Typhoid Fever

Question 1

Typhoid fever causative organisms

Answer 1

Salmonella typhi and Salmonella paratyphi

Question 2

hallmark of typhoid fever

Answer 2

penetration and multiplication w/m the mononuclear phagocytic cells in the liver, spleen, lymph nodes and Peyer’s patches of the ileum

Question 3

Incubation period (S. typhi and paratyphi)

Answer 3

10-20 days or 10-14 days

Question 4

Suspected Typhoid Fever Case

Answer 4

individuals who lives in or has a hx of travel to tropical and subtropical areas

fever >5 days

fever > 38 C plus any of the ff:

• headache
• diarrhea
• malaise/weakness
• abdominal distention/pain
• GI bleeding
• changes in orientation or confusion

Question 5

Acute Uncomplicated Disease

Answer 5

prolonged fever
disturbance in bowel dysfunction - constipation (ADULTS), diarrhea (CHILDREN)
non specific: headache, malaise, N/V, relative bradycardia
ROSE SPOTS: faint, salmon-colored, blanching, maculopapular rashes at the TRUNK area

Question 6

Complicated Disease

Answer 6

occult or overt GI bleeding
intestinal perforation and peritonitis
severe abdominal pain
altered mental status (delirium, obtundation, psychosis, coma)
meningitis, encephalomyelitis, neuritis
others: hepatitis, pancreatitis, myocarditis, DIC, pneumonia

Question 7

SYMPTOMS REPORTED ON INITIAL MEDICAL EVALUATION

Answer 7

headache (80%)
chills (35–45%)
cough (30%)
sweating (20–25%)
myalgias (20%)
malaise (10%)
arthralgia (2–4%)

Question 8

GASTROINTESTINAL MANIFESTATIONS

Answer 8

anorexia (55%)
abdominal pain (30–40%)
nausea (18–24%)
vomiting (18%)
diarrhea (22–28%)
constipation (13–16%)

Question 9

PHYSICAL FINDINGS

Answer 9

coated tongue (51–56%)
splenomegaly (5–6%)
abdominal tenderness (4–5%)

Question 10

EARLY PHYSICAL FINDINGS OF ENTERIC FEVER

Answer 10

rash (“rose spots” - 30%)
hepatosplenomegaly (3–6%)
epistaxis
relative bradycardia at the peak of high fever (<50%)

Question 11

PHYSICAL FINDINGS

Answer 11

coated tongue (51–56%)
splenomegaly (5–6%)
abdominal tenderness (4–5%)

Question 12

EARLY PHYSICAL FINDINGS OF ENTERIC FEVER

Answer 12

rash (“rose spots” - 30%)
hepatosplenomegaly (3–6%)
epistaxis
relative bradycardia at the peak of high fever (<50%)

Question 13

Confirmed Typhoid Fever

Answer 13

Fever >38 C for at least 3 days

Lab confirmed positive culture for S. typhi or S. paratyphi (blood, bone marrow, bone0

Question 14

Probable Typhoid Fever

Answer 14

Fever >38 C for at least 3 days

positive serodiagnosis or antigen detection but w/o S. typhi or S. paratyphi isolation

Question 15

Chronic Carrier

Answer 15

excretion of S. typhi or S. paratyphi in stool/urine for > 1 year after onset of acute symptoms

Question 16

Gold standard for diagnosis of typhoid fever

Answer 16

blood culture

taken from 2 different sites
can be taken anytime but yield is highest during the first 2 weeks

Question 17

Serology

Answer 17

Salmonella - somatic (O) and flagellar (H) antigens

Question 18

Felix-Widal test

Answer 18

measures agglutinating antibody levels against O and H antigens

Question 19

Typhoid tests

Answer 19

detect specific IgM and IgG antibodies to S. typhi

IgM: acute typhoid fever in early phase of infection
IgM and IgG: acute typhoid in the middle phase of infection
IgG: can persist for >2 years after typhoid infection

Question 20

Uncomplicated Typhoid Fever

Answer 20

Amoxicillin
Chloramphenicol
TMP-SMX
Cefixime
Azithromycin
Ciprofloxacin
Ofloxacin

Question 21

Complicated Typhoid Fever

Answer 21

Ceftriaxone then step down to Cefixime
Azithromycin (1 g IV –> 500 mg PO)
Ciprofloxacin 400 mg IV –> 500-740 PO)
Ofloxacin 400 mg IV –> Ofloxacin 400 mg PO