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Enteric fever in pediatrics
Enteric fever, also known as typhoid fever, is caused by the bacteria Salmonella enterica typhi or Salmonella paratyphi A, B, or C. It is transmitted through the fecal-oral route and has an incubation period of 7-14 days. Clinical features include sustained high fever, abdominal pain, diarrhea or constipation, and rose-colored spots on the trunk. Complications can affect the central nervous system, cardiovascular system, respiratory system, gastrointestinal system, hepatobiliary system, genitourinary system, and bones. Treatment involves antibiotics, hydration, and rest. Prevention focuses on proper sanitation, hand washing, and vaccination.
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Enteric fever in pediatrics
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- 2. Introduction • Also knownas “typhoid fever” • Etiology: ▫ Salmonella enterica typhi ▫ Salmonella paratyphi A,B,C • typhi: paratyphi = 10:1 • Route of transmission: faecal-oral route • Incubation period: 7- 14 days
- 3. Pathogenesis Oro-faecal route M cellsof gut mucosa of terminal ileum Peyer’s patch Mesenteric lymph node Primary bacteremia Reticulo-endothelial system Secondary bacteremia Disseminated to different organs
- 4. Clinical features • Highgrade fever • Coated tongue • Anorexia • Vomiting • Diarrhoea/ constipation • Abdominal pain • Headache • Obtundation
- 5. Examination • Relative bradycardia •Rose spots on trunk ( 1st week) • Hepatosplenomegaly • Tympanic abdomen
- 6. Complications • CNS ▫ Encephalopathy,delirium, ataxia, seizure • CVS ▫ Endocarditis, myocarditis, CCF • Respiratory ▫ Pneumonia, empyema • Gastrointestinal ▫ Peritonitis, paralytic ileus. Perforation
- 7. • Hepatobiliary ▫ Cholecystitis,heptitis, hepatic or splenic abscess • Genitourinary ▫ UTI, renal abscess, prostatitis • Bones ▫ Osteomyelitis, septic arthritis
- 8. Investigations • Leukopenia withrelative lymphocytosis • Deranged LFT • Blood culture • Agglutination test ▫ Widal test, Typhidot • Stool culture • Urine culture • Bone marrow culture • Monoclonal Antibody • PCR
- 9. Differential diagnosis • Viralfever • Malaria • Tuberculosis • Septicemia • Brucellosis • Leptospirosis • Dengue • Infectious mononucleosis • Acute hepatitis
- 10. Treatment • Adequate rest •Hydration • Antipyretics • Soft diet • Antibiotic treatment • Encephalopathy/ Shock: ▫ Dexamethasone ▫ 3mg/kg stat and 1mg/kg QID 48 hrs
- 11. Antibiotic treatment • Uncomplicatedtyphoid: ▫ Chloramphenicol : 50-75 mg/kg/d QID 14-21d ▫ Amoxycillin : 75 mg/kg/d TID 14 d ▫ Fluroquinolones: 15mg/kg/d BD 7-10 d ▫ Cefixime: 15- 20 mg/kg/d BD 7-14 d ▫ Azithromycin : 8-10 mg/kg/d OD 7d • Severe typhoid: ▫ Ampicillin: 100mg/kg/d IV QID 14 days ▫ Ceftriaxone: 60-75mg/kg/d BD 10-14days ▫ Gatifloxin: 10 mg’kg/d 7 days
- 12. Prognosis • Age • Generalstate of the health • Chronic carriers: ▫ Gall bladder ▫ Excretes S. typhi for >3mnths
- 13. Prevention • Proper sewage/sanitation • Hand washing • Vaccination ▫ Oral live vaccine: Ty21a strain ▫ Vi capsular polysaccharide vaccine
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