TYPHOID FEVER

Bacterial infection characterised by fever and abdominal symptoms. It is spread through contaminated food and water.

Causes

  • Salmonella typhi and S. paratyphi A & B

Clinical features

  • Gradual onset of chills and malaise, headache, anorexia, epistaxis, backache, and constipation
  • Usually occurring 10-15 days after infection
  • Abdominal pain and tenderness are prominent features
  • High fever > 38oC
  • Delirium and stupor in advanced stages
  • Tender splenomegaly, relative bradycardia, cough
  • Complications may include perforation of the gut with peritonitis, gastrointestinal hemorrhage

Differential diagnosis

  • Severe malaria, other severe febrile illnesses

Investigations

  • Blood culture (most reliable)
  • Stool culture
  • Rapid antibody test (e.g. Tubex, Typhidot) – not very sensitive or specific, possibly useful in epidemics

Widal’s agglutination reaction is neither sensitive nor specific for typhoid diagnosis: a single positive screening does not indicate presence of infection

Management

  • Ciprofloxacin 500 mg every 12 hours for 10–14 days
    Child: 10-15 mg/kg per dose

Other antibiotics

  • Chloramphenicol 500 mg 6 hourly for 10 days
    Child: 25 mg/kg IV, IM or oral for 10-14 days

In severe, resistant forms or pregnancy

  • Ceftriaxone 1 g IV every 12 hours for 10-14 days
    Child: 50 mg/kg per dose

Alternative in pregnancy

  • Amoxicillin 1 g every 8 hours for 10 days
    Child: 10-15 mg/kg per dose

Chronic carriers (treat for 4-6 weeks)

  • Ciprofloxacin 500-750 mg every 12 hours
  • Child: 10-15 mg/kg per dose
  • Refer complications (e.g. perforation) to a higher level of care

Note

  • Fever may persists for few days after starting treatment

Prevention

  • Early detection, isolation, treatment, and reporting
  • Proper faecal disposal
  • Use of safe clean water for drinking
  • Personal hygiene especially hand washing
  • Good food hygiene