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. 2021 Nov 23;224(Supple 5):S522-S528.
doi: 10.1093/infdis/jiab258.

Ileal Perforation and Enteric Fever: Implications for Burden of Disease Estimation

Swathi Krishna Njarekkattuvalappil  1 , Maria Thomas  2 , Arti Kapil  3 , Karnika Saigal  4 , Pallab Ray  5 , Shalini Anandan  1 , Savitha Nagaraj  6 , Jayanthi Shastri  7 , Sulochana Putli Bai Perumal  8 , Dasaratha Ramaiah Jinka  9 , Shajin Thankaraj  10 , Vijayanand Ismavel  10 , Pradeep Zachariah  11 , Ashita Singh  12 , Madhu Gupta  5 , Sheena Evelyn Ebenezer  13 , Mathew Santosh Thomas  13 , Dhruva Ghosh  2 , Kamal Kataria  3 , Mamta Senger  4 , Sundaram Balasubramanian  8 , Gagandeep Kang  1 , Jacob John  1
Affiliations

Ileal Perforation and Enteric Fever: Implications for Burden of Disease Estimation

Swathi Krishna Njarekkattuvalappil et al. J Infect Dis. .

Abstract

Background: Ileal perforation occurs in about 1% of enteric fevers as a complication, with a case fatality risk (CFR) of 20%-30% in the early 1990s that decreased to 15.4% in 2011 in South East Asia. We report nontraumatic ileal perforations and its associated CFR from a 2-year prospective enteric fever surveillance across India.

Methods: The Surveillance for Enteric Fever in India (SEFI) project established a multitiered surveillance system for enteric fever between December 2017 and March 2020. Nontraumatic ileal perforations were surveilled at 8 tertiary care and 6 secondary care hospitals and classified according to etiology.

Results: Of the 158 nontraumatic ileal perforation cases identified,126 were consented and enrolled. Enteric fever (34.7%), tuberculosis (19.0%), malignancy (5.8%), and perforation of Meckel diverticulum (4.9%) were the common etiology. In those with enteric fever ileal perforation, the CFR was 7.1%.

Conclusions: Enteric fever remains the most common cause of nontraumatic ileal perforation in India, followed by tuberculosis. Better modalities of establishing etiology are required to classify the illness, and frame management guidelines and preventive measures. CFR data are critical for comprehensive disease burden estimation and policymaking.

Keywords: Meckel diverticulum; burden estimates; case fatality rate; enteric fever; nontraumatic ileal perforation; surveillance; tuberculosis.

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