Typhoid fever

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Typhoid fever also known as enteric fever , is a life-threatening infectious disease characterized by progressive high fever , profuse sweating, rash and gastroenteritis caused by Salmonella typhi.

What causes the Typhoid fever?

Typhoid fever is caused by bacterias includes Salmonella typhi and Salmonella parathyphi. Bacteria is transmitted though fecal-oral route .

What are the signs and symptoms of Typhoid fever?

Signs and symptoms are developed gradually 

A.Clinical presentation in first week

1. Slowly progressive fever as high as 104 degree Fahrenheit.(stepladder fever pattern)
2. Headache
3. Profuse sweating
4. Decrease appetite
5. Constipation or diarrhea
6. Fatigue and weakness
7. Sore throat
8. Abdominal pain
9. Insomnia
10. Confusion
11. Psychosis
12. Jaundice
13. Sharp right lower quadrant pain
14. Joint pain , muscle pain
15. Rose spots
16. Urinary retention
17. Hematuria( blood in urine)

B.Clinical presentation in second week

1. Continuous high fever
2. Weight loss
3. Distention of abdomen
4. Malaise , confusion and delirium
5. Dicrotic Pulse ( a pulse characterized by two peaks, the second peak occurring in diastole )
6. Diarrhea ( pea soup like)

C.Clinical presentation in third week

1. Delirious
2. Motionless and exhausted eyes
3. Life-threatening complication may developed.

D.Clinical presentation in forth week

1. This is the recovery phase
2. Decreased fever
3. Improvement of other signs and symptoms

What are the complications of Typhoid fever?

1. Intestinal bleeding
2. Intestinal perforation ( most common complication may developed in the third week of illness)
3. Myocarditis
4. Pancreatitis
5. Pneumonia
6. Osteomyelitis
7. Meningitis
8. Cholecystitis

How is a Typhoid fever diagnosed?

Diagnosis relies on clinical findings, laboratory tests and radiological imaging.

Laboratory tests includes

1. Complete blood count (CBC) shows increased white blood cells and low platelet count. .
2. Blood culture isolate S.typhi or S.parathyphi , widely considered 100% specific.
3. Widal test shows salmonella antibodies against antigens H-falgellar and O-somatic .
4. Polymerase chain reaction(PCR) is to detect the H1-d flagellin gene of S typhi.
5. ELISA urine test shows S.typhi or S.parathyphi.
6. Bone marrow aspiration and culture of BMA is the most sensitive to detect S.typhi .

Radiological imaging includes X-ray, CT and MRI scan is useful in bowel perforation.

How is a Typhoid fever managed ?

1. Ciprofloxacin with the dose of 250-500 mg PO twice a day for 7-14 days is the drugs of choice where resistance is uncommon .If there is resistance to Ciprofloxacin third generation cephalosporin includes cefotaxime or ceftriaxone is the drugs of choice. Ampicillin, chloramphenicol , Bactrim are the alternatives to treat the typhoid fever.
2. Drinking a lot of fluid
3. Eating a hearty diet
4. Complete rest
5. Surgical management is indicated in cases of intestinal perforation.
6. Cholecystectomy is indicated in carrier state where antibiotics fails to eradicated the bacteria.

What is the prevention of typhoid fever ?

1. Maintain good hygiene
2. Avoid drinking contaminated water
3. Improved sanitation
4. Choose hot foods
5. Isolation of infected people
6. Vaccines are recommended for travel the endemic area ( vaccine is not 100% effective)

What is the prognosis of typhoid fever ?

Prognosis is excellent with early treatment but becomes worse if complications develop. 3%-4% developed as carries of thyroid fever .

References:

• http://www.emedicinehealth.com
• http://en.wikipedia.org
• http://www.mayoclinic.com
• http://emedicine.medscape.com
• http://www.medicinenet.com
• http://www.ncbi.nlm.nih.gov
• http://www.netdoctor.co.uk
• Harrison’s Principles of Internal Medicine, 17^th edition.
• Davidson’s Principles and Practice of Medicine, 20th Edition

Filed Under: Medicine

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