24, 25 and 26 Anaemia and drug resistance, but not hepatomegaly, have been associated with disease severity in previous studies24, 25 and 26 In this study, complications occurred Panobinostat purchase in 28% of children and mortality was 1.6%. The proportion of severe hospitalised cases partly depends on the threshold
for hospital admission and the availability of antimicrobials effective against the bacteria causing enteric fever locally. Population-based studies suggest that between 10% and 20% of cases are admitted to hospital with the remainder managed in the community.6 and 10 It is also possible that some children from rural Cambodia, with inadequate access to healthcare facilities, may develop severe enteric fever with complications and die without seeking medical attention. We identified a very limited number of cases due to serovar Paratyphi A. This is in contrast to other areas of Asia where the proportion Romidepsin order of enteric fever cases due to serovar Paratyphi A is increasing.27 The factors that determine the relative proportion of serovar Typhi to Paratyphi A in a community are not known, although of note, typhoid vaccination is not widely used in this area. The number of invasive infections with NTS was also low, unlike in some parts of sub-Saharan Africa where NTS are a common cause of invasive bacterial infection in children
below the age of five years.28 Most of the children with an invasive NTS infection in this study had previously recognized risk factors namely as a complication of severe diarrhoea in those under 1 year of age or in those with HIV infection.28 and 29 It is noteworthy that many of the NTS isolates were resistant to commonly used antimicrobials, as seen in adjacent countries.4 The control of enteric fever requires the identification of locally important risk factors and includes improving access to clean water, uncontaminated food and the availability of adequate
sanitation.6 The detection and treatment of chronic carriers 4-Aminobutyrate aminotransferase has been considered important in controlling enteric fever in developed countries but has not been employed in developing countries because of the difficulty of detecting carriers. Although vaccination as a public health tool is recommended in areas where the burden of enteric fever is high and antimicrobial resistance is a persistent problem, there are few places where it has actually been employed.30 Additional, prospective community based studies of the epidemiology of enteric fever in this area are required to enable a feasible control strategy to be devised. KE and CEM contributed equally to this study. CMP, KE, NC, CEM, KC, NES, SB and NPJD conceived and designed the study; all authors participated in the conduct of the study; CMP, KPA, CEM, SS, DPT, TVTN, VW, PA, VK, LW, NES, MJC and SB were involved in the analysis and interpretation of the data; CMP wrote the first draft of the paper.
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