Disease caused by the following salmonella: Salmonella typhi and Salmonella Paratyphi A, B and C. Commonly cause Enteric fever. Salmonella Enteritis causes Gastroenteritis.
Typhoid Fever
Systemic disease caused by S. Typhi. Typhoid bacilli are shed in the faeces of a symptomatic carriers or in the stool or urine of those with active diseases.
Transmission: via contaminated food or water. This may occur through:
• Direct contamination by faeces or urine
• Flies from faeces to food
• Through healthy carriers who are food handlers
• Health personnel through inadequate hygiene when changing soiled linen.
• Healthy carriers who can shed organisms for more than one year.
Clinical Features
High fever, headaches, anorexia, weight loss. Diarrhoea, constipation, abdominal tenderness, changes in sensorium, splenomegaly, relative bradycardia, Rose spots (blanching lesions). High index of suspicion is required when investigating any patient with unexplained fever.
Investigations
• Full haemogram: Relative leukopaenia in relation to the fever
• Cultures: Positive in blood in first week, stool and urine cultures become positive in the third week
• Widal test: Fourfold rise in spared specimen acquired two weeks apart suggest S. Typhi infection. Rising titres of O antigen are significant. NB: Only titres of O antibody of 1:160 or more are significant. The gold diagnostic standard should be isolation of bacilli in cultures.
Management
• Chloramphenicol: (2-4 gm in adults OR 50 mg/Kg body weight per day in children) for 2 weeks
• Cotrimoxazole 4 tabs BD for 2 weeks
• Amoxycillin 4-6 gm or 100 mg/Kg/day in 3 divided doses for 2 weeks
• Ciprofloxacin 500-750 mg BD for 14 days
OR
Ofloxacin 400 mg BD for 14 days
OR
Norfloxacin 400 mg BD for 14 days
OR
Ceftriaxone 1 gm ODIV for 7-14 days
Complications
Intestinal haemorrhage, perforation. Chronic carrier state.
Prevention
• Wholesome drinking water (boil water for 10 minutes or chlorinated)
• Pausterised milk
• Avoidance of food handling by healthy carriers
• Treat the healthy carriers
• Hygienic waste disposal
• Vaccination:
- live attenuated oral vaccine 4 capsules given on alternate days. Avoid antibiotic for 1 week
NB: contra-indicated in immuno-suppression cases.
- Typhim VI vaccine - single dose 0.5 ml IM. (70% efficacy boost every two-three years.
Surgical Complications
intestinal perforation leading to peritonitis, septicaemia.
Clinical Features
Abdominal pain and distension, rebound tenderness
Investigations
• Plain abdominal x-ray: Erect/decubitus which may show pneumoperitonium or multiple Quid levels
Management
• Drugs - as above
• Surgical - laparotomy.
Refer for
• Surgical intervention.
