Typhoid

Description

Diagnostic criteria

General and supportive measures

Medicine treatment

Referral

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ICD-10 code: A01.1

*Notifiable condition.

DESCRIPTION

A systemic disease caused by Salmonella typhi.

DIAGNOSTIC CRITERIA

Clinical

• Fever
• Anorexia
• Headache
• Vomiting
• Diarrhoea or constipation
• Ileus
• Abdominal pain or tenderness
• Epistaxis
• Cough
• Delirium
• Hepatomegaly and/or splenomegaly
• Meningismus
• Stupor

Investigations

• Leucopenia, anaemia and thrombocytopenia.
• Positive cultures from blood (1^st week), stool (after 1^st week), urine and bone marrow.
• Serology not recommended.

GENERAL AND SUPPORTIVE MEASURES

• Isolate patient until eradication confirmed.
• Correct and maintain fluid and electrolyte status.

Collect 3 stool samples: 1 week after completion of treatment and every 48 hours thereafter.

MEDICINE TREATMENT

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Note:
Relapse and carrier state may occur despite adequate therapy.

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Initiate therapy with:

• Ceftriaxone 100 mg/kg daily for 10 days, consider 14 days for more severe cases.
  • Maximum: 2 g/dose.

Once patient is stable, consider switching to oral ciprofloxacin based on clinical response and susceptibility testing results:

• Ciprofloxacin 15 mg/kg/dose 12 hourly for 7–10 days.

Retreatment

If any one of the 3 follow-up stool samples are positive for S. typhi: retreat and repeat stool sampling 1 week later.
If any of these 3 samples are positive for S. typhi: treat for carriage (ciprofloxacin x 4–6 weeks).
Check stool cultures monthly.

REFERRAL

• Inadequate response to treatment.
• Patients with complications.
• Chronic carriers (stool positive x ≥ 12 months).

Click here for the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024 

Chapter 8: Infective/Infectious Diseases,  8.23 Typhoid