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
No comments:
Post a Comment