Typhoid Fever in Children:

a hospital based follow-up

Dr. Pushpa R Sharma

Professor of Child Health
Department of Child Health
HISTORY OF THE TYPHOID FEVER

Antonius Musa, a Roman physician who achieved

fame by treating the Emperor Augustus 2,000
year ago, with cold baths when he fell ill with
typhoid.
Thomas Willis who is credited with the first
description of typhoid fever in 1659.
William Wood Gerhard who was the first to
differentiate clearly between typhus fever and
typhoid in 1837.
Carl Joseph Eberth who discovered the typhoid
bacillus in 1880.
Georges Widal who described the Widal
agglutination reaction of the blood in 1896.
 History
In the mid-nineteenth
Typhoid bacilli in culture plate
The genus is named for
the pathologist
Salmon, who first
isolated Salmonella
choleraesuis from
porcine intestine.
century, Sir William Jenner
undertook the first
successful definition of
typhoid, clearly delineating
it from typhus, which is
spread by lice and has
differing symptoms. Karl J.
Erberth isolated the first
causal organism for typhoid
fever in 1880, thus providing
the basis for a definitive
diagnosis.
History (contd)
The best known carrier
was "Typhoid Mary";
Mary Mallon was a cook
in Oyster Bay, New York
in 1906 who is known to
have infected 53 people,
5 of whom died.
Five years after her
release, she was found
to have been the source
of 25 cases of typhoid
at the Women's Hospital
in Manhattan.
 Epidemiology

Typhoid and paratyphoid fevers are endemic

in the Indian subcontinent.
Typhoid fever affects 17 million people
worldwide every year, with approximately
600,000 deaths.
Case fatality rates of 10-50%
children aged 1-5 years are at the highest risk
The incubation period range 3-56 days.
Typhoid fever strikes mostly children

% of typhoid fever cases

Mean age at KCH is 7.8 yrs (n=32): 2002
25%

20%

15%

10%

5%

0%
0-4 '10-14 20-24 45-54 years of age
 Symptomatology (contd)
Long and constraining clinical features
Diarrhea
Splenomegaly
Toxic look
Headache Hepatomegaly
Abdominal pain Abdominal
Cough distension
Constipation, diarrhoea 40C Crackles

Asymptomatic Long convalescence

37C

D3-56 D0 D7 D21

Incubation Invasion Status period Recovery

Diseases do not follow the text book picture

 Symptoms (contd)
Typhoid fever (%) Paratyphoid A & B
Symptoms KCH 2002 (n=32) (%)

Fever 89-100 100% 92-100

Headache 43-90 32% 60-100
Nausea 23-36 33-58
Vomiting 24-35 3.1% 22-45
Abdominal pain 8-52
29-92
Distension 21.8%
Diarrhoea 30-57 25% 17-68
Constipation 10-79 9.3% 2-29
 Total leukocytes count
(n=32)

<4000
4000-6000
6000-8000
8000-10000
>10000

Total counts are not helpful

Pattern of antibiotics being used
n=32
Cefixime

Cephal

Oflo Bar 1

Chloro

Cipro

0 5 10 15 20
 Antibiotic Sensitivity
100 Ciprofloxacin
90
80 Cefotaxime
70
60 Norfloxacin
50
Chloramphenic
40
ol
30
Cotrimoxazole
20
10 Amoxycilline
0
Approach to a child with fever
A child with fever without any
localizing signs

Fever in the Fever in Fever in the

first week the first second
without week with week with
treatment antibiotics various
antibiotics
Observe for the general condition, look for the
specific signs
Work-up for investigations, counsel the parents
 Treatment (contd)

Temperature subsides when

drugs are withheld
 Problem with i.v. ceftriaxone
Drug fever
Cost

Single daily dose by syringe

for three days only. 1
Reduces the cost and fever
m J Trop Med Hyg., 52(2), 1995. 162-165.
 Ceftriaxone fever in Typhoid

through i.v Through syringe

drip
 Thank you

Thank you