K Mitiku1, G Mengistu. 1. Department of Paediatrics, Gondar College of Medical Sciences, Ethiopia.
Abstract
OBJECTIVE: To determine the magnitude of relapsing fever, the rate of Jarisch-Herxheimer reaction (JHR) and its outcome and compare these parameters between adults and children in the same setting, time period and more or less similar management. DESIGN: A retrospective descriptive record analysis. SETTING: Gondar College of Medical Sciences (GCMS) hospital, paediatric ward and medical wards, northwest Ethiopia. SUBJECTS: Clinical records of 262 patients discharged with confirmed diagnosis of primary relapsing fever admitted between September 1995 and August 2000. RESULTS: Of the 13,177 patients admitted during the study period, 262 (1.99%) had a primary diagnosis of relapsing fever of which 70.6% were males. Children below 14 years of age comprised 41.2%. Of the total admissions, 83.6% were from Gondar town and the rest from outside. JHR was observed in 31.7% of the patients. The overall case fatality rate was 4.6%. Bad outcome was observed more frequently in adult patients. CONCLUSIONS AND RECOMMENDATIONS: Relapsing fever is still a public health problem. Because of the potential danger of the epidemic and its outcome it should not be neglected. Preventive programmes must be integrated with other services. Though the JHR is the most feared part of the management of relapsing fever, if health personnel are trained and competent, the management of relapsing fever can be delegated to the peripheral health workers, especially when it occurs in children. Moreover, the reason for bad outcome in adult patients than in children needs to be established.
OBJECTIVE: To determine the magnitude of relapsing fever, the rate of Jarisch-Herxheimer reaction (JHR) and its outcome and compare these parameters between adults and children in the same setting, time period and more or less similar management. DESIGN: A retrospective descriptive record analysis. SETTING: Gondar College of Medical Sciences (GCMS) hospital, paediatric ward and medical wards, northwest Ethiopia. SUBJECTS: Clinical records of 262 patients discharged with confirmed diagnosis of primary relapsing fever admitted between September 1995 and August 2000. RESULTS: Of the 13,177 patients admitted during the study period, 262 (1.99%) had a primary diagnosis of relapsing fever of which 70.6% were males. Children below 14 years of age comprised 41.2%. Of the total admissions, 83.6% were from Gondar town and the rest from outside. JHR was observed in 31.7% of the patients. The overall case fatality rate was 4.6%. Bad outcome was observed more frequently in adult patients. CONCLUSIONS AND RECOMMENDATIONS: Relapsing fever is still a public health problem. Because of the potential danger of the epidemic and its outcome it should not be neglected. Preventive programmes must be integrated with other services. Though the JHR is the most feared part of the management of relapsing fever, if health personnel are trained and competent, the management of relapsing fever can be delegated to the peripheral health workers, especially when it occurs in children. Moreover, the reason for bad outcome in adult patients than in children needs to be established.