TYPHOID FEVER

Clinical picture

1st week
bacteraemia gradual temperature(step ladder), > at night relative bradycardia headache,anorexia, abdominal pain constipation, non-productive cough

2nd week
toxic and apathy sustained temperature slight abdominal distensiaon and spleenomegaly rose spots

3rd week
more toxic and ill sustained high temperature abdominal distension with scanty bowel sound delirious confusional state pea soup diarrhea

Complication

Intestinal
Intestinal hemorrhage intestinal perforation

Liver, gall bladder & pancreas

mild jaundice liver biopsy show "typhoid nodules" pancreatitis

Cardio respiratory
toxic myocarditis mild bronchitis pneumonia(rar e)

CNS
disorientation and restlessness convulsion, polyneuropath y& encephalomye litis

Hemato logical
DIC Hemolysis HUS nephrotic syndrome immune complex glomerulitis

Musculoskele tal system and other system

zenker's degeneration polymyositis arthritis osteomyelitis spleenomegal y and spleen abscess parotitis

INVESTIGATION
WBCs 15-20% - leukopenia and neutropenia majority - normal WBCs leukocytosis mild normocytic normochromic anaemia mild thrombocytopenia liver function test liver enzyme

CBC

cultures

blood culture bone marrow culture stool culture urine culture gastric/ intestinal secretion cultures rose spots culture

serology

widal test antibody v/s O and H ag

new method

ELISA P R

Chloramphenicol

corticosteroid

ampicillin & amoxicillin

TREATMENT

3rd generation cephalosporins

cotrimoxazole

ciprofloxacin and other 4 quinolone drugs