typhoid fever in children

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Slide 1 : TYPHOID FEVER D r . MUHAMMAD UMER ARIF PGR-UNIT 1 PEDIATRICS MEDICINE MAYO HOSPITAL
Slide 2 : SCENARIO A 7 year old male child comes to the opd with complains of fever for the past 9days, low grade initially but usually high grade in after noon now, no response to medicine, no afebrile interval , associated with headache and projectile vomiting. There is also complain of pain in right iliac fossa and bloody diarrhea along with 2 episodes of epitaxis.
Slide 3 : ON EXAMINATION Child had toxic, look with following signs OBSERVATION 1.coated tongue 2.congested throat 3.rose spots on chest PALPATION 1.mild tender abdomen 2.Hepatomegaly 3.Minimal spleenomegaly
Slide 4 : INVESTIGATION CBC shows: Leukopenia relative to high grade fever LFTS: Mildly elevated Widal test: positive
Slide 5 : DIAGNOSIS: TYPHOID FEVER Cause : gram-negative bacillus Salmonella typhi. Enteric/Paratyphoid fevers:which are usually milder ,are caused by S paratyphi A, B, and C). pathogenesis: no animal reserviour,transmitted by fecal-oral route ,enters the walls of the intestinal tract by attachment to M cells,actin dearrangement and tight juction destablization. following a transient bacteremia, multiplies in the reticuloendothelial cells of the liver and spleen. Reinfection of the intestine occurs as organisms are excreted in the bile,end of incubation period.
Slide 6 : PATTERN The classic lengthy three-stage disease seen in adult patients often is shortened in children. The incubation period is 4-8 days. The prodrome may last only 2–4 days, physical findings may be absent, but abdominal distention and tenderness, meningismus, mild hepatomegaly, and minimal splenomegaly may be present the toxic stage only 2–3 days(2nd week of disease) Classical sign: Bacterial emboli produce the characteristic skin lesions (rose spots). Rose spots are erythematous maculopapular lesions 2–3 mm in diameter that blanch on pressure. They are found principally on the trunk and chest and they generally disappear within 3–4 days.they are present in 10–15% of children the defervescence stage 1–2 weeks.
Slide 7 : Clinical signs: % High-grade fever 95 Coated tongue 76 Anorexia 70 Vomiting 39 Hepatomegaly 37 Diarrhea 36 Toxicity 29 Abdominal pain 21 Pallor 20 Splenomegaly 17 Constipation 7 Headache 4 Jaundice 2 Obtundation 2 Ileus 1 Intestinal perforation 0.5
Slide 8 : Laboratory study Results of blood cultures are positive in 40-60% of the patients in 1st week stool and urine culture become positive after the 1st wk. Widal test is based on widal reaction i.e.antibodies in the blood of an infected person causes clumping of the bacteria. Serum agglutinin are raised in 2nd and 3rd week,widal test detects antibodies against O (1 in 160 dilution)and H antigens(1 in 320 dilution). Two serum specimenobtained at interval of 7-10 days to read the raise in antibodies. It is of limited value.
Slide 9 : complications Intestinal perforation and hemorrhage although not frequent in children(less than 1%) ,are the most lethal complication. Encapholopathy,meningitis,ceberal empyema and edema are prevalent (35%) but usualy resolve. DIC is also a common complication
Slide 10 : treatment UNCOMPLICATED TYPHOID FEVER Chloramphenicol Fluoroquinolone, e.g., ofloxacin or ciprofloxacin Amoxicillin SEVERE TYPHOID FEVER Azithromycin Cefixime Ceftriaxone
Slide 11 : THANK YOU

 


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