Typhoid (Enteric Fever)
Description
Typhoid, also called enteric fever, is an acute systemic illness caused by Salmonella typhi or Salmonella paratyphi infection. It is more common in children living in areas with poor sanitation and limited access to clean water.
Signs and Symptoms
| Clinical Feature | Details / Notes |
|---|---|
| Fever | High-grade, persistent; suspect typhoid if >72 hours without localizing signs of malaria, meningitis, or respiratory infection |
| Gastrointestinal | Abdominal pain, diarrhea, constipation, coated tongue, anorexia, vomiting, ileus |
| Hepatosplenomegaly | Hepatomegaly, splenomegaly |
| Toxicity | Pallor, obtundation, headache, jaundice |
| Complications | Intestinal perforation, hemorrhage |
Clinical Tip: Mainstay of diagnosis is careful clinical evaluation; early recognition improves outcomes.
Investigations
| Investigation | Timing / Notes |
|---|---|
| Blood culture | Ideally during 1st week of symptoms |
| Urine culture | During 2nd week |
| Stool culture | During 3rd week |
| Widal test | Single test positive in ~50% cases in endemic areas; serial testing may be needed |
| Full Blood Count | Often leukopenia (WCC < 4 × 10⁹/L) with left shift; leukocytosis may occur in young infants |
Note: Because many children present late, take all three cultures at admission.
Treatment
Supportive Care
-
Adequate rest, hydration, and nutrition
-
Fluid-electrolyte correction
-
Antipyretics for fever >39°C
Antibiotic Therapy
| Line | Drug / Dose | Duration | Notes |
|---|---|---|---|
| 1st line | Ciprofloxacin 15 mg/kg/day | 10–14 days | Oral in 2 divided doses |
| 2nd line (drug-resistant) | Imipenem 25 mg/kg/day | 10–14 days | IV, QID |
| Alternative | Ceftriaxone 50 mg/kg/day | 10–14 days | IV, for resistant or severe cases |
| Alternative | Azithromycin 10 mg/kg/day | 5 days | Oral, uncomplicated cases only |
Early diagnosis and timely initiation of antibiotics are critical to prevent complications.
Complications
| Complication | Clinical Clues / Management |
|---|---|
| Intestinal perforation (0.5–1%) | Sudden severe abdominal pain, tachycardia, hypotension, hyperpyrexia, obtundation. Urgent surgical consult required. |
| Peritonitis | Guarding, rigidity on examination. |
| Intestinal hemorrhage (<1%) | Rising WBC, left shift, free air on abdominal X-ray. |
Investigation: Plain abdominal X-ray; urgent referral to surgery if perforation suspected.