| ID | 186 |
|---|---|
| Name | TYPHOID & PARATYPHOID (ENTERIC) FEVER |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Diagnosis: A. Clinical feature: 1. Characteristic fever (step-ladder fashion) 2. Relative bradycardia. 3. Alteration of the bowel habit etc. B. Investigations: 1. In the first week- a. Blood count- leucopenia. b. Blood culture- positive usually. 2. During 2nd and 3rd week-a. Stool and urine culture |
| Management | |
| Introduction | These are caused by infections with salmonella typhi and salmonella paratyphi. The organism’s gain access to the body through ingestion of contaminated food, water and milk. Infected shellfishes are occasionally responsible for an outbreak. The incubation period of typhoid fever is 10-14 days; that of paratyphoid fever is somewhat shorter. |
| History | |
| Etiology | |
| Clinical Features | Clinical features: Typhoid fever: 1. Onset may be insidious. 2. The temperature rises in a step-ladder fashion. 3. There is malaise with increasing headache, drowsiness and aching in the limbs 4. Cough and epistaxis may occur. 5. Constipation may be present. Although in children diarrhoea and vomiting may be prominent, relative bradycardia is present. 6. At the end of 1st week the typical rash may appear on the upper abdomen and on the back as sparse slightly raised, rosered spots which fades on pressure. 7. About the 7th to 10th day of illness the spleen becomes palpable. 8. In this time constipation is succeeded by diarrhoea and generalised abdominal distention with tenderness in the right illiac fossa. 9. Bronchitis and delirium may develop. By the end of the second week the patient may be profoundly ill unless the disease is modified by antibiotic treatment. 10. In the 3rd week toxemia increases and the patient may pass into coma and die. Paratyphoid fever: 1. The course tends to be shorter and milder than that of typhoid fever. 2. The rash may be more abundant and 3. The intestinal complications less frequent. |
| Preventions | |
| Treatment | Treatment: 1. Bed rest during febrile period and for 10-14 days after. 2. Diet- sufficient fluid intake, low roughage diet, chicken and vegetable soup, egg flips during the febrile stage and then the patient should have gradually soft rice, boiled fish etc. 3. Proper nursing care. 4. Tab. Cotrimoxazole 980mg (2 tab. or 1 DS tab.) 12 hourly orally for 10-14 days or Trimethoprim 300mg 12 hourly for same period. Or, 5. Cap. Amoxycillin 750mg (or 100mg/kg daily in divided doses.) 6 hourly for 14 days. Or, 6. Ciprofloxacin 500mg 12 hourly for 14 days. Or, 7. Chloramphenicol 250mg 6 hourly for 14 days. 8. If the patient is very toxic with poor general condition then, tab. Prednisolone 5mg (1 tab.) 3-4 times daily till the temperature subsides then withdraw it gradually. 9. The chronic carrier should be treated with Ciprofloxacin for 4 weeks. 10. Cholecystectomy may be necessary in some patients such as perforation. Negative culture of consecutive six stool or urine samples indicate complete cure. |
| Complications | Complications: 1. Hemorrhage and perforation at the end of 2nd week or during the 3rd week. 2. Pneumonia, thrombophlebitis, myocarditis, myositis, arthritis, periostitis, osteomyelitis, meningitis and cholecystitis may occur due to septicemia which may present during the first week. |
| Prognosis | |
| Types | |
| Classification | |
| Observation | |
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