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hoid fever
Typhoid fever
– S y stem ic infectio n d ue to Salmonella typhi. T h e o rganism enters th e bo d y via th e
gastro intestinal tract and gains access to the blo o d stream via the ly m p hatic sy stem .
– T y p ho id fever is acquired by ingestio n o f co ntam inated water and fo o d o r by d irect
co ntact (d irty hand s).
Clinical features
– S ustained fever ( lasting m o re th an o ne w eek ) , h ead ach e, asth enia, inso m nia,
ano rexia, ep istaxis.
– A bd o m inal p ain o r tend erness, d iarrho ea o r co nstip atio n, gurgles.
– T o xic co nfusio nal state, p ro stratio n.
– M o d erate sp leno m egaly , relative brad y card ia (no rm al p ulse d esp ite fever).
– Differential diagnosis m ay be d ifficult as sy m p to m s resem ble tho se o f lo wer
resp irato ry
tract infectio ns, urinary infectio ns, and m alaria o r d engue fever in end em ic areas.
– Complications can o ccur d uring the active p hase o r d uring co nvalescence (even d uring
treatm ent) : intestinal p erfo ratio n o r h aem o rrh age, p erito nitis, m y o card itis,
encep halitis, co m a.
Laboratory
– R elative leuk o p enia (no rm al white blo o d cell co unt d esp ite sep ticaem ia).
– I so latio n o f S. typhi fro m blo o d cultures ( tak e at least 1 0 m l o f blo o d ) and sto o l
cultures d uring the first 2 week s.
– W id al's agglutinatio n reactio n is no t used (bo th sensitivity and sp ecificity are p o o r).
Treatment (at ho sp ital level)
– Iso late the p atient.
– K eep und er clo se surveillance, hy d rate, treat fever (see Fever, p age 2 6 ).
– A ntibio tic th erap y : case-fatality rates o f 1 0 % can be red uced to less than 1 % with
early antibio tic treatm ent based o n the find ings o f blo o d cultures. T he o ral ro ute is
m o re effective th an the p arenteral ro ute. I f th e p atient canno t tak e o ral treatm ent,
start by injectable ro ute and change to o ral ro ute as so o n as p o ssible.
Antibiotic treatment (except during pregnancy or breast-feeding)
• T he treatm ent o f cho ice is: ciprofloxacin P O fo r 5 to 7 d ay s
C hild ren: 3 0 m g/ k g/ d ay in 2 d ivid ed d o ses (usually no t reco m m end ed in
child ren
und er 1 5 y ears, ho wever, the life-threatening risk o f ty p ho id o utweighs the risk o f
ad verse effects)
A d ults: 1 g/ d ay in 2 d ivid ed d o ses
174
Typhoid fever
– S y stem ic infectio n d ue to Salmonella typhi. T h e o rganism enters th e bo d y via th e
gastro intestinal tract and gains access to the blo o d stream via the ly m p hatic sy stem .
– T y p ho id fever is acquired by ingestio n o f co ntam inated water and fo o d o r by d irect
co ntact (d irty hand s).
Clinical features
– S ustained fever ( lasting m o re th an o ne w eek ) , h ead ach e, asth enia, inso m nia,
ano rexia, ep istaxis.
– A bd o m inal p ain o r tend erness, d iarrho ea o r co nstip atio n, gurgles.
– T o xic co nfusio nal state, p ro stratio n.
– M o d erate sp leno m egaly , relative brad y card ia (no rm al p ulse d esp ite fever).
– Differential diagnosis m ay be d ifficult as sy m p to m s resem ble tho se o f lo wer
resp irato ry
tract infectio ns, urinary infectio ns, and m alaria o r d engue fever in end em ic areas.
– Complications can o ccur d uring the active p hase o r d uring co nvalescence (even d uring
treatm ent) : intestinal p erfo ratio n o r h aem o rrh age, p erito nitis, m y o card itis,
encep halitis, co m a.
Laboratory
– R elative leuk o p enia (no rm al white blo o d cell co unt d esp ite sep ticaem ia).
– I so latio n o f S. typhi fro m blo o d cultures ( tak e at least 1 0 m l o f blo o d ) and sto o l
cultures d uring the first 2 week s.
– W id al's agglutinatio n reactio n is no t used (bo th sensitivity and sp ecificity are p o o r).
Treatment (at ho sp ital level)
– Iso late the p atient.
– K eep und er clo se surveillance, hy d rate, treat fever (see Fever, p age 2 6 ).
– A ntibio tic th erap y : case-fatality rates o f 1 0 % can be red uced to less than 1 % with
early antibio tic treatm ent based o n the find ings o f blo o d cultures. T he o ral ro ute is
m o re effective th an the p arenteral ro ute. I f th e p atient canno t tak e o ral treatm ent,
start by injectable ro ute and change to o ral ro ute as so o n as p o ssible.
Antibiotic treatment (except during pregnancy or breast-feeding)
• T he treatm ent o f cho ice is: ciprofloxacin P O fo r 5 to 7 d ay s
C hild ren: 3 0 m g/ k g/ d ay in 2 d ivid ed d o ses (usually no t reco m m end ed in
child ren
und er 1 5 y ears, ho wever, the life-threatening risk o f ty p ho id o utweighs the risk o f
ad verse effects)
A d ults: 1 g/ d ay in 2 d ivid ed d o ses
174
