Typhoid fever

Bula-Rudas FJ, et al. Salmonella Infections in Childhood. Adv Pediatr. 2015 Aug; 62(1):29-58.

“The clinical manifestations of typhoid fever vary from an isolated fever to severe toxemia and involvement of multiorgan systems. Typhoid fever, also referred to as enteric fever, is classically associated with SalmonellaTyphi and Paratyphi, but other Salmonellae can cause disease manifestations similar to this syndrome. The onset of symptoms usually develops between 5 to 21 days after ingestion of the pathogen. During the first week of illness, there is a stepwise occurrence of symptoms starting with low-grade fever that increases insidiously and eventually becomes unremitting. Febrile seizures may occur, especially in children. The fever is then followed by the appearance of other manifestations of systemic disease, such as headache, malaise, myalgia, and lethargy. Constipation may be an early feature of typhoid fever, and other gastrointestinal symptoms, which include abdominal pain, nausea, vomiting, or diarrhea, may soon follow. At this stage, typhoid fever is indistinguishable from other nonspecific systemic illnesses caused by bacterial or viral pathogens.”

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Wain J, et al. Typhoid fever. Lancet. 2015 Mar 21;385(9973):1136-45.

Control of typhoid fever relies on clinical information, diagnosis, and an understanding for the epidemiology of the disease. Despite the breadth of work done so far, much is not known about the biology of this human-adapted bacterial pathogen and the complexity of the disease in endemic areas, especially those in Africa. The main barriers to control are vaccines that are not immunogenic in very young children and the development of multidrug resistance, which threatens efficacy of antimicrobial chemotherapy. Clinicians, microbiologists, and epidemiologists worldwide need to be familiar with shifting trends in enteric fever. This knowledge is crucial, both to control the disease and to manage cases. Additionally, salmonella serovars that cause human infection can change over time and location. In areas of Asia, multidrug-resistant Salmonella enterica serovar Typhi (S Typhi) has been the main cause of enteric fever, but now S Typhi is being displaced by infections with drug-resistant S enterica serovar Paratyphi A. New conjugate vaccines are imminent and new treatments have been promised, but the engagement of local medical and public health institutions in endemic areas is needed to allow surveillance and to implement control measures.

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Typhoid fever. Chapter 111: Salmonella. From Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 7th ed. (2014)

“The response to treatment with antibiotics is slow. Fever may persist for many days, even after bacteremia has resolved. The emergence and spread of multidrug-resistant S. ser. Typhi (MDRST) since 1989 has caused a shift in empiric therapy from chloramphenicol, TMP-SMX, or ampicillin to a fluoroquinolone in adults and a third-generation cephalosporin, such as ceftriaxone, azithromycin, or a fluoroquinolone, in children (Table 121-7). MDRST is particularly common in the Indian subcontinent, Southeast Asia, and Africa; strains resistant to ciprofloxacin are being recognized increasingly.”

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Enteric Fever (Typhoid Fever). Chapter 146: Salmonella Species. From the Long’s Principles and Practice of Pediatric Infectious Diseases, 4th ed. (2012)

“Although enteric fever classically is associated with S. Typhi and Paratyphi, other Salmonella occasionally cause disease mimicking this syndrome.The clinical features of enteric fever with S. Typhi and Paratyphi are indistinguishable. During the first week of illness, there is a stepwise, insidious increase in fever, which eventually becomes unremitting and is associated with systemic symptoms such as headache, lethargy, malaise, myalgia, and abdominal pain. In the second week, hepatosplenomegaly occurs and rose spots may be seen; headache is replaced by stupor. Relative bradycardia is not a feature of typhoid fever in children. During the third to fourth week of fever, intestinal hemorrhage and perforation are common; fever begins to show morning remissions, and there is a gradual decline in fever spikes. Myocarditis, shock, meningitis, and pneumonia can complicate the course.”

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Sánchez-Vargas FM, et al. Salmonella infections: an update on epidemiology, management, and prevention. Travel Med Infect Dis. 2011 Nov;9(6):263-77.

“Salmonella species are a group of Gram-negative enterobacteria and known human pathogens in developing as well as industrialized countries. Despite significant advances in sanitation, provision of potable water, and highly controlled food chain surveillance, transmission of Salmonella spp. continues to affect communities, preferentially children, worldwide. This review summarizes updated concepts on typhoidal and non-typhoidal Salmonella infections, starting with a historical perspective that implicates typhoid Salmonella as a significant human pathogen since ancient times. We describe the epidemiology of this pathogen with emphasis on the most recent non-typhoidal Salmonella outbreaks in industrialized countries and continued outbreaks of typhoid Salmonella in underserved countries. An overview of clinical aspects of typhoid and non-typhoid infections in developing and industrialized countries, respectively, is provided, followed by a description on current treatment concepts and challenges treating multidrug-resistant Salmonella infections. We conclude with prevention recommendations, and recent research studies on vaccine prevention.”

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Fanella S, et al. Index of suspicion – Typhoid Fever. Pediatr Rev. 2008 Aug;29(8):281-7.

“Symptoms begin in the bacteremic stage, with fever and malaise. Temperature
increases progressively and can exceed 104°F (40°C). Chills occur, but rigors are less common.Headache, anorexia, myalgias, and dry cough may be seen. Abdominal
pain is common, and although adults often have constipation, diarrhea is more likely in children. An absence of abdominal or intestinal changes is not typical of typhoid.”

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Created 03/05/13; updated 06/21/16.

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