Based on Table-1, the highest age group was in the age group 12 - <36 months with a percentage of 48.28%. This may be because, at that age, the children's hygiene habits are still lacking, and the children already have the desire to buy snacks at street vendors . Inadequate hygienic habits were associated with carriers of bacterial enteric pathogens in families with children who had typhoid fever . Salmonellae on the hands of convalescent carriers are easily removed by washing hands with soap and water . In contrast to Setiabudi et al.'s research, it was found that the highest percentage was found in children under five years of age with a percentage of 65.8% .
Based on gender, it appears that typhoid fever was more prevalent in male children under five, namely 32 (55.17%) children; this can happen because the boys are more active outside the house .
According to nutritional status, it appears that most children have normal body weight, namely 65.52%. This study's results are different from Ramaningrum research that shows children with poor nutritional status will be more at risk of suffering from typhoid fever due to decreased immune systems .
Based on Table-2, it appears that 27 (46.55%) children suffer from anemia. Based on the RDW value, the Mentzer index (MCV: RBC), and the RDW index (MCV: RBCxRDW), all 27 children suffering from anemia had IDA. The Mentzer Index and RDW index are used as IDA indicators . If the Mentzer index value is <13, anemia is suspected due to minor thalassemia. If the Mentzer index value is ≥13, then the anemia may be due to iron deficiency. RDW index value ≥220 indicates anemia caused by iron deficiency . The results of this study are different from the research by Lestari et al., which found that out of 158 children with typhoid fever, 116 (73.4%) children had normal hemoglobin levels . Low serum iron concentrations characterize anemia caused by inflammation (including typhoid fever); due to inhibited iron absorption because hepcidin degrades ferroportin, resulting in iron accumulation in intra-enterocyte cells [13-15].
Based on Table-3, it was found that leukopenia was found in 10 (17.24%) patients. Leukopenia is associated with fever and disease toxicity.1 Qamar found 78 patients (52%) had leukopenia . Leukopenia occurs because patients infected with S. typhi bacteria secrete endotoxin on the germ's outer wall in the form of lipopolysaccharide to stimulate activated macrophages and phagocyte leukocytes and function to activate neutrophils. Also, leukopenia results from depression of the bone marrow by the endotoxins and endogenous mediators present [16,17].
On the leukocyte count, all patients had normal basophil values. Eosinopenia was found in 38 (69.09%) pediatric patients. Ishaq et al. study (2020) found that 59% of typhoid fever patients experience eosinopenia . Eosinophils are active primarily in the late stages of inflammation when antigen-antibody complexes are formed and have the ability to phagocytose [19,20]. Eosinopenia is usually associated with the presence of an acute bacterial infection that usually causes fever. The decrease of eosinophils is caused by the release of cytokines during margination that occurs in eosinophils .
Band neutropenia was seen in 50 (90.90%) children and segmented neutropenia in 31 (56.37%) children. Neutropenia is caused by decreased neutrophil production, increased cell damage, bacterial and viral infections, drugs, administration of chemotherapy, and autoimmune diseases [19,20]. This is suits with the study of Qamar et al. (2013) and Uplaonkar, which found neutropenia in 48 (32%) typhoid fever patients [21,22].
Lymphocytosis was found in 58.18% of children. Relative lymphocytosis followed by neutropenia during the recovery phase is considered a feature of complications of typhoid fever . Monocytosis was found in 58.18% of pediatric patients. This study's results are the same as that of Qamar et al. (2013), who found monocytosis in 30.67% of typhoid fever patients . Monocytes are the largest blood cells and have a function as the body's second layer of defense and can perform phagocytosis properly and include macrophages. In the blood, monocytes will go to the source of inflammation to assist the host immune response and act as mediators of antimicrobial defense. Monocytosis is usually caused by infection with viruses, bacteria, parasites, autoimmune diseases .
In this study, thrombocytopenia and thrombocytosis were found in the same percentage, namely 13.80% of children. In Ahmad et al. study, they found thrombocytopenia in 127 (63,5%%) patients . Thrombocytopenia is an essential marker in children presenting with typhoid fever, especially in those having severe symptoms. So platelet count should be monitored in patients with enteric fever. Because severe thrombocytopenia can lead to multi-organ failure and can considerably lead to increased morbidity and mortality .