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TYPHOID

FEVER

D r . MUHAMMAD UMER ARIFPGR-UNIT 1

PEDIATRICS MEDICINE

MAYO HOSPITAL

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SCENARIO

A 7 year old male child comes to the opdwith complains of fever for the past 9days,

low grade initially but usually high gradein after noon now, no response tomedicine, no afebrile interval , associatedwith headache and projectile vomiting.

There is also complain of pain in right iliacfossa and bloody diarrhea along with 2episodes of epitaxis.

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ON EXAMINATION

Child had toxic, look withfollowing signs

OBSERVATION

1.coated tongue

2.congested throat

3.rose spots on chest

PALPATION

1.mild tender abdomen

2.Hepatomegaly

3.Minimal spleenomegaly

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INVESTIGATION

CBC shows:

Leukopenia relative to high grade fever 

LFTS:

Mildly elevated

Widal test:

positive

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DIAGNOSIS: TYPHOID FEVERCause : gram-negative bacillus Salmonella typhi.

Enteric/Paratyphoid fevers:which are usually milder ,are caused by S paratyphi A, B, and C).

pathogenesis: no animal reserviour,transmitted byfecal-oral route ,enters the walls of the intestinal tractby attachment to M cells,actin dearrangement andtight juction destablization. following a transientbacteremia, multiplies in the reticuloendothelial cells

of the liver and spleen.Reinfection of the intestine occurs as organisms are

excreted in the bile,end of incubation period.

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PATTERN The classic lengthy three-stage disease seen in adult

patients often is shortened in children. The incubationperiod is 4-8 days.

The prodrome may last only 2 – 4 days, physical findingsmay be absent, but abdominal distention and tenderness,meningismus, mild hepatomegaly, and minimalsplenomegaly may be present

the toxic stage only 2 – 3 days(2nd week of disease) Classical sign: Bacterial emboli produce the characteristic

skin lesions (rose spots). Rose spots are erythematousmaculopapular lesions 2 – 3 mm in diameter that blanch onpressure. They are found principally on the trunk and chestand they generally disappear within 3 – 4 days.they are

present in 10 – 

15% of children

the defervescence stage 1 – 2 weeks.

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Clinical signs: %

High-grade fever 95Coated tongue 76

Anorexia 70

Vomiting 39

Hepatomegaly 37

Diarrhea 36

Toxicity 29Abdominal pain 21Pallor 20

Splenomegaly 17

Constipation 7

Headache 4Jaundice 2

Obtundation 2

Ileus 1Intestinal perforation 0.5

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Laboratory study Results of blood cultures are positive in 40-60% of the patients in 1st week 

stool and urine culture become positive after the 1st wk.

Widal test is based on widal reactioni.e.antibodies in the blood of an infectedperson causes clumping of the bacteria.

Serum agglutinin are raised in 2nd and 3rd week,widal test detects antibodies against O (1in 160 dilution)and H antigens(1 in 320 dilution).

Two serum specimenobtained at interval of 7-10days to read the raise in antibodies.

It is of limited value.

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complications

Intestinal perforation and hemorrhagealthough not frequent in children(less than1%) ,are the most lethal complication.

Encapholopathy,meningitis,ceberalempyema and edema are prevalent(35%) but usualy resolve.

DIC is also a common complication

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treatment

UNCOMPLICATED TYPHOID FEVER

Chloramphenicol

Fluoroquinolone, e.g., ofloxacin or ciprofloxacin

Amoxicillin

SEVERE TYPHOID FEVER

AzithromycinCefixime

Ceftriaxone

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