Typhoid fever: Difference between revisions
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==Treatment== | ==Treatment== | ||
*Consultation with Infectious Disease should be considered since there are increasingly multidrug resistant strains of S. Typhi and coinfection with diseases such as [[Malaria]] may complicate treatment. The therapy favors the use of fluorquinolones unless suspected or known resistance.<ref>Bhutta ZA. et al. Current concepts in the diagnosis and treatment of typhoid fever. BMJ. 2006 Jul 8;333(7558):78-82. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489205/pdf/bmj33300078.pdf PDF]</ref> | *Consultation with Infectious Disease should be considered since there are increasingly multidrug resistant strains of S. Typhi and coinfection with diseases such as [[Malaria]] may complicate treatment. The therapy favors the use of fluorquinolones unless suspected or known resistance.<ref>Bhutta ZA. et al. Current concepts in the diagnosis and treatment of typhoid fever. BMJ. 2006 Jul 8;333(7558):78-82. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489205/pdf/bmj33300078.pdf PDF]</ref> | ||
===Antibiotics== | ===Antibiotics=== | ||
''' | '''Oral therapy with Quinolone Susceptibility:''' | ||
*Ciprofloxacin 500-750 mg PO q 12 hrs x 14 days | *Ciprofloxacin 500-750 mg PO q 12 hrs x 14 days | ||
'''Parenteral Therapy with Quinolone Susceptibility: ''' | '''Parenteral Therapy with Quinolone Susceptibility: ''' | ||
*Ciprofloxacin 400 mg IV q 12 hrs x 10 days | *Ciprofloxacin 400 mg IV q 12 hrs x 10 days | ||
'''Parenteral Therapy with Quinolone Resistance:''' | '''Parenteral Therapy with Quinolone Resistance:''' | ||
''if nalidixic acid resistant, can assume fluoroquinolone resistant'' | ''if nalidixic acid resistant, can assume fluoroquinolone resistant'' | ||
*Ceftriaxone 2mg IV q 24 hrs x 14 days | *Ceftriaxone 2mg IV q 24 hrs x 14 days | ||
::'''OR''' | |||
*Cefixime 10-15 mg/kg IV q 12 hrs x 8 days | *Cefixime 10-15 mg/kg IV q 12 hrs x 8 days | ||
'''Oral Therapy with Quinolone Resistance:''' | '''Oral Therapy with Quinolone Resistance:''' | ||
*Azithromycin 1 g PO daily x 5 days | *Azithromycin 1 g PO daily x 5 days | ||
| Line 122: | Line 124: | ||
If associated delirium, coma, shock, and/or DIC: Dexamethasone 3 mg/kg IV load over 30 minutes, then 1 mg/kg IV every 6 hours x 8 doses | If associated delirium, coma, shock, and/or DIC: Dexamethasone 3 mg/kg IV load over 30 minutes, then 1 mg/kg IV every 6 hours x 8 doses | ||
==Disposition | ==Disposition== | ||
Admit if any complication | Admit if any complication | ||
==Sources | ==Sources== | ||
<references/> | |||
==See Also== | ==See Also== | ||
Revision as of 13:28, 11 August 2014
Typhoid Fever. Catherine Neal, MD and Alex Koyfman, MD. Department of Emergency Medicine, UT Southwestern Medical Center / Parkland Memorial Hospital, Dallas, Texas, USA
Background
Diagnosed in 2% of febrile travelers
Caused by Salmonella enterica serotype Typhi (formerly Salmonella typhi) serotype paratyphi A, B, and C
Endemic in Mexico, Indonesia, Peru, and the Indian subcontinent
Prior vaccination does not exclude infection
Incubation period 1-3 weeks
Chronic carrier state defined as organism in urine or stool > 12 months
Chronic carrier state risk factors: biliary tract abnormalities
Symptoms:
Classic symptoms:
- Bradycardia relative to fever
Initial symptoms:
- Fever
- Abdominal pain
- Headache
Subsequent symptoms:
- Chills (rarely rigors)
- Cough
- Abdominal distension
- Constipation (more common than diarrhea)
- “Rose spots” – truncal light red macular rash (in the 2nd wk)
- Prostration
- Hepatosplenomegaly
- GI bleeding
- Transaminitis
- Leukopenia with left shift (adults)
- Leukocytosis (children)
Diagnosis and Work-Up:
Blood culture
Urine culture
Stool culture
“Rose spot” aspiration
Bone marrow culture (most sensitive)
Sensitivity testing for nalidixic acid
Complications:
Small-bowel ulceration
Intestinal perforation
Anemia
DIC
Pneumonia
Meningitis
Myocarditis
Cholecystitis
Renal failure
Chronic carrier state
Differential Diagnosis:
Malaria
Typhus
Viral hepatitis
Amebic Liver Abscess
Infectious enteritis
Treatment
- Consultation with Infectious Disease should be considered since there are increasingly multidrug resistant strains of S. Typhi and coinfection with diseases such as Malaria may complicate treatment. The therapy favors the use of fluorquinolones unless suspected or known resistance.[1]
Antibiotics
Oral therapy with Quinolone Susceptibility:
- Ciprofloxacin 500-750 mg PO q 12 hrs x 14 days
Parenteral Therapy with Quinolone Susceptibility:
- Ciprofloxacin 400 mg IV q 12 hrs x 10 days
Parenteral Therapy with Quinolone Resistance:
if nalidixic acid resistant, can assume fluoroquinolone resistant
- Ceftriaxone 2mg IV q 24 hrs x 14 days
- OR
- Cefixime 10-15 mg/kg IV q 12 hrs x 8 days
Oral Therapy with Quinolone Resistance:
- Azithromycin 1 g PO daily x 5 days
Adjunctive Therapy
If associated delirium, coma, shock, and/or DIC: Dexamethasone 3 mg/kg IV load over 30 minutes, then 1 mg/kg IV every 6 hours x 8 doses
Disposition
Admit if any complication