Typhoid Fever
36 Questions
3 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the correct dosage and duration for Ciprofloxacin in the treatment of UNCOMPLICATED typhoid fever?

  • 750 mg q12 for 7 days
  • 250 mg q12 for 10 days
  • 500 mg q12 for 14 days
  • 500 mg q12 for 7 days (correct)

    • Which side effect is associated with the use of Chloramphenicol in the treatment of typhoid fever?

  • Bone marrow suppression (correct)
  • QT prolongation
  • Collateral damage to TB
  • SJS

    • What is the duration required to be afebrile before stepping down to oral antibiotics?

  • 48 hours (correct)
  • 1 week
  • 24 hours
  • 72 hours

    • Which of the following antibiotics is NOT associated with QT prolongation?

    <p>TMP-SMX</p> Signup and view all the answers

    Which antibiotic would be considered a step-down option for a pregnant patient who received Ceftriaxone?

    <p>Amoxicillin</p> Signup and view all the answers

    What is the primary vaccine used for preventing typhoid fever for individuals over 2 years old?

    <p>Vi capsular polysaccharide vaccine</p> Signup and view all the answers

    In the context of typhoid fever, what defines a multi-drug resistant (MDR) strain?

    <p>Resistance to chloramphenicol, ampicillin, and TMP-SMX</p> Signup and view all the answers

    What is the recommended dosage for empirical treatment of suspected multi-drug resistant typhoid fever with Ciprofloxacin?

    <p>500 mg tab q12 for 7 days</p> Signup and view all the answers

    Which antibiotic treatment is indicated for chronic carriers of typhoid fever?

    <p>TMP-SMX 800/160 mg q12 for 6-12 weeks</p> Signup and view all the answers

    What clinical sign may indicate the occurrence of multi-drug resistant typhoid fever?

    <p>No response to antibiotics after 5-7 days</p> Signup and view all the answers

    Which of the following is NOT a clinical manifestation of typhoid fever?

    <p>Vomiting</p> Signup and view all the answers

    What percentage of typhoid fever patients may exhibit hepatosplenomegaly?

    <p>29% to 50%</p> Signup and view all the answers

    Which complication of typhoid fever is characterized by blood clotting abnormalities?

    <p>Disseminated intravascular coagulation</p> Signup and view all the answers

    Which of the following conditions warrants admission due to complications of typhoid fever?

    <p>Pregnancy with typhoid fever</p> Signup and view all the answers

    Which laboratory test is considered a direct detection method for diagnosing typhoid fever?

    <p>PCR</p> Signup and view all the answers

    What is the significance of 'rose spots' in typhoid fever diagnosis?

    <p>They are common but not diagnostic.</p> Signup and view all the answers

    What general clinical finding in patients with advanced typhoid fever may indicate intestinal complications?

    <p>Rebound tenderness</p> Signup and view all the answers

    Which of these statements about the WIDAL test is accurate?

    <p>Its usage has been largely replaced by more accurate methods.</p> Signup and view all the answers

    Which clinical manifestation is present in less than a quarter of typhoid fever patients?

    <p>Rose spots</p> Signup and view all the answers

    What complication of typhoid fever involves severe inflammation of the heart muscle?

    <p>Myocarditis</p> Signup and view all the answers

    Which lab method falls under the indirect detection classification for confirming typhoid fever?

    <p>Antibody detection</p> Signup and view all the answers

    What potential condition may warrant admission for a patient diagnosed with typhoid fever?

    <p>Unavailability of a caregiver</p> Signup and view all the answers

    What type of abdominal exam finding indicates possible intestinal bleeding in advanced typhoid fever?

    <p>Rebound tenderness</p> Signup and view all the answers

    Which of the following is a risk factor for complicated typhoid fever in patients?

    <p>Pregnancy</p> Signup and view all the answers

    Which direct detection method is used for the diagnosis of typhoid fever?

    <p>PCR</p> Signup and view all the answers

    Which statement regarding the clinical criteria for typhoid fever is accurate?

    <p>Headache is one of the common early symptoms.</p> Signup and view all the answers

    Which antibiotic is recommended for the empiric treatment of suspected multi-drug resistant typhoid fever?

    <p>Ofloxacin 400 mg tab</p> Signup and view all the answers

    What characterizes an asymptomatic chronic carrier of typhoid fever?

    <p>Positive rectal swab cultures for a year post-recovery</p> Signup and view all the answers

    Which side effects are associated with the use of Azithromycin?

    <p>QT prolongation</p> Signup and view all the answers

    In what situation would a step-down antibiotic be used for a patient with complicated typhoid fever?

    <p>When the patient is afebrile for 48 hours</p> Signup and view all the answers

    Which of the following statements about typhoid vaccination is accurate?

    <p>Primary vaccination with the Ty21a vaccine requires multiple doses</p> Signup and view all the answers

    Which of these drugs may cause collateral damage to tuberculosis and MRSA?

    <p>Ciprofloxacin</p> Signup and view all the answers

    What dosage of Chloramphenicol is recommended for treatment of uncomplicated typhoid fever?

    <p>500 mg, 2 caps q6</p> Signup and view all the answers

    During which conditions is the typhoid vaccine recommended?

    <p>For individuals traveling to endemic regions</p> Signup and view all the answers

    Which medication is NOT typically indicated for treating chronic carriers of typhoid fever?

    <p>Metronidazole</p> Signup and view all the answers

    What does the presence of a fever after 5-7 days of treatment indicate in a patient with typhoid fever?

    <p>The strain is likely multi-drug resistant</p> Signup and view all the answers

    Study Notes

    Clinical Manifestations of Typhoid Fever

    • Recent travel history to tropical and subtropical regions.
    • Persistent fever lasting ≥5 days, typically with a temperature of 38°C.
    • Common symptoms include headache, diarrhea, body malaise, weakness, abdominal distention, and abdominal pain.
    • Possible gastrointestinal complications such as GI bleeding and changes in orientation.
    • Rose spots presenting as blanching, 2-4 mm erythematous maculopapular lesions occur in <25% of patients.
    • Hepatosplenomegaly found in 29%-50% of cases; rebound tenderness and guarding suggest intestinal bleeding or perforation.

    Admission Criteria for Typhoid Fever

    • Patients with complicated typhoid fever.
    • Pregnant individuals diagnosed with typhoid.
    • Absence of a caregiver to administer medications.
    • Long-distance travel requirements affecting care.

    Complications of Typhoid Fever

    • Potential myocarditis and disseminated intravascular coagulation.
    • Risk of hemolytic uremic syndrome and severe pneumonia.

    Laboratory Diagnosis of Typhoid Fever

    • Direct detection methods: culture and isolation, PCR testing.
    • Indirect detection methods: antibody tests (e.g., Tubex, Thypidot, Thypirapid).
    • Widal test is no longer recommended for diagnosing typhoid fever.
    • Amoxicillin: 500 mg, 2 caps every 6 hours for 14 days.
    • Chloramphenicol: 500 mg, 2 caps every 6 hours for 14 days (risk of bone marrow suppression).
    • TMP-SMX: 800/160 mg, 1 tab every 12 hours for 14 days (risk of Steven-Johnson syndrome).
    • Cefixime: 200 mg, 1 tab every 12 hours for 7 days.
    • Azithromycin: 500 mg, 1-2 tabs daily for 7 days (risk of QT prolongation).
    • Ciprofloxacin: 500 mg every 12 hours for 7 days (concerns about collateral damage to TB and MRSA; QT prolongation risk).
    • Ofloxacin: 400 mg, 1 tab every 12 hours for 7 days (same risks as ciprofloxacin).

    Drugs Causing QT Prolongation or Collateral Damage

    • QT prolongation associated with azithromycin, ciprofloxacin, and ofloxacin.
    • Ciprofloxacin and ofloxacin may cause collateral damage to tuberculosis and MRSA.

    Antibiotic Regimen for Complicated Typhoid Fever

    • Ceftriaxone: 2-3 g IV every 24 hours for 14 days, may step down to cefixime 200 mg, 1 tab every 12 hours.
    • Azithromycin: 1 g IV every 24 hours for 7 days, may step down to azithromycin 500 mg, 1 tab daily.
    • Ciprofloxacin: 400 mg IV every 12 hours for 14 days, may transition to 500-750 mg every 12 hours.
    • Ofloxacin: 400 mg IV every 12 hours for 14 days, may step down to 400 mg, 1 tab every 12 hours.

    Criteria for Transitioning to Oral Antibiotics

    • Patient must be afebrile for 48 hours.
    • Ability to tolerate oral medications confirmed.

    Antibiotics for Pregnant Patients with Typhoid Fever

    • Ampicillin: 1-2 g IV every 6 hours for 10-14 days, can transition to amoxicillin 1 g every 6 hours.
    • Ceftriaxone: 2-3 g IV for 7 days, can step down to cefixime 200 mg, 1 tab every 12 hours for 7 days.

    Multi-Drug Resistant Typhoid Fever (MDRTF)

    • Caused by Salmonella typhi strains resistant to first-line treatments (chloramphenicol, ampicillin, TMP-SMX).
    • Clinical indicators include lack of response after 5-7 days of treatment, contact with a documented case, or an epidemic of MDRTF.

    Empiric Treatment for Suspected MDRTF

    • Cefixime: 200 mg, 1 tab every 12 hours for 7 days.
    • Ciprofloxacin: 500 mg, 1 tab every 12 hours for 7 days.
    • Ofloxacin: 400 mg, 1 tab every 12 hours for 7 days.
    • Azithromycin: 500 mg, 1-2 tabs daily for 7 days.

    Chronic Carriers of Typhoid Fever

    • Defined as patients with positive stool or rectal swab cultures for S. typhi one year after acute illness.
    • Treatment options include TMP-SMX, amoxicillin, ampicillin, and fluoroquinolones (e.g., norfloxacin and ciprofloxacin) for 6-12 weeks.

    Indications for Typhoid Vaccination

    • Recommended for travelers to endemic regions (Sub-Saharan Africa, Central Asia, Indian subcontinent, Latin America, Middle East, Southeast Asia).
    • Individuals with intimate exposure to documented typhoid carriers.
    • Laboratory workers with routine exposure to S. typhi cultures.

    Typhoid Vaccines Available

    • Vi capsular polysaccharide vaccine:
      • Primary dose for ≥2 years, 0.5 ml IM.
      • Booster every 2 years.
    • Oral live attenuated Ty21a vaccine:
      • Primary for ≥6 years, given in 4 doses (days 0, 2, 4, 6).
      • Booster every 5 years after primary series.

    Clinical Manifestations of Typhoid Fever

    • Recent travel history to tropical and subtropical regions.
    • Persistent fever lasting ≥5 days, typically with a temperature of 38°C.
    • Common symptoms include headache, diarrhea, body malaise, weakness, abdominal distention, and abdominal pain.
    • Possible gastrointestinal complications such as GI bleeding and changes in orientation.
    • Rose spots presenting as blanching, 2-4 mm erythematous maculopapular lesions occur in <25% of patients.
    • Hepatosplenomegaly found in 29%-50% of cases; rebound tenderness and guarding suggest intestinal bleeding or perforation.

    Admission Criteria for Typhoid Fever

    • Patients with complicated typhoid fever.
    • Pregnant individuals diagnosed with typhoid.
    • Absence of a caregiver to administer medications.
    • Long-distance travel requirements affecting care.

    Complications of Typhoid Fever

    • Potential myocarditis and disseminated intravascular coagulation.
    • Risk of hemolytic uremic syndrome and severe pneumonia.

    Laboratory Diagnosis of Typhoid Fever

    • Direct detection methods: culture and isolation, PCR testing.
    • Indirect detection methods: antibody tests (e.g., Tubex, Thypidot, Thypirapid).
    • Widal test is no longer recommended for diagnosing typhoid fever.
    • Amoxicillin: 500 mg, 2 caps every 6 hours for 14 days.
    • Chloramphenicol: 500 mg, 2 caps every 6 hours for 14 days (risk of bone marrow suppression).
    • TMP-SMX: 800/160 mg, 1 tab every 12 hours for 14 days (risk of Steven-Johnson syndrome).
    • Cefixime: 200 mg, 1 tab every 12 hours for 7 days.
    • Azithromycin: 500 mg, 1-2 tabs daily for 7 days (risk of QT prolongation).
    • Ciprofloxacin: 500 mg every 12 hours for 7 days (concerns about collateral damage to TB and MRSA; QT prolongation risk).
    • Ofloxacin: 400 mg, 1 tab every 12 hours for 7 days (same risks as ciprofloxacin).

    Drugs Causing QT Prolongation or Collateral Damage

    • QT prolongation associated with azithromycin, ciprofloxacin, and ofloxacin.
    • Ciprofloxacin and ofloxacin may cause collateral damage to tuberculosis and MRSA.

    Antibiotic Regimen for Complicated Typhoid Fever

    • Ceftriaxone: 2-3 g IV every 24 hours for 14 days, may step down to cefixime 200 mg, 1 tab every 12 hours.
    • Azithromycin: 1 g IV every 24 hours for 7 days, may step down to azithromycin 500 mg, 1 tab daily.
    • Ciprofloxacin: 400 mg IV every 12 hours for 14 days, may transition to 500-750 mg every 12 hours.
    • Ofloxacin: 400 mg IV every 12 hours for 14 days, may step down to 400 mg, 1 tab every 12 hours.

    Criteria for Transitioning to Oral Antibiotics

    • Patient must be afebrile for 48 hours.
    • Ability to tolerate oral medications confirmed.

    Antibiotics for Pregnant Patients with Typhoid Fever

    • Ampicillin: 1-2 g IV every 6 hours for 10-14 days, can transition to amoxicillin 1 g every 6 hours.
    • Ceftriaxone: 2-3 g IV for 7 days, can step down to cefixime 200 mg, 1 tab every 12 hours for 7 days.

    Multi-Drug Resistant Typhoid Fever (MDRTF)

    • Caused by Salmonella typhi strains resistant to first-line treatments (chloramphenicol, ampicillin, TMP-SMX).
    • Clinical indicators include lack of response after 5-7 days of treatment, contact with a documented case, or an epidemic of MDRTF.

    Empiric Treatment for Suspected MDRTF

    • Cefixime: 200 mg, 1 tab every 12 hours for 7 days.
    • Ciprofloxacin: 500 mg, 1 tab every 12 hours for 7 days.
    • Ofloxacin: 400 mg, 1 tab every 12 hours for 7 days.
    • Azithromycin: 500 mg, 1-2 tabs daily for 7 days.

    Chronic Carriers of Typhoid Fever

    • Defined as patients with positive stool or rectal swab cultures for S. typhi one year after acute illness.
    • Treatment options include TMP-SMX, amoxicillin, ampicillin, and fluoroquinolones (e.g., norfloxacin and ciprofloxacin) for 6-12 weeks.

    Indications for Typhoid Vaccination

    • Recommended for travelers to endemic regions (Sub-Saharan Africa, Central Asia, Indian subcontinent, Latin America, Middle East, Southeast Asia).
    • Individuals with intimate exposure to documented typhoid carriers.
    • Laboratory workers with routine exposure to S. typhi cultures.

    Typhoid Vaccines Available

    • Vi capsular polysaccharide vaccine:
      • Primary dose for ≥2 years, 0.5 ml IM.
      • Booster every 2 years.
    • Oral live attenuated Ty21a vaccine:
      • Primary for ≥6 years, given in 4 doses (days 0, 2, 4, 6).
      • Booster every 5 years after primary series.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    This quiz covers the clinical criteria and manifestations of typhoid fever, including symptoms such as prolonged fever, stomach pain, diarrhea, and specific skin lesions known as rose spots. It is essential for medical students and healthcare professionals to recognize these symptoms for effective diagnosis and management.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser