This is for 4 th year bams medical students

1. Typhoid Fever in Children:
a hospital based follow-up
Dr. Pushpa R Sharma
Professor of Child Health
Department of Child Health

2. Antonius Musa, a Roman physician who achieved
fame by treating the Emperor Augustus 2,000
year ago, with cold baths when he fell ill with
typhoid.
HISTORY OF THE TYPHOID FEVER

3. Thomas Willis who is credited with the first
description of typhoid fever in 1659.

4. William Wood Gerhard who was the first to
differentiate clearly between typhus fever and
typhoid in 1837.

5. Carl Joseph Eberth who discovered the typhoid
bacillus in 1880.

6. Georges Widal who described the ‘Widal
agglutination reaction’ of the blood in 1896.

7. History
• In the mid-nineteenth
century, Sir William Jenner
undertook the first
successful definition of
typhoid, clearly delineating
it from typhus, which is
spread by lice and has
differing symptoms. Karl J.
Erberth isolated the first
causal organism for typhoid
fever in 1880, thus providing
the basis for a definitive
diagnosis.
Typhoid bacilli in culture plate
The genus is named for
the pathologist
Salmon, who first
isolated Salmonella
choleraesuis from
porcine intestine.

8. History (contd)
• The best known carrier
was "Typhoid Mary";
Mary Mallon was a cook
in Oyster Bay, New York
in 1906 who is known to
have infected 53 people,
5 of whom died.
• Five years after her
release, she was found
to have been the source
of 25 cases of typhoid
at the Women's Hospital
in Manhattan.

9. • Typhoid and paratyphoid fevers are endemic
in the Indian subcontinent.
• Typhoid fever affects 17 million people
worldwide every year, with approximately
600,000 deaths.
• Case fatality rates of 10-50%
• children aged 1-5 years are at the highest risk
• The incubation period range 3-56 days.
Epidemiology

10. 0-4 '10-14 20-24 45-54
0%
5%
10%
15%
20%
25%
0-4 '10-14 20-24 45-54 years of age
% of typhoid fever cases
Typhoid fever strikes mostly children
• Mean age at KCH is 7.8 yrs (n=32): 2002

11. Symptomatology (contd)
Long and constraining clinical features
37°C
40°C
D 0 D7 D21
D3-56
Incubation Invasion Status period Recovery
Long convalescence
Asymptomatic
Headache
Abdominal pain
Cough
Constipation, diarrhoea
Diarrhea
Splenomegaly
Toxic look
Hepatomegaly
Abdominal
distension
Crackles
• Diseases do not follow the text book picture

12. Symptoms (contd)
• Symptoms
Typhoid fever (%)
KCH 2002 (n=32)
Paratyphoid A & B
(%)
Fever 89-100 100% 92-100
Headache 43-90 32% 60-100
Nausea 23-36 33-58
Vomiting 24-35 3.1% 22-45
Abdominal pain
Distension
8-52
21.8%
29-92
Diarrhoea 30-57 25% 17-68
Constipation 10-79 9.3% 2-29

13. Total leukocytes count
(n=32)
<4000
4000-6000
6000-8000
8000-10000
>10000
• Total counts are not helpful

14. Pattern of antibiotics being used
n=32
0 5 10 15 20
Cipro
Chloro
Oflo
Cephal
Cefixime
Bar 1

15. Antibiotic Sensitivity
0
10
20
30
40
50
60
70
80
90
100 Ciprofloxacin
Cefotaxime
Norfloxacin
Chloramphenic
ol
Cotrimoxazole
Amoxycilline

16. Approach to a child with fever
• Fever in the
first week
without
treatment
• Fever in
the first
week with
antibiotics
• Fever in the
second
week with
various
antibiotics
• A child with fever without any
localizing signs
• Observe for the general condition, look for the
specific signs
• Work-up for investigations, counsel the parents

17. Treatment (contd)
• Temperature subsides when
drugs are withheld

18. • Problem with i.v. ceftriaxone
• Drug fever
• Cost
• Single daily dose by syringe
for three days only. 1
• Reduces the cost and fever
m J Trop Med Hyg., 52(2), 1995. 162-165.

19. Ceftriaxone fever in Typhoid
• through i.v
drip
• Through syringe

20. • Thank you
•Thank you