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Questions and Answers
What antibiotics are preferred for empiric therapy of typhoid fever pending sensitivities?
What antibiotics are preferred for empiric therapy of typhoid fever pending sensitivities?
What is the concern associated with the use of chloramphenicol?
What is the concern associated with the use of chloramphenicol?
How long should antimicrobial therapy for endovascular infections be continued after successful surgery?
How long should antimicrobial therapy for endovascular infections be continued after successful surgery?
What is the preferred empirical treatment for typhoid fever in developed countries?
What is the preferred empirical treatment for typhoid fever in developed countries?
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What is the treatment duration for Salmonella bacteremia?
What is the treatment duration for Salmonella bacteremia?
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Why are fluoroquinolones not preferred for use in children?
Why are fluoroquinolones not preferred for use in children?
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What is the treatment of choice for proven or possible CNS involvement?
What is the treatment of choice for proven or possible CNS involvement?
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What antibiotics are recommended for treatment of salmonella infection in pregnancy?
What antibiotics are recommended for treatment of salmonella infection in pregnancy?
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What is the typical incubation period of typhoid fever?
What is the typical incubation period of typhoid fever?
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What is a common indicator of typhoid fever?
What is a common indicator of typhoid fever?
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What is the accuracy of blood culture in detecting bacteremia?
What is the accuracy of blood culture in detecting bacteremia?
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What is a common symptom of typhoid fever in the first week?
What is a common symptom of typhoid fever in the first week?
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What is a complication of typhoid fever that can occur if left untreated?
What is a complication of typhoid fever that can occur if left untreated?
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What predisposes to Salmonella urinary tract infections?
What predisposes to Salmonella urinary tract infections?
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What is a characteristic of the fever in typhoid fever?
What is a characteristic of the fever in typhoid fever?
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What is a characteristic of relapses in immunosuppressed patients with Salmonella bacteremia?
What is a characteristic of relapses in immunosuppressed patients with Salmonella bacteremia?
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What is the preferred specimen for isolation of nontyphoidal Salmonella species?
What is the preferred specimen for isolation of nontyphoidal Salmonella species?
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What is the significance of a high sedimentation rate in salmonellosis?
What is the significance of a high sedimentation rate in salmonellosis?
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Why is bone marrow aspirate and culture superior to blood culture for diagnosing Salmonella infection?
Why is bone marrow aspirate and culture superior to blood culture for diagnosing Salmonella infection?
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What is the significance of eosinophilia in patients with salmonellosis?
What is the significance of eosinophilia in patients with salmonellosis?
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What is the indication for antibiotic therapy in patients with nontyphoidal Salmonella gastroenteritis?
What is the indication for antibiotic therapy in patients with nontyphoidal Salmonella gastroenteritis?
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What is the role of imaging studies in patients with salmonellosis?
What is the role of imaging studies in patients with salmonellosis?
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What is the significance of a low eosinophil count in patients with salmonellosis?
What is the significance of a low eosinophil count in patients with salmonellosis?
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What is the usual outcome of Salmonella gastroenteritis?
What is the usual outcome of Salmonella gastroenteritis?
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Study Notes
Typhoid Fever Treatment
- Quinolone, macrolide, and third-generation cephalosporin antibiotics are preferred for empiric therapy pending sensitivities.
- Sensitivity to quinolones has been steadily declining, and they are no longer fool-proof agents for typhoid fever.
- Azithromycin is the preferred empirical treatment, often given together with ceftriaxone, in developed countries.
- Chloramphenicol is reserved for life-threatening situations where no alternatives are available.
Antimicrobial Therapy
- Salmonella bacteremia is generally treated with a single bactericidal drug for 10-14 days.
- Life-threatening infections should be treated with both a third-generation cephalosporin and a fluoroquinolone until the susceptibilities of antimicrobial agents are known.
- Antimicrobial therapy for endovascular infections should be continued for a minimum of 6 weeks after successful surgery.
Special Considerations
- High-dose ceftriaxone is the best choice for CNS involvement due to optimal penetration of the blood-brain barrier.
- Antibiotic therapy should be reserved for cases of invasive disease in pregnancy, using amoxicillin or cephalosporin.
Diagnosis
Laboratory Tests
- Freshly passed stool is the preferred specimen for isolation of nontyphoidal Salmonella species.
- PCR is performed.
- Bone marrow aspirate and culture is superior to blood culture, since the bacterial concentration in bone marrow is 10 times that of peripheral blood.
Hematology and Chemistry
- The WBC count is usually within the reference range in patients with salmonellosis.
- Approximately one-fourth of patients with typhoid fever are leukopenic, neutropenic, or anemic.
- Thrombocytopenia is neither universal nor diagnostic.
- Mild hepatocellular liver function abnormality is common.
Imaging Studies
- Radiologic findings in salmonellosis are nonspecific.
- Patients older than 50 years with nontyphoidal Salmonella bacteremia should undergo clinical assessments such as CT or MRI to rule out concurrent vascular infections.
Salmonella Gastroenteritis
- Salmonella gastroenteritis is usually a self-limiting disease.
- Fluid and electrolyte replacement may be indicated in severe cases.
- Antibiotics are not routinely used to treat uncomplicated nontyphoidal Salmonella gastroenteritis.
Typhoid Fever
- The clinical course of typhoid fever varies greatly, ranging from fever with little other morbidity to marked multisystem toxemia.
- The incubation period is 10-14 days, and typhoid fever is usually associated with prolonged low-grade fever, dull frontal headache, malaise, myalgia, dry cough, anorexia, and nausea.
Other Presentations of Salmonella Infection
- Urolithiasis or structural abnormalities and immunosuppressive therapy predispose to Salmonella urinary tract infections.
- Relapses can occur, even with appropriate therapy, and the relapse rate is significantly higher in immunosuppressed patients with Salmonella bacteremia.
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Description
This quiz covers the preferred antibiotics for treating typhoid fever, including quinolones, macrolides, and cephalosporins, and the growing resistance to these agents. It also touches on the decline of chloramphenicol resistance in endemic areas.
