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close this bookStandard Treatment Guidelines - Ghana (GNDP; 2004; 510 pages)
View the documentPREFACE
View the documentACKNOWLEDGEMENT
Open this folder and view contentsCHAPTER 1: INTRODUCTION
Open this folder and view contentsCHAPTER 2: DISORDERS OF THE GASTROINTESTINAL TRACT
Open this folder and view contentsCHAPTER 3: DISORDERS OF BLOOD AND BLOOD-FORMING ORGANS
Open this folder and view contentsCHAPTER 4: CHILDHOOD IMMUNISABLE DISEASES
Open this folder and view contentsCHAPTER 5: PROBLEMS OF THE NEONATE
Open this folder and view contentsCHAPTER 6: DISORDERS OF THE CARDIOVASCULAR SYSTEM
Open this folder and view contentsCHAPTER 7: DISORDERS OF THE CENTRAL NERVOUS SYSTEM
Open this folder and view contentsCHAPTER 8: DISORDERS OF THE SKIN
Open this folder and view contentsCHAPTER 9: DISORDERS OF THE ENDOCRINE SYSTEM
Open this folder and view contentsCHAPTER 10: DISORDERS OF THE GENITO-URINARY SYSTEM
Open this folder and view contentsCHAPTER 11: SEXUALLY TRANSMITTED INFECTIONS
Open this folder and view contentsCHAPTER 12: HIV INFECTION AND AIDS
close this folderCHAPTER 13: INFECTIOUS DISEASES AND INFESTATIONS
View the documentFEVER
View the documentTUBERCULOSIS
View the documentMENINGITIS
View the documentTYPHOID FEVER
View the documentMALARIA
View the documentWORM INFESTATION (INTESTINAL)
Open this folder and view contentsCHAPTER 14: DISORDERS OF THE RESPIRATORY SYSTEM
Open this folder and view contentsCHAPTER 15: EAR, NOSE AND THROAT DISORDERS
Open this folder and view contentsCHAPTER 16: ORAL AND DENTAL CONDITIONS
Open this folder and view contentsCHAPTER 17: DISORDERS OF THE MUSCULOSKELETAL SYSTEM
Open this folder and view contentsCHAPTER 18: TRAUMA AND INJURIES
Open this folder and view contentsCHAPTER 19: EMERGENCIES
View the documentCHAPTER 20: ANTIBIOTIC PROPHYLAXIS IN SURGERY
View the documentOTHER PUBLICATIONS
View the documentABOUT THIS BOOK
 

TYPHOID FEVER

Typhoid fever (enteric fever) is a common disease wherever sanitary conditions are poor. The infection is caused by consumption of food or water contaminated by faeces. It is caused by a bacterium, Salmonella typhi. The S. typhi invades the intestinal wall and spreads through the bloodstream to all organs. Typhoid fever can be a serious illness characterised by fever, abdominal symptoms, and may end fatally. However, typhoid fever is over diagnosed by many practitioners in Ghana based on only a Widal test, which is an unreliable indicator of typhoid infection. The indiscriminate use of antibiotics for this condition has resulted in the resistance of S. typhi to previously effective treatments such as chloramphenicol. Evidence from many centres in Ghana show some resistance to chloramphenicol.

SYMPTOMS

• Fever which increases gradually to a high fever and persists for weeks (fever does not respond to antimalarials)

• Constipation in the early stages

• Abdominal pain and diarrhoea in the second week of illness

• Severe headache

• Dry cough

• Psychosis and confusion in 10% of adults


SIGNS

• High fever with a relatively slow pulse rate (occasionally pulse is fast especially with myocarditis or intestinal perforation)

• Abdominal tenderness

• Hepato-splenomegaly

• Mental confusion


COMPLICATIONS

• Intestinal perforation with peritonitis (rapidly fatal, refer urgently to a surgeon) - presents as severe abdominal pain, tenderness, rebound tenderness and guarding

• Acute psychosis (never refer any patient with fever and psychosis to the psychiatric hospital)

• Severe intravascular haemolysis leading to acute renal failure especially in G6PD deficiency


INVESTIGATIONS

• FBC, differential, blood film for malaria parasite

• Blood culture

• Stool culture

• Urine culture

• Widal test - unreliable


SPECIAL NOTE

• Diagnosis of typhoid fever is based on a strong clinical suspicion backed by

• blood cultures, positive during first 10 days of fever
• stool cultures, positive after tenth day up to fourth or fifth week
• urine cultures, positive during second and third week


• The above tests are superior to the Widal test, which is unreliable and rarely useful, in confirming a diagnosis of typhoid fever

• A Widal test with 'O' titres of 1/160 or less seldom suggests typhoid fever in the absence of positive blood and stool cultures

• The Widal test, if done, must be repeated after 10 days

• A two-fold or more increase in titre on the repeat test increases the possibility of typhoid

• Positive Widal's test may occur in non-specific febrile illnesses (anamnestic reaction) and autoimmune disease

• More than 10% of patients with typhoid fever have a negative Widal's test

TREATMENT

Pharmacological Treatment

(Evidence rating: B)

Ciprofloxacin, oral

Adults:

500 mg 12 hourly for 14 days

Children:

10 mg/kg BW 12 hourly for 14 days

or

Ciprofloxacin, IV, may be given in severely ill patients who cannot take oral medication. Revert to oral medication as soon as clinically indicated.

Adults:

200 mg 12 hourly

Children:

10 mg/kg body weight 12 hourly

CAUTION:

Ciprofloxacin should be used with caution in children. Ciprofloxacin may rarely cause tendinitis. At the first sign of pain or inflammation, patients must discontinue treatment and alternative treatment (e.g. Ceftriaxone) started.

Alternatively

Ceftriaxone, IV,

Adults:

1-2 g daily for 7 days

REFER

Refer very ill if patients who require hospitalisation for intravenous fluids or antibiotics or are suspected to have intestinal perforation or intravascular haemolysis. Before referral, start oral antibiotics. If peritonitis is suspected give the antibiotics intravenously.

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