Typhoid

Question 1

Define

Answer 1

Caused by Salmonella typhi or paratyphi

Faeco-oral transmission

N.B. travel buzzword = Pakistan, India, Bangladesh

Question 2

Symptoms and signs

Answer 2

• Worsening fever
• Headaches
• Dry cough
• Abdominal pain
• Anorexia, malaise, myalgia
• Diarrhoea or constipation – may not appear until second week (first constipation, then diarhoea normally)
• Splenomegaly
• Bradycardia
• Rose-spots (RARE)

Complications

• GI perforation
• Myocarditis
• Hepatitis
• Nephritis

Investigations

• Send blood cultures, stool samples and do bloods
• Do HIV test, malaria, TB test to rule out

Question 3

Management

Answer 3

IV Ceftriaxone 2g OD

PO Azithromycin 500mg BD for 7 days

Supportive care- antipyretics, IV fluids

If encephalopathic, add high-dose dexamethasone