers serve as a reservoir in the ongoing transmission of typhoid fever and were not explored mainly in, developing world due to limited availability of investigating tools. This study aims to determine the frequency of typhoid carrier and its associated factors on duodenal fluid culture in patients undergoing upper gastrointestinal (GI) endoscopy in Karachi. Methodology: We conducted a crossectional study at Aga Khan University Hospital (AKUH), Karachi from February 2017 to August 2017. Individuals of age more than or equal to 1 year who underwent upper gastrointestinal endoscopy for any reason were included. We interviewed all the participants using a pre-structured questionnaire. For isolation of Salmonella. typhi and paratyphi, we investigated microbiological culture of duodenal fluid aspirate. Statistical analysis was carried out using Stata software (version 12.0). Frequencies with percentages were reported for categorical variables and for quantitative variables mean/median and standard deviation/interquartile range was reported depending upon the data distribution. For socioeconomic status factor analysis was performed for constructing wealth index. Overcrowding was assessed by estimating crowding index. Geographical location GIS mapping was done for visualizing distribution of study participants using Google Earth Pro. Results: Total 801 patients were approached to achieve the sample size of 477. The mean±SD age (years) of the individuals was 42.4±15.5. Children \u3c 18 years accounted for 17/477 (3.6%). Majority 287/477 (60.2%) of participants were males. Participants were widely dispersed representing around 74.5% from the province of Sindh (54% from Karachi), 13.6%, 3.4% and 3.4% from Baluchistan, Punjab and KPK respectively. In addition, 5% of participants belonged to the neighboring countries like Afghanistan. 205/477(42.9%) reported use of unsafe water for drinking in their homes ,yet 67/477(14%) were not washing their hands with soap and water after defecation. 389/477 (81.5%) of the participants who underwent upper gastrointestinal (GI) endoscopy visited the hospital due to underlying diagnosis of gastrointestinal illness. Approximately 185/477 (38.8%) of the participants living in crowded house 73(15.3%) of the participants reported past history of typhoid fever. Only 9/477 (1.9%) of the participants stated that they received antibiotics in the prior two weeks of upper gastrointestinal endoscopy. Out of 477 duodenal fluid cultures, 250 (52.4%) came out to be positive. We observed that none of the duodenal fluid culture was positive for salmonella typhi or paratyphi. However, common pathogens isolated were Escherichia coli 68 (27.2%) followed by Pseudomonas species 58(23.6%), Klebsiella pneumonia 35 (14%). Conclusion: We did not find any typhoid carrier on duodenal fluid culture among subjects who underwent upper gastrointestinal endoscopy in our study. Carrier detection remains one of the best ways to stop salmonella epidemics. Cohort studies and molecular detection methods can be planned to determine its prevalence and to establish temporality and cause effect relationship