UMEM Educational Pearls

Category: International EM

Title: Typhoid Fever

Posted: 5/15/2013 by Walid Hammad, MD, MBChB
Click here to contact Walid Hammad, MD, MBChB

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 1^st week of symptoms, 7-14 days to result)

Treatment:

· Abx: amoxicillin, trimethoprim-sulfamethoxazole, and ciprofloxacin

· MDR typhoid: ceftriaxone or Azithromycine 1^st 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 (1^st 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