Typhoid

Question 1

60-year-old man was admitted to the hospital with fever for a week at home, with a travel history to South Asia for vacation. On admission, his temperature was 39.7°C, heart rate 65 beats per minute, and blood pressure 110/60 mmHg. His skin showed a faint, salmon-colored, blanching maculopapular rash located mainly on the trunk. He also complained of moderate abdominal pain and nausea. Blood culture revealed no organisms; however, a bone marrow culture grew Gram-negative rods. The bacteria produce acid on glucose fermentation, reduce nitrates, and do not produce cytochrome oxidase or ferment lactose, and they are motile by means of flagella.

Answer 1

What is the most likely diagnosis?
Typhoid fever
عرفتها منين؟
Travel to South Asia (endemic region)
+
Prolonged fever with relative bradycardia (Faget sign)
+
“Rose spots”: salmon-colored maculopapular rash on trunk
+
Abdominal pain and nausea
+
Blood cultures negative, but bone marrow culture positive for Gram-negative, motile, glucose-fermenting, non-lactose fermenting bacilli
+
Oxidase-negative, nitrate-reducing, and flagella-mediated motility – all consistent with Salmonella Typhi

Question 2

b) How is this disease diagnosed?

Answer 2

1. Blood cultures (positive in the first week; sensitivity ~40–80%)
2. Bone marrow culture – most sensitive test (~90% sensitivity), even after antibiotics
   3.urine culture in 2nd week
   4- Stool culture in 3rd week.
   5- Serologic tests (e.g., Widal test) – not specific or reliable in endemic areas
   6- PCR assays – used in some settings for rapid diagnosis

Question 3

c) How to treat this case?

Answer 3

Ceftriaxone (3rd-generation cephalosporin) – IV

Azithromycin – oral

Fluoroquinolones (e.g., ciprofloxacin) – only if resistance is not suspected (resistance is now common in South Asia)
Duration:
Uncomplicated typhoid fever: 7–14 days depending on drug and response

Complicated or severe cases (e.g., bacteremia, bone marrow involvement): IV antibiotics and longer duration