Typhoid fever

Notes
  • Typhoid fever is caused by Salmonella typhi (also known as Salmonella enterica serotype typhi).
  • Statistics: Annual incidence – 21 million; annual mortality rate: 220,000; The 3yr cumulative efficacy of a single injectable dose of Vi polysaccharide vaccine - 55 to 70%); efficacy of 2 oral doses of the Vi-rEPA vaccine - 50 to 96%; risk of death without treatment - 25%; risk of death with treatment - 1 and 4%.
  1. Transmission
  • It is spread by ingestion of food or water that is contaminated with the infected feces or urine.
  • Healthy carriers –especially food handlers
  • Flies – from stool to food
  • Handling of patients or patients’ linen without observing proper hygiene.
Symptoms
  • Some cases are asymptomatic
  • Prolonged high fever
  • Headaches
  • Nausea
  • Loss of appetite
  • Weight loss
  • Epistaxis – especially at early stage.
  • Constipation or diarrhoea.
  • Abdominal tenderness
  • Weakness
  • Changes in sensorium
  • Rose coloured spots (by some people)
  • Confusion (occasionally)
  • Leukopenia
  • Bradycardia
  • Delirium may occur
  • Hepatosplenomegaly
  • Dehydration
  • Thrombocytopenia (low platelet counts) – tendency to bleeding is increased.
  • Pneumonia
  • Acute bronchitis
  • Encephalitis
  • Intestinal haemorrhage (caused by bleeding in congested Peyer's patches)
  • Intestinal perforation in the distal ileum
Diagnosis
  • For blood, results are obtained within a week while it takes 3 weeks to get results for stool and urine
  • Molecular diagnostics of stool, blood and bone marrow (most sensitive)
  • Widal test that detects antibodies against Salmonella antigens O-somatic and H-flagellar is no longer recommended for use in diagnosis of typhoid fever due to its low sensitivity (Only titres of O antibody of 1:160 is considered significant and the rising titre implies the presence of the disease).
  • Abdomen X-Ray in case of suspected complications
Differential
  • Malaria
  • Pneumonia
  • Brucellosis
  • Tuberculosis
  • Amebic hepatic abscesses
  • Appendicitis
  • Dengue
  • Leishmaniasis
  • Abdominal abscesses
  • Typhus
  • Tularemia
  • Toxoplasmosis
  • Rickettsial diseases
  • Sub-acute bacterial endocarditis
Prevention
  • Promotion of hygiene practices such as;

_Washing of hands after visiting a toilet

_Washing of hands before handling food

  • Vaccination;

  Either,

_Purified Vi capsular polysaccharide from salmonella typhi injection. Booster dose given 2-3yrs

Or;

_Vi-rEPA vaccine oral vaccine 4 capsules given on alternate days.

 

Management
  • Either,

_Tabs Norfloxacin 400mg BD x 2/52

Or;

_Tabs Ciprofloxacin  500-750mg BD x 2/52

Or;

_Tabs Ofloxacin  400 BD x 2/52

Or;

_IV Ceftriaxone Igm OD  x 1/52 to 2/52

Or;

_Amoxicillin 100mg/kg/day in 3 divided doses  x 2/52

Or;

_Tabs Cotrimoxazole  4 tabs of 480mg BD x 2/52

Or;

_Caps /IV chloramphenicol  50mg / kg / day x 2/52

Or;

_Tabs Azithromycin  500mg OD x 1/52

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