Description
Acute systemic illness resulting from Salmonella typhi or Salmonella paratyphi infection.
Signs and Symptoms
High grade fever, coated tongue, anorexia, vomiting, hepatomegaly, diarrhoea, toxicity, abdominal pain, pallor, splenomegaly, constipation, headache, jaundice, obtundation, ileus, intestinal perforation. Mainstay of diagnosis is clinical evaluation.
Any high fever of >72 hours duration (with features), especially with no localizing upper respiratory signs or signs of meningitis or malaria must be suspected of typhoid and managed accordingly.
Investigations
Blood culture
Ideally:
- 1st week of symptoms - Blood culture
- 2nd week of symptoms - Urine culture
- 3rd week of symptoms - Stool culture
NB: As most patients present late, all three cultures should be taken on admissions.
Widal test
- A single Widal test may be positive in only 50% cases in endemic
- Serial tests may be
Full Blood count (White cell count)
- Leucopoenia (WCC < 4 x109/litre) with a left shift in neutrophils may be Young infants may also commonly present with leukocytosis
Treatment
- Early diagnosis and instituting appropriate supportive measures and specific antibiotic therapy is the key to appropriate management
- Adequate rest, hydration, correction of fluid-electrolytes and nutrition
- Anti-pyretic therapy for fever > 39o
- Antibiotic therapy
- 1st line therapy- Ciprofloxacin 15mg/kg /day in two divided doses for 10-14
- 2nd line (drug resistant) – Imipenem 25mg/kg/day QID for 10-14
Alternative:
- Ceftriaxone 50mg/kg/day for 10-14
- Azithromycin 10mg/kg/day oral for 5 days in uncomplicated
Complications
• Intestinal perforation (0.5- 1%), Peritonitis and Intestinal hemorrhage (<1%)
• Presents as a sudden increase in abdominal pain with associated tachycardia, tachypnea, hypotension, hyperpyrexia and obtundation.
• Examination reveals marked abdominal tenderness with guarding, and subsequent abdominal rigidity.
• Urgent Plain –X-ray abdomen and consultation to surgery required.
• A rising white blood cell count with a left shift and free air on abdominal radiographs may be seen in such
cases.