Here's a case study on enteric fever. Understanding your disease helps better with your recovery. Please use it as a reference for your studies and keep learning and progessing. Thank you!!

1. Case study on Enteric Fever

2. Introduction
● It is the acute illness associated with fever caused by the Salmonella typhi bacteria.
● The main mode of transmission is via faeco-oral route and can also be transmitted if we have
close contact with the patients or carriers.
Symptoms:
● Fever
● Constipation
● Dry cough
● Abdominal pain
● Rose spots

3. Patients Details
● Patient No.: 861772
● Name: Shivahari Poudel
● Age: 20Y
● Gender: Male
● Permanent address: Banepa
● Admitted date: 2019/01/11
● Discharged date: 2019/01/14

4. Chief Complaints:
● Fever for 5 days, acute onset , maximum temperature not associated with
chills and rigors.
● Cough for 3 days, non productive associated with runny nose.
● History of loss of appetite and myalgias.
● No burning micturations, no abdominal pain and vomiting.
● No shortness of breath(SOB), no DM, no HTN,TB
● Bowel and bladder habit: Normal

5. Vital Examinations
● Pulse(P): 100 BPM
● BP: 110/70
● Temperature: 101F
● Respiratory rate(RR): 20/min
● SPO2: 94% at room air
System Examinations:
● CNS: Grossly intact
● P/A: Soft; non tender; no organomegaly
● Chest: B/L equal air entry, no added sounds

7. Clinical Investigations
1.Widal test: negative (The widal test detects antibodies against O and H antigens.)
2.Scrub IgM : negative (This test detects IgM antibodies in Human.)
3.Leptospira IgM : negative (This test detects IgM antibodies for leptospira species.)
4..Blood c/s culture: Salmonella Typhi A isolated
5. L 422

8. Tests Obtained value Normal range
EPI cells 3 - 5 2 - 5
Pus cells 1-2 <2 - 5
TC( T cytotoxic cells) 6000 500-1000 per m3
Neutrophil test 46 45% - 75% of total WBC
Urea 10 5 - 20 mg/dl
Haemoglobin test 15.8 13.5 - 17.5 gm per dl
PLTS 208,000 150,000 - 400,000 per mcl
Random Blood Sugar 120 80 - 140 mg/dl

9. Tests
● EPI cells : detection of epithelial cells in urine
● Pus cells : Detection of WBC cells in urine
● PLTS : gives platelet count per microliter (mcl) blood
Treatment During Hospitalization:
List of drugs is:
1. Injection of Ceftriaxone
2. Injection PCM (NSAIDs)
3. Tab Aciloc
4. Tab Fexofenadine

10. Treatment given in Hospital
1) Injection ceftriaxone:
They selectively and irreversibly inhibits bacterial cell wall synthesis by binding to transpeptidases, also
called transamidases, which are penicillin-binding proteins (PBPs) that catalyze the cross-linking of the
peptidoglycan polymers forming the bacterial cell wall.
1) Injection PCM( Paracetamol) NSAIDS:
They inhibit the synthesis of prostaglandins by the inhibition of cyclooxygenase enzyme.
1) Aciloc:
They inhibit the secretion of acid by binding to the receptors of the proton pump in the stomach.
1) Fexofenadine:
They selectively antagonize H1 receptors on the surface of cells on stomach.

11. Medication on Discharge
1. Tab Cefixime 400 mg PO BD for 7 days.
2. Tab Aciloc 150 mg PO BD for 7 days.
3. Tab PCM 500 mg PO TDS for 3 days or sos
4. Tab Fexofenadine 120 mg PO HS for 5 days.
5. Tab Pantoprazole 40 mg PO OD for 7 days.
● Follow up after 1 week or sos.

12. Adverse Effects
● Cefixime can cause swelling under the skin due to accumulation of fluids.
● Aciloc, on chronic use,may cause acidity, heartburn and ulcers.
● PCM upsets stomach and causes constipation.
● Ear infection, trouble hearing and fussiness in a child is associated with the use of
fexofenadine.
● Vomiting, N&V and hypersensitivity reactions.

13. Precautions:
● Avoid intake of raw fruits like nuts, seeds, legumes, grapes, etc
● Avoid drinking untreated water.
Rationale:
● Giving aciloc and pantoprazole for some treatment is quite irrational.

14. Inference
The given treatment underlies with the WHO guideline.