Typhoid fever: Difference between revisions
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''Not to be confused with [[typhus]], a distinct disease caused by a different genera of bacteria'' | ''Not to be confused with [[typhus]], a distinct disease caused by a different genera of bacteria'' | ||
==Background== | ==Background== | ||
[[File:Mm7207a2-F-large.gif|thumb|Estimated national typhoid fever incidence* and typhoid conjugate vaccine introduction† status — worldwide, 2019 and 2022. TCV = typhoid conjugate vaccine. Cases per 100,000 population. † Liberia, Nepal, Pakistan, Samoa, and Zimbabwe have introduced TCV.<ref>Global Burden of Disease Collaborative Network, Global Burden of Disease study, 2019. https://www.healthdata.org/gbd/gbd-2019-resources</ref>]] | |||
*Also known as "enteric fever" (of which paratyphoid fever is an additional subset) | *Also known as "enteric fever" (of which paratyphoid fever is an additional subset) | ||
*Diagnosed in 2% of febrile travelers and caused by ''[[Salmonella]] enterica serotype Typhi'' (formerly ''Salmonella typhi'') ''serotype paratyphi A, B, and C''<ref>Tintinalli et. al. Typhoid Fever. In: Tintinalli et. al. Emergency Medicine A Comprehensive Study Guide. New York, NY: McGraw Hill. 2011. 1082-1084. </ref> | *Diagnosed in 2% of febrile travelers and caused by ''[[Salmonella]] enterica serotype Typhi'' (formerly ''Salmonella typhi'') ''serotype paratyphi A, B, and C''<ref>Tintinalli et. al. Typhoid Fever. In: Tintinalli et. al. Emergency Medicine A Comprehensive Study Guide. New York, NY: McGraw Hill. 2011. 1082-1084. </ref> | ||
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==Clinical Features== | ==Clinical Features== | ||
[[File:Typhoid patient.png|thumb|Typical clinical features in patient suffering from typhoid.]] | [[File:Typhoid patient.png|thumb|Typical clinical features in patient suffering from typhoid.]] | ||
[[File:Salmonella typhi typhoid fever PHIL 2215 lores.jpg|thumb|Rose spots (flat, rose-colored spots) on the chest of a patient with typhoid fever.]] | |||
[[File:Typhoid Stool.jpg|thumb|Example of frank bloody "pea soup" diarrhea characteristic during the second week.]] | [[File:Typhoid Stool.jpg|thumb|Example of frank bloody "pea soup" diarrhea characteristic during the second week.]] | ||
===Classic symptoms=== | ===Classic symptoms=== | ||
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==Evaluation== | ==Evaluation== | ||
[[File:Microscopic Typhoid Fever.jpg|thumb|Bacilli of typhoid fever from a culture. The long flagellae, which are constantly in motion, are very charatteristic of this organism.]] | |||
*Blood culture | *Blood culture | ||
*Urine culture | *Urine culture | ||
Latest revision as of 22:14, 7 February 2024
Not to be confused with typhus, a distinct disease caused by a different genera of bacteria
Background
Estimated national typhoid fever incidence* and typhoid conjugate vaccine introduction† status — worldwide, 2019 and 2022. TCV = typhoid conjugate vaccine. Cases per 100,000 population. † Liberia, Nepal, Pakistan, Samoa, and Zimbabwe have introduced TCV.[1]
- Also known as "enteric fever" (of which paratyphoid fever is an additional subset)
- Diagnosed in 2% of febrile travelers and caused by Salmonella enterica serotype Typhi (formerly Salmonella typhi) serotype paratyphi A, B, and C[2]
- Endemic in Mexico, Indonesia, Peru, and the Indian subcontinent
- Prior vaccination does not exclude infection
- Incubation period 1-3 weeks with chronic carrier state defined as organism in urine or stool > 12 months
- Chronic carrier state risk factors: biliary tract abnormalities[3]
Clinical Features
Classic symptoms
- Bradycardia relative to fever (Faget sign)
Initial symptoms
Subsequent symptoms
- Chills (rarely rigors)
- Cough
- Abdominal distension
- Constipation (more common than diarrhea)
- “Rose spots” – truncal light red macular rash (in the 2nd wk)
- Hepatosplenomegaly
- GI bleeding
- Transaminitis
- Leukopenia with left shift (adults)
- Leukocytosis (children)
Differential Diagnosis
- Viral hepatitis
- Amebic Liver Abscess
- Infectious enteritis
Fever in traveler
- Normal causes of acute fever!
- Malaria
- Dengue
- Leptospirosis
- Typhoid fever
- Typhus
- Viral hemorrhagic fevers
- Chikungunya
- Yellow fever
- Rift valley fever
- Q fever
- Amebiasis
- Zika virus
Evaluation
- Blood culture
- Urine culture
- Stool culture
- “Rose spot” aspiration
- Bone marrow culture (most sensitive)
- Sensitivity testing for nalidixic acid
Management
- 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.[4]
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, 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 3mg/kg IV load over 30 minutes, then 1mg/kg IV every 6 hours x 8 doses
Disposition
- Admit if any complication
Complications
- Small-bowel ulceration
- Intestinal perforation
- Anemia
- DIC
- Pneumonia
- Meningitis
- Myocarditis
- Cholecystitis
- Renal Failure
- Chronic carrier state
References
- ↑ Global Burden of Disease Collaborative Network, Global Burden of Disease study, 2019. https://www.healthdata.org/gbd/gbd-2019-resources
- ↑ Tintinalli et. al. Typhoid Fever. In: Tintinalli et. al. Emergency Medicine A Comprehensive Study Guide. New York, NY: McGraw Hill. 2011. 1082-1084.
- ↑ Hohmann, E. Epidemiology, microbiology, clinical manifestations, and diagnosis of typhoid fever . In: UpToDate. Last updated: July 2013. Accessed July 30, 2014.
- ↑ Bhutta ZA. et al. Current concepts in the diagnosis and treatment of typhoid fever. BMJ. 2006 Jul 8;333(7558):78-82. PDF