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TYPHOID FEVER in children


TYPHOID FEVER

       Dr Sadia Hayat

EVALUATION

  • Fever: high grade continuous, classic step ladder pattern may not be seen in children.
  • Diarrhea: constipation, less common
  • Rash: salmon colored, maculopapular, blanchable, truncal rash of 1-4 cm size lesions that appear at the end of 1st week & disappear in 2-3 days
  • Toxicity, Anorexia ,Wt loss
  • Abdominal pain, distention (due to hepatosplenomegaly)
  • Intestinal hemorrhage: (hematemesis, melena)
  • Perforation (distention, bilious vomiting, absent bowel sounds, pneumoperitonium)
  • Encephalopathy (apathy, confusion, psychosis, chorea,loss of speech or irrelevant speech)
  • Cholecystitis ( Chronic carriers of salmonella typhi)

LAB WORK
  • Hb, TLC ( there may be Low TLC ), DLC, Platelets, ESR
  • Blood culture (40-60% positive even in late stages of disease but require good volume of blood to be taken in culture bottle)
  • Urine & Stool culture( in early stages of disease may be positive)
  •  CXR ( to rule out other causes of high fever ), X-Ray plain abdomen ( to rule out perforation, bowel obstruction),
  • Widal test has poor sensitivity / specificity (only supportive)
  • Rule out Malaria with Rapid Antigen test or MP slide thick and thin films.



MANAGEMENT

  • Admit the patient –(Persistent Fever, Poor intake, drowsiness, fits, extreme toxicity  )
  • Maintain IV Line.
  • Record TPR x 4 hourly.
  • Expose to lower Temperature.
  • Syp. Paracetamol (15mg/kg/dose 4-6 hourly) or ibuprofen (10mg/kg/dose) 6-8 hourly
  • IV fluids: correct Dehydration with deficit therapy and then give 100% maintenance as 5% dextrose / N/5 saline.
  • Start Antibiotics.
·         Inj. Ciprofloxacin (15mg/kg/dose IV x 12 hourly for 10 days if age > 8 y).
·         Inj. Ceftriaxone 50mg/kg/dose IV x 12 hourly for 10-14 days
·         Start steroids if patient very toxic, has encephalopathy or impending perforation, (Inj. Dexamethasone 1mg/kg/day , or Pulses on inj Methylprednisolone 20-30 mg/kg/day).                                                                                             
  • Surgical opinion for abdominal complications like perforation, peritonitis, & cholecystitis

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