TYPHOID FEVER IN CHILDREN

This is a systemic disease and is caused by Salmonella typhi. Salmonella bacilli are shed in the faeces of asymptomatic carriers or in the stool or urine of those with active disease.

Transmission

Transmission of the Salmonella bacilli occurs via contaminated food or water.
This may occur through:

  • Direct contamination by faeces or urine
  • Flies from faeces to food
  • Through healthy carriers especially if they are food handlers
  • Health personnel through inadequate hygiene when changing soiled linen.

CLINICAL FEATURES

  • High fever
  • Headaches
  • Anorexia
  • Weight loss
  • Diarrhoea
  • Constipation
  • Abdominal tenderness
  • Changes in sensorium
  • Splenomegaly
  • Relative bradycardia
  • Rose spots (blanching lesions).

A high index of suspicion is required when handling any patient with unexplained fever. The clinical picture tends to be atypical in infants, who may develop shock and
hypothermia.

Complications

  • Intestinal haemorrhage
  • Convulsion
  • Coma
  • Shock
  • Perforation with resultant acute abdomen
  • chronic carrier status.

Investigations

  • Full haemogram: Relative leucopaenia in relation to the fever
  • Cultures: Positive in blood in first week, stool and urine cultures become
    positive in the third week.
  • Widal test: A four fold rise of O antigen titres suggest S. Typhi infection
    significant. NB: Only titres of O antibody of 1:320 or more are significant. The
    gold diagnostic standard should be isolation of bacilli in cultures.
  • Abdominal x-ray in suspected perforation: Erect/decubitus, which may show
    pneumoperitonium or multiple fluid levels.

Management

  • Treat all patients for 14 days using:
    • Ciprofloxacin 20–30mg/kg/24 hours BD (max 1.5g/24 hours)
  • Refer for
    • Surgical intervention if signs of perforation.

Prevention

Preventive measures for typhoid fever include the following:

  • Using wholesome drinking water (water boiled for 10 minutes or chlorinated).
  • Using pasteurized milk.
  • Screening food handlers for typhoid and treating those infected, including healthy carriers.
  • Ensuring proper hygiene while preparing or/and handling foods.
  • Ensuring hygienic waste disposal.
  • Vaccination.