Enteric Fever PDF

Enteric Fever Presented by : DR. Omer Dakeen Senior Pediatric specialist  Introduction Also known as “typhoid fever” Etiology: ▫ Salmonella enterica typhi ▫ Salmonella paratyphi A,B,C typhi: paratyphi = 10:1 Route of transmission: faecal-oral route ...

Enteric Fever Presented by : DR. Omer Dakeen Senior Pediatric specialist  Introduction Also known as “typhoid fever” Etiology: ▫ Salmonella enterica typhi ▫ Salmonella paratyphi A,B,C typhi: paratyphi = 10:1 Route of transmission: faecal-oral route  Epidemiology Frequent in Summer season Can occur from infancy to old age Children 2 to 15 years very commonly affected Pathogenesis  Clinical features High grade fever Coated tongue Anorexia Vomiting Diarrhoea/ constipation Abdominal pain Headache Obtundation  Examination Relative bradycardia Rose spots on trunk ( 1st week) Hepatosplenomegaly Tympanic abdomen  Complications CNS ▫ Encephalopathy, delirium, ataxia, seizure CVS ▫ Endocarditis, myocarditis, CCF Respiratory ▫ Pneumonia, empyema Gastrointestinal Hepatobiliary ▫ Cholecystitis, heptitis, hepatic or splenic abscess Genitourinary ▫ UTI, renal abscess, prostatitis Bones ▫ Osteomyelitis, septic arthritis  Investigations Leukopenia with relative lymphocytosis Deranged LFT Blood culture (gold standard) Agglutination test ▫ Widal test Stool culture Urine culture Bone marrow culture Monoclonal Antibody  Differential diagnosis Viral fever Malaria Tuberculosis Septicemia Brucellosis Leptospirosis Dengue Infectious mononucleosis Acute hepatitis  Treatment Adequate rest Hydration Antipyretics Soft diet Antibiotic treatment Encephalopathy/ Shock: ▫ Dexamethasone  Antibiotic treatment Uncomplicated typhoid: ▫ Amoxycillin : 75 mg/kg/d TID 14 d ▫ Fluroquinolones: 15mg/kg/d BD 7-10 d ▫ Cefixime: 15- 20 mg/kg/d BD 7-14 d ▫ Azithromycin : 8-10 mg/kg/d OD 7d Severe typhoid: ▫ Ampicillin: 100mg/kg/d IV QID 14 days ▫ Ceftriaxone: 60-75mg/kg/d BD 10-14days ▫ Gatifloxin: 10 mg’kg/d 7 days  Prognosis Age General state of the health Chronic carriers: ▫ Gall bladder ▫ Excretes S. typhi for >3mnths  Prevention Proper sewage/ sanitation Hand washing Thank you