Typhoid fever

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Contents

Introduction

Aetiology

One of 2 Gram negative bacilli:

  • Samonella typhi
  • Samonella paratyphi (paratyphoid fever - a less aggressive illness but clinically indistingishable)

Clinical

Symptoms

  • Fever/chills
  • Abdominal pain
  • Constipation/Diarrhoea
  • Headache
  • Myalgia

Signs

  • Pyrexial
  • Slight abdominal distension
  • Hepatosplenomegaly (neither/either/both)
  • "Septic" - tachycardic, tachypnoeic
  • Confusion

Investigations

Blood tests

  • FBC - leucocytosis
  • U+Es - often mild hyponatraemia and hypokalaemia
  • LFTs - deranged (predominately transaminases)
  • Blood cultures

Other cultures

  • Stool (frequently positive)
  • Urine

Radiology

  • CXR
  • AXR if indicated by examination
  • Abdominal ultrasound to investigate LFTs (also excludes perforation if no free fluid)

Treatment

Antibiotics

Ciprofloxacin is currently standard, although there are increasing concerns about resistance. Extended-spectrum βlactmase producing strains exist, and many are now resistent to co-trimoxazole, ampicillin and chloramphenicol.

Supportive

Antipyretics, intravenous fluids and analgesia

Surgical

If complications arise, eg perforation

Prevention

  • Exclusion of food handlers is essential, and needs to be prolonged. Their contacts also need to be excluded until screened. See enteric pathogens article for more details.
  • Vaccination
    • Current vaccines not suitable for young children
    • Typhoid conjugate vaccines (TCVs) are in advanced development (eg Typbar-TCV, Vi-TT, Vi-PS). These vaccines have about 50% efficiency at 1 month after single inoculation[1].

Notification

Statutorily notifiable

External links

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