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Typhoid Fever

• Greek: typhus=smoke (refers to clouding of consciousness)
• Caused by Salmonella typhi 

Transmission

• faecal-oral
• incubation 10-14 days

Carriers

• Types
  • chronic
  • convalescent
• usually in gallbladder

History

• insidious onset
• headache
  • gradually increases in steps over 3-4 day
• cough
• sore throat
• altered behaviour
• constipation initially / diarrhoea later

Examination

• 1st week
  • toxic
  • relative bradycardia
• 2nd week
  • 'rose spots'
    • erythematous maculopapular rash
    • blanches on pressure
    • mainly thorax, upper abdomen
    • lasts 2-3 days
  • soft splenomegaly (75%)
  • cervical lymphadenopathy
  • hepatosplenomegaly
  • right iliac fossa tenderness
• 3rd Week
  • lobar Pneumonia
  • Haemolytic Anaemia
  • Meningitis
  • Polyneuropathy
  • acute cholecystitis
  • Urinary Tract Infection
  • Osteomyelitis
  • Intestinal perforation (2-3%)
  • Intsetinal haemorrhage (2-8%)

Investigations

• FBC
  • leucopenia
• blood cultures (80% +ve 1st week, 30% 3rd week)
• urine cultures (2nd week)
• stool cultures (2nd to 4th week)
• serology
  • Widal

Treatment

• Ciprofloxacin (500mg BD for 2 weeks)
• Chloramphenicol
• Co-trimoxazole
• Amoxicillin

Paratyphoid

• milder but indistinguishable caused by Salmonella paratyphi

Treatment

• co-trimoxazole 960mg for 2 weeks