Typhoid Fever in Children: a hospital based follow-up of recent outbreak

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Typhoid 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

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History

• 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.
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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.

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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.

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Typhoid 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
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Symptomatology (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

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Symptoms (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

• Symptoms

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Total leukocytes count(n32)

• Total counts are not helpful

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Pattern of antibiotics being usedn32
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Antibiotic Sensitivity
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Approach to a child with fever
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Treatment (contd)

• Temperature subsides when
• drugs are withheld

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• Problem with i.v. ceftriaxone

• Drug fever
• Cost

• Single daily dose by syringe
• for three days only. 1
• Reduces the cost and fever

1. Am J Trop Med Hyg., 52(2), 1995. 162-165.

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Ceftriaxone fever in Typhoid

• through i.v drip

• Through syringe

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• Thank you

• Thank you