Systemic infection with Salmonella Typhi/Paratyphi causing stepwise fever, abdominal symptoms and bacteraemia.
Clinical features
- • Sustained stepwise fever
- • Relative bradycardia
- • Abdominal pain, constipation then diarrhoea
- • Rose spots, hepatosplenomegaly
Investigations
- • Blood cultures (highest yield in first week)
- • Bone marrow culture if pre-treated
- • FBC (leucopenia), LFTs
- • Widal has poor specificity — do not rely on it
Management
- • Ceftriaxone 2 g IV OD or azithromycin 1 g OD × 7–14 days
- • Fluoroquinolone only if susceptible (widespread resistance in South Asia)
- • Dexamethasone for severe disease with shock or altered mental state
- • Surgical review for perforation
Complications
- • Ileal perforation (week 3)
- • GI haemorrhage
- • Encephalopathy
- • Chronic gallbladder carriage
Related in WardRound
Educational — verify locally.
