Typhoid fever in adults

Question 1

Clinical manifestations of typhoid fever

Answer 1

-(+) history of travel
-fever for ≥ 5 days
-fever of > 38o
C
-headache, diarrhea, body malaise, abdominal pain, GI bleeding, confusion

Question 2

Candidates for hospital admission

Answer 2

1. Complicated typhoid fever
2. Typhoid fever in pregnancy
3. Social circumstances

Question 3

Definition of complicated typhoid fever

Answer 3

unable to take oral fluids due to persistent vomiting
at risk of developing severe form of TF
unstable VS

Question 4

Laboratory test to confirm TF

Answer 4

Culture and isolation
PCR

Antibody detection: tubex, typhidot, typhirapid

Question 5

Management for UNCOMPLICATED TF

Answer 5

-Amoxicillin 500mg/cap
2 caps q6h 14 days Compliance issues due to
pill burden

-Chloramphenicol 
500mg 2caps q6h 14 days
Compliance issues due to 
pill burden
Risk for bone marrow 
suppression

-TMP-SMX 800/160
mg 1 tab q12h 14 days
Increased drug pressure
and risk for Stevens-Johnson’s Syndrome

-Cefixime 200 mg 1 tab
q12h 7 days Higher cost
Inaccessibility

-Azithromycin 500 mg 
1-2 tab q24h 7 days
Higher cost 
Increased drug pressure
Risk of QT prolongation

-Ciprofloxacin 500mg 
q12h 7 days
Collateral damage to 
tuberculosis and MRSA
Risk of QT prolongation

-Ofloxacin 400 mg 1 
tab q12h 7 days
Collateral damage to 
tuberculosis and MRSA
Risk of QT prolongation