Typhoid Fever
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Typhoid is an acute life-threatening systemic disease characterized by persistent high-grade fever and abdominal pain.
Causes
- It is caused by Salmonella typhi, transmitted by ingestion of contaminated food or water and is common where sanitary conditions are poor.
- Symptoms are most severe in the elderly, infants, and those who have an existing illness.
- AIDS patients are frequently affected and have recurrences.
Signs and symptoms
- Severe headache
- High fever
- Malaise
- Loss of appetite
- Diarrhoea or constipation
- Abdominal pain
Complications
- Intestinal perforation or haemorrhage
- Peritonitis
- Myocarditis
- Encephalitis
Investigations
- Do complete blood count
- Collect appropriate specimen (blood, urine and stool) for culture and drug susceptibility where the facility is available.
Treatment objectives
- Reduce fever
- Prevent dehydration
- Eliminate infection
- Prevent the spread of the disease in the community
Non-pharmacologic treatment
- Give adequate hydration
- Maintain nutrition (frequent small feeds)
Pharmacological treatment
Uncomplicated Typhoid
Ciprofloxacin oral
|
Age |
Dose |
Frequency and duration |
|
Adult and child >13 years |
500mg |
Every 12 hours for 10 days |
|
Child < 13 years |
250mg |
Every 12 hours for 10 days |
Amoxicillin oral
|
Age |
Dose |
Frequency and duration |
|
Adult and child >13 years |
50mg/kg |
Every 12 hours for 10 days |
|
Child < 13 years |
50mg/kg |
Every 12 hours for 10 days |
Complicated Typhoid
Ceftriaxone IV
|
Age |
Dose |
Frequency and duration |
|
Adult |
2 g |
Once or in 2 dived doses for 14 to 21 days |
|
Child < 13 years |
50mg/kg |
Daily (max. 4 g daily) for 14 to 21 days |
Note
- Never give laxatives in typhoid cases because of the danger of perforation
- Never give ciprofloxacin in pregnant and breastfeeding mothers
Pregnant or breast-feeding women
- Use azithromycin or ceftriaxone for pregnant or breastfeeding mothers
Neurological disorders
- In case of severe typhoid fever with neurological disorders (hallucinations, altered mental status) give:
Dexamethasone IV
3 mg/kg stat
Then continue with
1 mg/kg every 6 hours for 2 days (8 doses)
Referral
- Patients who have a high fever and altered state of consciousness
- Patients who have signs of intestinal bleeding or perforation