Typhoid Fever In Children

Typhoid fever is systemic infection caused by Salmonella enterica serovar Typhi. Paratyphoid fever is caused by related Salmonella Paratyphi organisms.

Transmission is faeco oral through contaminated food or water. Disease ranges from uncomplicated febrile illness to intestinal haemorrhage, perforation, encephalopathy and shock.

Antimicrobial resistance increasingly determines treatment choice.

Common features include:

• Persistent fever
• Headache
• Malaise
• Abdominal pain
• Anorexia
• Vomiting
• Diarrhoea or constipation
• Hepatosplenomegaly

Relative bradycardia and rose spots are classically described but are neither sensitive nor consistently present in children.

Severe disease may cause:

• Altered consciousness
• Gastrointestinal bleeding
• Intestinal perforation
• Shock
• Hepatitis
• Myocarditis
• Encephalopathy

Blood culture is the preferred diagnostic test, particularly early in illness.

Obtain cultures before antibiotics when feasible.

Bone marrow culture is more sensitive but rarely required routinely.

Stool and urine cultures may become positive later.

Widal testing has poor specificity and should not be used as the sole basis for diagnosis in endemic settings.

Assess FBC, liver function, electrolytes and renal function in moderate or severe disease.

Antibiotic choice must reflect local resistance.

For uncomplicated disease where susceptibility is expected:

Azithromycin 10 to 20 mg/kg PO once daily, maximum 1 g/day, usually for 7 days.

For hospitalized or severe disease:

Ceftriaxone 50 to 75 mg/kg IV once daily, maximum 2 g/day, generally for 10 to 14 days, adjusted to clinical response and microbiology.

Where extensively drug resistant typhoid is suspected, obtain infectious disease or microbiology guidance urgently because carbapenem based therapy may be required.

Manage dehydration, electrolyte disturbance, bleeding and perforation aggressively.

Suspected intestinal perforation requires immediate surgical review.