Causative agent of Typhoid fever:

Typhoid fever is caused by Salmonella typhi.

Signs-symptoms of typhoid fever:

In the first week:

1. Fever, where temperature increases in a stepladder pattern for 4 or 5 days
2. Malaise
3. Headache
4. Anorexia
5. Myalgia
6. Constipation
7. Diarrhea and vomiting (in children)
8. Relative bradycardia
9. Drowsiness.

End of the first week:

1. Rose red spots on the back and upper abdomen. These are maculo – popular rash which fade on pressure.
2. Splenomegaly (Hepatomegaly can also be present)
3. Cough
4. Epistaxis
5. Diarrhoea
6. Abdominal distension with tenderness
7. Bronchitis
8. Delirium.

End of the second week:

1. Increased toxemia
2. coma.

Complications (Usually occurs in 3^rd to 4^th weeks):

Commonest complications:

1. Perforation of typhoid ulcer in the small intestine
2. Bleeding from typhoid ulcer.

Other complications :

1. Within the abdomen-

• Pancreatitis
• Splenic abscess
• Liver abscess
• Nephritis

2. In the CVS

• Endocarditi
• Myocarditis
• Pericarditis

3. In Respiratory system- Pneumonia

4. In CNS –

• Bacterial meningitis
• Peripheral neuropathy

5. In Skeletal system –

• Arthritis
• Osteomyelitis.

Investigations:

1. TC, DC- usually leucopenia occurs with relative lymphocytosis.[But in 2^nd week – leukocytosis occurs]
2. Blood for C/S – gold standard for diagnosis of enteric fever[in 1^st week]
3. Stool culture – in second week
4. Urine culture – in third week
5. Widal test – It is done in 2^nd wk to see the rise of antibody titre
6. Bone marrow examination.

Treatment of typhoid fever:

General treatment:

1. Bed rest
2. Maintenance of proper nutrition.

Specific treatment:

Ciprofloxacin – 500 mg twice daily for 14 days
Or, Ofloxacin -500mg twice daily for 14 days
Alternative choice is Ceftriaxone 1-2 gm IV 12 hourly for 10 -14 days
Drug of choice for treatment of typhoid in pregnancy – Ceftriaxone.

Prevention of typhoid fever:

1. Avoid taking contaminated foods and drinks
2. Take Typhoid vaccine in endemic areas.