“DIAGNOSTIC VALUE OF DETECTION OF MESENTERIC LYMPHADENOPATHY IN THE EARLY DIAGNOSIS OF ENTERIC FEVER IN A RESOURCE LIMITED SETTING”.

Abstract

Objective: The objective of our study was to determine the diagnostic value of detection of mesenteric lymphadenopathy in the early diagnosis of enteric fever in a resource limited setting.

Study Design: Prospective cross-sectional study.

Place and duration of study: This study was conducted at Pediatric Medicine department of Government teaching hospital Shahdara, Lahore from October 2020 to October 2021.

Materials and Methods: 286 patients fulfilling the operational definition of suspected/confirmed enteric fever between 6 months to 5 years of age were initially enrolled after informed consent. Blood culture and abdominal USG were performed in all cases. Only culture confirmed cases of enteric fever (156/286) were included in the study. Data was analyzed using SPSS version 23 and stratified into age, gender, clinical signs and symptoms, types of salmonella and types of typhoid. Chi-square test was applied to see the association of different variables with mesenteric lymph nodes (MLNs). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MLNs to diagnose enteric fever were calculated. While logistic regression model was used to calculate the odds ratio to see the significant predictors of positive blood culture.

Results: Mesenteric lymph nodes were detected in 67.3% (n=105/156) patients and these were significantly more common in 1-5 year age group (P value 0.009). Diagnostic accuracy of MLNs to diagnose enteric fever was 65.88% (59.25, 71.94) with sensitivity and specificity of 67.31% and 61.82% respectively. While positive predictive value (PPV) and negative predictive value (NPV) was 83.33% and 40% respectively. Similarly, positive MLNs were highly predictive of positive blood culture (Odds ratio=5.837, CI-95%: 2.12-15.99) as was fever (Odds Ratio=0.003, CI-95%: 0.00-0.02) and hepatomegaly (Odds ratio= 0.119, CI-95%: 0.03-0.40).

Conclusion: Mesenteric lymphadenopathy can be used to diagnose enteric fever early in the course of illness in resource limited settings where enteric fever is endemic and blood culture is not available or could not be done.

Keywords: mesenteric lymphadenopathy, abdominal ultrasound, enteric fever, resource limited setting.