Transcript TYPHOID FEVER IN CHILDREN

Typhoid Fever in Children:
a hospital based follow-up of
recent outbreak
• Hem Sagar Sharma
• Abhisek Tiwari
• Prakash Rana
• Parag Bhattarai
• Fakir C gami
• Pushpa R Sharma
• Department of Child Health
History
• In the mid-nineteenth
century, Sir William Jenner
undertook the first
successful definition of
typhoid, clearly delineating
Typhoid bacilli in culture plate
it from typhus, which is
spread by lice and has
The genus is named for
differing symptoms. Karl J.
the pathologist
Erberth isolated the first
Salmon, who first
causal organism for typhoid
isolated Salmonella
fever in 1880, thus providing
choleraesuis from
porcine intestine.
the basis for a definitive
diagnosis.
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.
Epidemiology
• 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.
Typhoid fever strikes mostly children
% of typhoid fever cases
• Mean age at KCH is 7.8 yrs (n=32)
25%
20%
15%
10%
5%
0%
0-4
'10-14
20-24
45-54 years of age
Symptomatology (contd)
Long and constraining clinical features
Headache
Abdominal pain
Cough
Constipation, diarrhoea
40°C
Diarrhea
Splenomegaly
Toxic look
Hepatomegaly
Abdominal
distension
Crackles
Long convalescence
Asymptomatic
37°C
D3-56
Incubation
D0
D7
D21
Invasion Status period Recovery
• Diseases do not follow the text book picture
Symptoms (contd)
Typhoid fever (%)
KCH 2002 (n=32)
Paratyphoid A & B
(%)
Fever
Headache
89-100
43-90
92-100
60-100
Nausea
Vomiting
Abdominal pain
Distension
Diarrhoea
Constipation
23-36
24-35
8-52
• Symptoms
30-57
10-79
100%
32%
3.1%
33-58
22-45
29-92
21.8%
25%
17-68
9.3% 2-29
Total leukocytes count
(n=32)
<4000
4000-6000
6000-8000
8000-10000
>10000
• Total counts are not helpful
Pattern of antibiotics being used
n=32
Cefixime
Cephal
Oflo
Bar 1
Chloro
Cipro
0
5
10
15
20
Antibiotic Sensitivity
100
90
80
70
60
50
40
30
20
10
0
Ciprofloxacin
Cefotaxime
Norfloxacin
Chloramphenic
ol
Cotrimoxazole
Amoxycilline
Approach to a child with fever
• A child with fever without any
localizing signs
• Fever in the
first week
without
treatment
• Fever in
the first
week with
antibiotics
• Fever in the
second
week with
various
antibiotics
• Observe for the general condition, look for the
specific signs
• Work-up for investigations, counsel the parents
Treatment (contd)
• Temperature subsides when
drugs are withheld
• 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.
Ceftriaxone fever in Typhoid
• through i.v
drip
• Through syringe
• Thank you
•Thank you