Mrs. L, a 26-year-old unmarried female, presented with fever, abdominal pain, diarrhea, and coldness. Her history included ulcerative colitis and polycystic ovary syndrome. Laboratory tests confirmed typhoid fever through a positive Widal test. She was started on ceftriaxone and her symptoms improved over three days. The pharmacist recommended monitoring drug levels and alternative progestin medication due to risk of breast cancer with long-term use. The patient was counseled on diet, hydration, disease monitoring, and preventing transmission.

1. CASE PRESENTATION
ON TYPHOID FEVER

2. SUBJECTIVE
PATIENT NAME : Mrs. L
AGE : 26
SEX : Female
CURRENT PROBLEM :
giddiness, fever, pain in abdomen, loose motion, cold peripheries
PAST MEDICAL HISTORY :
• Chronic bowel infection (treated and for now not on medication – Ulcerative Colitis)
• PCOS since 6 months
PAST MEDICATION HISTORY :
• PCOS - Tab. Meprate 10mg PO OD for last 3 cycles
SOCIAL HISTORY :
She is a unmarried women and went for the study tour 3 weeks before admission

3. OBJECTIVE
VITAL SIGNS :
VITALS / DAY DAY 1 DAY 2 DAY 3
Temp ˚ F 104 102 101.2
BP (mm / Hg) 120 / 80 120 / 80 120 / 80
RR / min 24 24 22
PHYSICAL EXAMINATION :
conscious , oriented , febrile, weak

4. OBJECTIVE
LABORATORY INVESTIGATION :
CONSTITUENTS DETECTED VALUE NORMAL VALUE
Hb 11.2 12 – 15 g/dl
PCV 34.7 36 – 46 %
MCV 78.9 79.4 – 94.8 Fl
MCH 25.5 25.6 – 32.2 pg
WIDAL TEST :

5. OBJECTIVE
ENDOSCOPY FINDINGS :
showing ULCERATIVE COLITIS

6. OBJECTIVE
ULTRASOUND FNDINGS :
showing POLY CYSTIC OVARY SYNDROME

7. DIAGNOSIS
TYPHOID FEVER

8. ASSESSMENT
INTERPRETATION
SUBJECTIVE :
A female patient of unmarried 26 years is admitted due to giddiness, fever, pain
in abdomen, loose motion, cold peripheries. Her past medical history showing
that she is having Ulcerative colitis and PCOS. She is under medication for PCOS
Tab. Meprate 1omg PO OD since last three cycle on day 5th of cycle.
She went for a study tour 3 weeks before admission.
OBJECTIVE :
• Elevated body temperature
• WIDALTEST showing Salmonella typhi O and H positive
• Laboratory Investigation showing decreased HB, PCV, MCV and MCH
• Endoscopy showing patient with ulcerative colitis
• USG showing patient having PCOS

9. PLAN
DRUGTHERAPY :

10. TREATMENT PROGRESSION
DAY 1 :
Patient with elevated body temperature, loose motion, giddiness, abdominal pain
and history of Ulcerative Colitis. Blood sample taken and undergone widal test and
endoscopy. Started with antibiotics.
DAY 2 :
Widal test report showing Salmonella typhi O and H positive and Endoscopy result
showing ulcerative colitis . Continue Ceftriaxone for 5 days. Body temperature
started to decrease and the loose motion stopped.
DAY 3 :
Abdominal pain slightly reduced.Antibiotics yet to complete the dose. Avoid
infection and

11. PHARMACIST INTERVENTION
Check for the presence of salmonella gastroenteritis if the patient having
frequent abdominal pain
Check the blood serum level as many of the prescribed drugs may result in
higher serum level
Meprate 10mg (medroxyprogesterone) should not use incase of planning to
get pregnant
Long term use of medroxyprogesterone may increase the risk of breast
cancer and could be alternated with other progestin tablets Camil 0.35mg
(norethindrone) OD PO

12. PATIENT COUNSELLINIG
DIET BASED :
• Drink bottled water , preferably carbonated drink while travelling
• If water bottle cannot be sourced , ensure water is heated in a rolling boil
for at least one minute
• Do not have ice in drinks
• Stay well hydrated atleast 3litre per day
• Avoid eating street and raw foods which may cause infection
DRUG BASED :
• Check the blood serum level atleast once in a month
• Check urine output according to the intake of water

13. PATIENT COUNSELLING
DISEASE BASED :
• To do widal test after 2 weeks to detect the presence of Salmonella typhi
• Undergo physical examination incase of any abdominal pain
• Perform self breast examination once a week to check the lump or any mass
formation.
• Avoid the visitors as they may get the chance to get infected as it is a
communicable disease
• People who treats the patient should NOT have the utensils, personal
belongings, left by food eaten by the patient as bacteria may transfer
through oral route also other than fecal