A case on Typhoid Fever

Group 4
Baccay, Ezra Kimraja
Clemente, Kristine Jane
Lasam, Janine Marie
Padilla, Jiane Karla
Pattaguan, Donesthel
Tabugay, Lolaine
Vargas, Aige
 Demographics

Name

N.P.

Age/Sex
Ward Number
17 y/o F
SA46

Resident-In-Charge
Chief Complaint
Fever change in sensorium
 History of Present Illness
7 Days Prior to 3 Days Prior to Few Hours Prior to
Consult Consult Consult

High grade fever

associated with
changes in
Given sensorium
Chloramphenicol
Fever
Other Patient Information

Past Medical Lifestyle Family Medical

History History
Feb 18: Dog bite Not Available Not Available
with 3 shots of anti-
rabies vaccine
 Review of Systems

01 02 03 04 05
Drowsy, confused
Anicteric sclerae Tachycardia, Full (+) Pallor SLE, CBS
pulses (-) Jaundice
 Laboratory Results
Vital Signs
Vital Signs 04-14-18 04-15-18 04-16-18 Interpretation
N 110/80 110/80 110/80
Blood
A 110/80 110/80 110/80 *Normal
Pressure
P 110/80 110/80 110/70
N 92 94 96
*Slightly
Heart Rate A 98 91 100 Increased
04-16-18
P 86 90 120
N 22 20 24
Respiratory
A 22 20 21 *Normal
Rate
P 20 20 26
N 36.1 36.3 36.8
Temperature A 36 36.5 36.1 *Normal
P 36.5 37.2 36
 Laboratory Results
Hematology
Hematology 04-02-18 04-10-18 Interpretation

Hgb 12.0-16.0 g/dL 13.9 11.9 Normal

Slightly
HCT 39-54% 40 37 Decreased
04-10-18

Normal (except
WBC 5.0-10.0x109/L 12.34 10.30
04-02-18)

LYMPH 0.18-0.48 0.18 0.16 Normal

MONO 0.04-0.14 0.08 0.09 Normal

PLT 150-459x109/L 251 487 Increased

RDW 11.5-15 12.5 13.5 Normal

 Laboratory Results
Blood Chemistry

Blood Chemistry 04-02-18 04-07-18 04-11-18

Sodium 135-155 mmol/L 132.9 130.40 132.9

Potassium 3.6-5.5 mmol/L 3.18 3.45 3.10

Chloride 95-108 mmol/L - -- ---

Magnesium 0.8-1.0 mmol/L - -- ---

 Laboratory Results
Urinalysis

Urinalysis 03-30-18 Interpretation

Color Pale Yellow Normal
Transparency Turbid Normal
Sp. Gravity 1.016-1.022 1.020 Normal
Sugar (-) (-) Normal
RBC 0-2/hpf -- ---
Mucous Threads Few Occasional Normal
Epith Cells Few Squamous
Bacteria (-) Few Need intervention*
Protein (-) (-) Normal
 Laboratory Results
Culture and Sensitivity

DATE SPECIMEN ORGANISM RESULT

04-11-18 CSF Microbiology No growth after
report 3 days of
incubation
Diagnostic Results
 Normal CT-scan of the head
Cranial CT-SCAN or the brain, contrast
04-02-18 enhance study suggested
for further evaluation if
clinically warranted

CXR  Pneumonia
04-12-18  R Parahilar area
 Present Working Impression

Typhoid Fever

Typhoid Encephalopathy
Medications and Indications
For Severe Typhoid Fever

Ceftriaxone 2g Empiric Tx of Severe Typhoid Fever

q12h

Mannitol 100cc To decrease intracranial pressure

caused by typhoid
q12h

Heraclene 1mg Used

To as adjunctive
stimulate appetite
1 cap OD treatment with ASA
Used to reduce risks of stroke in
patients with CHF and angina
Medications and Indications
For Typhoid Encephalopathy

Phenobarbital Prophylaxis Tx Typhoid

6omg/tab BID encephalopathy
Medications and Indications
Other Medication

Ranitidine To Tx Stress-Induced Ulcer

150mg/tab BID
Pathophysiology
 Intervention:
• Consider an increase in dose of Dibencozide
when concomitantly used with Phenobarbital
(Medscape)

Phenobarbital
+ Dibencozide
Phenobarbital decreases level of Dibencozide
by inhibition of GI absorption
 Intervention:
• Relapse rate is much lower following treatment
with quinolone drugs which has effective
intracellular penetration. A dose of Ciprofloxacin
500mg/tab orally 2x/day for 7-10 days can be
given.
• After discharge, relapse or complication should
be monitored for 3 months.

Possibility of Reference:
Medscape
The Phil Working Group Drug

Relapse Resistant on Typhoid Fever

Your Picture Here

Typhoid fever may occur in rare cases as such

a second or third relapse can occur
 Pharmacist’s Care Plan
Health Care Pharmacotherapeutic Recommendation/Inter Monitoring Desired
Frequency
Need Goal vention Parameter EndPoint
Obj. therapeutic: Daily
Urinalysis No bacterial
C/S growth Q after 2
Gram stain 37° days
Temp. Daily

Subj. (-) Diarrhea,

1.) therapeutic: intestinal Daily
Management a.) To eradicate Compliance with (-) Diarrhea, bleeding
of Typhoid etiological agent Ceftriaxone 2g q12h intestinal
Fever bleeding

Subj. toxic:
Watch out for SE No occurrence Daily
Ceftriaxone of SE
 Swelling of
Tongue
 Vaginal itching
 Pharmacist’s Care Plan
Health Care Pharmacotherapeutic Recommendation/Inte Monitoring Desired
Frequency
Need Goal rvention Parameter EndPoint

Obj. therapeutic:
ELISA
b.) To manage Severe
(-) Salmonella
Typhoid Complication Q 3 mos.
Subj. toxic: Antibody
1.)  To treat Typhoid Compliance with
Watch our for
Management encephalopathy Phenobarbital 60mg tab
SE:
of Typhoid 1 tab BID
Mannitol No occurrence
Fever  To decrease Daily
 Electrolyte of SE
intracranial Compliance with
imbalance
pressure Mannitol 100cc q12h
Phenobarbital
 Hangover
effect

Subj.
Compliance with:
therapeutic:
c.) To increase Dibencozide
(-) poor appetite (-) poor
appetite (Heraclene) 1mg 1 cap Daily
due to typhoid appetite
OD
fever
 Pharmacist’s Care Plan
Health Care Pharmacotherapeuti Recommendation/Int Monitoring Desired
Frequency
Need c Goal ervention Parameter EndPoint
Obj.
therapeutic:
Urinalysis Daily
C/S No bacterial Q after 2
Gram stain growth days
2.)
To prevent Compliance with Q after 2
Prevention of
recurrence and Ciprofloxacin 500mg Subj. toxic: days
Typhoid
further infection tab BID for 7-10 days Ciprofloxacin No occurrence
Fever
Severe of S.E.
dizziness Daily
Bloody
diarrhea
 Pharmacist’s Notes
To Doctor
Re: Patient N.P. Ward and Room Number: 5A46 Date: April 17, 2018

Recommendation:
We would like to recommend to increase the dose of
Dibencozide(Heraclene) from 1mg to 3mg when concomitantly use with
Phenobarbital

Discussion:
Phenobarbital decreases level of Dibencozide by inhibition of GI
absorption

Reference: Medscape
 Pharmacist’s Notes
To Doctor
Re: Patient N.P Ward and Room Number: 5A46 Date: April 17, 2018

Recommendation:
We would like to recommend an initiation of Ciprofloxacin 500mg tab
BID for 7-10 days for prevention of relapse.

Discussion:
Possibility of relapse of typhoid fever may occur in rare cases. A
relapse rate is much lower following treatments with Quinolone drug, which
has effective intracellular penetration. Example of which is Ciprofloxacin.

Reference: Medscape,
The Phil Working Group on
Drug Resistant Typhoid
Fever
 Pharmacist’s Notes
To Nurse
Re: Patient N.P Ward and Room Number: 5A46 Date: April 17, 2018

Recommendation:
We would like to recommend a follow up check up after 3 months to
monitor relapse or recurrence of typhoid fever.

Discussion:
Possibility of relapse of typhoid fever may occur in rare cases. As
such 2nd or 3rd relapse can occur. Monitoring after 3 months is a must to
prevent the spread of infection
Reference: Medscape
 References
Medscape.com

A
Drugs.com B D Lexicomp

The Phil Working Group on Drug Resistant Typhoid Fever

Thank you