A01.0-4
*Notifiable medical condition (Typhoid fever).
DESCRIPTION
Systemic infection due to S. enteritica serotype Typhi or related organisms (e.g. S. paratyphi, S. choleraesuis). Initial symptoms are abdominal pain, headache, cough and fever, with diarrhoea developing after a few days. Bacteraemia is common in the first week of illness, subsequently stool culture has the highest yield.
GENERAL MEASURES
Transfusion is indicated for severe haemorrhage.
Replace fluid and electrolytes.
Contact isolation during acute phase of illness.
MEDICINE TREATMENT
Antibiotic therapy
There is increasing resistance to ciprofloxacin in South Africa and it is important to send specimens for culture and sensitivity prior to commencing antibiotic therapy.
Total duration of antibiotic therapy: 10 days.
- Ceftriaxone, IV, 2 g 12 hourly.
Follow with oral therapy as soon as patient can swallow and the temperature is <37.8°C for 24 hours, based on culture sensitivity results:
- Ciprofloxacin, oral, 500 mg 12 hourly.
Stool cultures must be repeated at weekly intervals after convalescence to ensure that a carrier state has not developed. Two consecutive negative stool cultures are required to exclude carrier state. This is of vital importance in food handlers, who must not be permitted to return to work until stools are negative.
Chronic carriers: (Z22.0)
- Ciprofloxacin, oral, 500 mg 12 hourly for 6 weeks (if sensitive to ciprofloxacin).
- Advise strict hand washing.
- Avoid food preparation for others during severe illness.
REFERRAL
Surgical consultation for complications such as intestinal haemorrhage, threatening bowel perforation or localisation with metastatic infection with or without abscess formation, and peritonitis.
Drug resistant organism: consult microbiology/infectious diseases services.