Typhoid fever (enteric fever)

Typhoid fever is an infections disease caused by a bacterium known as Salmonella Typhi. The organism is excreted in urine and stool and is transmitted through contaminated food and water. Hence the disease is more common among those living in poor hygienic conditions.

Clinical features: The disease starts with fever and is clinically indistinguishable from other causes of fever. It can be accompanied by many other non specific symptoms like cough, vomiting, abdominal pain and head ache. The child may have a few loose stools.

Diagnosis: The only way to diagnose enteric fever in the early stage is to do blood culture. This may not be positive in every patient. During an epidemic typhoid fever should be suspected in every patient with fever.

Tests to detect antibodies to the bacteria are positive only after the first week. In endemic areas the test may be positive in low titers even when the patient does not have enteric fever. The test is called widal test. A rising titer is more significant than a single reading.

Complications: The disease causes ulcers in the intestine and perforation of intestine can occur. The bacteria can invade various organs causing inflammation of those organs.

The toxins released by the bacteria can affect the brain leading to a condition called typhoid encephalopathy.

Treatment: Hospitalization may be required if the child is very sick, has frequent vomiting or when frequent review is not possible. Intravenous fluids may be required if child is not able to take adequate oral feeding.

Liquids and semisolid foods should be given till fever subsides. Paracetamol may be given for fever.

Specific treatment: Ceftriaxone is highly effective for this disease. It is given as injection is a dose of 50-75msddfsadsf/kg body weight.

Once the fever subsides treatment may be continued with oral drugs. Cefixime can be used to complete the course. Treatment should be continued for 2 weeks.

Quinolone group of drugs are usually avoided in children. But those who are not responding to the above drug may have to be given these drugs. Ciprofloxacin may be given initially as an injection and later as oral medication.

Prognosis: In general the prognosis is good.

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