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:
- Leucopaenia, anaemia and thrombocytopaenia.
- Positive cultures from blood (1st week), stool (after 1st 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
Note:
Relapse and carrier state may occur despite adequate therapy.
Initiate therapy with:
- Ceftriaxone 100mg/kg daily for 10 days, consider 14 days for more severe cases.
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 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).