Category: International EM
Posted: 5/15/2013 by Walid Hammad, MD, MBChB
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General information:
· Salmonella typhi – transmission through fecal-oral, contaminated food, human carriers
· Most cases in the US acquired abroad – Africa, Latin American, Asia
· Vaccine available – not life-long immunity, need 1-2 weeks to take effect
Clinical Presentation:
· sustained high fever (103-104)
· Faget sign: fever and bradycardia (also seen in yellow fever, atypical pneumonia, tularemia, brucellosis, Colorado tick fever))
· Abdominal pain, GI bleed/perforation, hepatosplenomegaly, delirium
· “Rose spots” – erythematous macular rash over chest and abdomen
· Without treatment sx can resolve after 3-4 weeks, mortality from secondary infections 12-30%
Diagnosis:
· Pan-culture for S. typhi
· Serologic: Widal test (negative for 1st week of symptoms, 7-14 days to result)
Treatment:
· Abx: amoxicillin, trimethoprim-sulfamethoxazole, and ciprofloxacin
· MDR typhoid: ceftriaxone or Azithromycine 1st line
Bottom Line:
· Get vaccinated if travelling to endemic areas 1-2 weeks before travel
· Suspect in travelers to endemic areas with sustained high fevers
· Spontaneous resolution does occur but may become carriers without abx
Famous victims or Typhoid fever:
· Wilbur Wright (Wright brothers)
· Prince Albert (Queen Victoria’s husband)
· Hakaru Hashimoto (discovered Hashimoto’s thyroiditis)
· Abigail Adams (1st Lady, wife of John Adams)
University of Maryland Section of Global Emergency Health
Author: Veronica Pei, MD
http://www.cdc.gov/nczved/divisions/dfbmd/diseases/typhoid_fever/technical.html#risk
