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