Title: Typhoid Fever in Children: a hospital based follow-up of recent outbreak
1Typhoid Fever in Childrena 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
2History
- 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.
3History (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.
4Epidemiology
- 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.
5Typhoid fever strikes mostly children
of typhoid fever cases
- Mean age at KCH is 7.8 yrs (n32)
25
20
15
10
5
0
0-4
'10-14
20-24
45-54
0-4
'10-14
20-24
45-54 years of age
6Symptomatology (contd)
Long and constraining clinical features
Diarrhea Splenomegaly Toxic look Hepatomegaly Abdo
minal distension Crackles
Headache Abdominal pain Cough Constipation,
diarrhoea
40C
Long convalescence
Asymptomatic
37C
D 0
D7
D21
D3-56
Incubation
Invasion
Status period
Recovery
- Diseases do not follow the text book picture
7Symptoms (contd)
Typhoid fever () KCH 2002 (n32) 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
Cough 11-36 8.4 10-68
8Total leukocytes count(n32)
- Total counts are not helpful
9Pattern of antibiotics being usedn32
10Antibiotic Sensitivity
11Approach to a child with fever
12Treatment (contd)
- Temperature subsides when
- drugs are withheld
13- Problem with i.v. ceftriaxone
- Single daily dose by syringe
- for three days only. 1
- Reduces the cost and fever
- Am J Trop Med Hyg., 52(2), 1995. 162-165.
14Ceftriaxone fever in Typhoid
15