Typhoid Fever

Question 1

What is responsible for 50% of the cases of typhoid in Asia?
Resistant to?

Answer 1

Salmonella typhi
Resistant to fluoroquinolones rising

Question 2

Main cause typhoid fever in southern china?

Answer 2

Salmonella Paratyphi A

Question 3

Phase 1 pathogenesis?
Phase 2 pathogenesis?

Answer 3

Phase 1: Bacteraemia and/or endotoxemia
Phase 2: Localisation and/or complications such as bowel perforation, GI bleeding, hepatitis and pneumonitis

Question 4

What does typhoid initially present as?

Answer 4

High fever, malaise and headache

Question 5

What happens between weeks 2-3 in typhoid fever?

Answer 5

30-60% of people go on to develop complications:
GI bleeding
Myocarditis
CNS involvement
15% of people died

Question 6

How many people relapse?

Answer 6

5-10% within 8 weeks

Question 7

What can happen in the following year after typhoid infection?

Answer 7

1-5% of people will be asymptomatic carriers

Question 8

Whar are the clinical presentations of typhoid?

Answer 8

Fever common at night
Headahce
No sweating
Abdominal pain
Diarrhea common in children
Adults get constipation
Insomina in adults, hypersomnia in children

Question 9

Other tell-tale signs of typhoid fever?

Answer 9

Dissociation between pulse and fever (eg pulse 80, temp 40C)
Rose spots (occur between 2nd and 5th week
Hepatomegaly

Question 10

Most serious complication of TF?

Answer 10

Terminal ileus bowel perforation

Question 11

How do you diagnose TF?

Answer 11

Blood cultures
Use BACTEC (can only do this without abx use!!), this is gold standard
Stool cultures more accurate in children (70-80% as kids get diarrhoea, much more easily isolated)
Bone marrow useful as independent of abx use
Can use bile culture with sting capsule

Question 12

Tx of TF?

Answer 12

Ciprofloxacin PO or IV for 10 days

Question 13

Drawbacks to chloramphenicol?

Answer 13

Doesn’t reduce transitory carrier or relapse rate and does not prevent chronic carriage

Question 14

SEs of Chloraphenicol?

Answer 14

Haemtological: Anaemia, leucopenia and rarely bone marrow aplasia

ChlorampHEnicol

Question 15

Other first line drugs against TF?

Answer 15

Amoxicillin
Trimethroprim-sulfamethoxazole
Ceftriaxone-cefoperazone

Question 16

Why use ciprofloxacin for tx?

Answer 16

High cure rate
Better for community management

Question 17

What do you use in MDR TF?

Answer 17

Azithromycin for 10 dyas

Question 18

What is the most serious complication of TF?

Answer 18

Perforation
Usually in 2nd-3rd week
Pain in RIF
In ILEUM

Question 19

Frequent complication of TF?

Answer 19

Enteric bleeding
Need ilectomy and right hemicolectomy if bleeding massive

Question 20

What can you give in severe typhoid fever to improve mortality? When systemic illness

Answer 20

Dexamethasone for 2 days

Question 21

What is chronic carriage of S Typhi or S paratyphi?

Answer 21

Salmonella Typhi excreted in bile and/or stools for 12 months
More common in adults, women and those with gallbladder disease

Question 22

How do you treat chronic carrier?

Answer 22

Fluoroquinolones
Cipro 28 days BD

Question 23

Where in the world are chronic carriers of S Typhi associated with schistosomiasis?

Answer 23

Egypt

Question 24

What are chronic carriers at risk of?

Answer 24

cancer of biliary tract

Question 25

Common cause of TF?

Answer 25

Caused by Salmonella Typhi
Spread by contaminated food and water

Question 26

Vaccine for Typhoid Fever

Answer 26

Typhoid conjugate vaccine containing Vi polysaccharide conjugated to tetanus toxoid is a single-dose parental vaccine prequalified by WHO in 2017 and recommended for children as young as 6 months of age as well as for adults.

Question 27

What is the difference between S Typhi and S Paratyphi and Non S Typhi?

Answer 27

Non S Typhi is gastroenteritis Not typhoid
Rarely causes mortality
Only dangerous in immunocompromised host, otherwise does not require tx