Systemic infection by Salmonella Typhi/Paratyphi acquired by ingestion of contaminated food/water.
History taking
- • Step-ladder fever 1–3 weeks, headache, abdominal pain, constipation or diarrhoea, malaise, anorexia
- • Source of water/food, recent travel, vaccination history
Examination
- • Relative bradycardia, coated tongue, rose spots (rare), hepatosplenomegaly
- • Abdominal tenderness; look for complications
Red flags
- • GI bleed, intestinal perforation, peritonitis (third week)
- • Encephalopathy, myocarditis, septic shock
Differential diagnosis
- • Malaria, dengue, viral fever, leptospirosis, brucellosis, TB
Recommended investigations
- • Blood culture (best in first week) — gold standard
- • Stool & urine culture (second/third week)
- • Widal test — supportive only (rising titres)
- • CBC: relative leucopenia; LFT raised
Diagnosis
- • Positive blood/stool culture; supported by clinical picture
Initial treatment / management
- • Empirical: Ceftriaxone OR Azithromycin (high local resistance to FQ)
- • Duration usually 7–14 d
- • Hydration, antipyretics, soft diet
Prescription examples
- • Inj Ceftriaxone 2 g IV OD x 10–14 d (severe)
- • Tab Azithromycin 1 g PO OD x 5 d (uncomplicated)
- • Tab Cefixime 20 mg/kg/day PO BD x 14 d (paediatric/outpatient)
Follow-up advice
- • Improvement expected by day 3–5; persisting fever — culture & sensitivity
- • Stool culture at 4 weeks for carrier state
Patient counselling
- • Safe water (boil/filter), food hygiene, handwashing
- • Typhoid vaccination (Vi or live oral) for travellers and endemic areas
Referral criteria
- • Complications (perforation, GI bleed)
- • Treatment failure, MDR or XDR typhoid
Clinical pearls
- • Always document blood culture before starting antibiotics if possible
- • MDR & XDR typhoid increasing — follow local sensitivity patterns
- • Chronic carriers (gallstones) need cholecystectomy ± prolonged antibiotic
References
- • WHO Guidelines on Typhoid Fever 2018
- • Indian Academy of Paediatrics — Enteric Fever Guidelines 2022
Educational outpatient guide — verify against local guidelines before clinical use.
