Typhoid and Paratyphoid Fever management

Definition

Typhoid and paratyphoid fever are acute systemic infections caused by:

• Salmonella typhi (Typhoid fever)

• Salmonella paratyphi serogroups A and B (Paratyphoid fever)

Infection is acquired through ingestion of contaminated food or water.

Clinical presentation

• Fever

• Severe headache

• Abdominal pain

• Myalgia (muscle pain)

Severe or complicated disease

• Delirium

• Obtundation

• Intestinal haemorrhage

• Bowel perforation

• Neuropsychiatric sequelae

Investigations

Microbiological Diagnosis

• Positive culture from:

  • Bone marrow aspirate

  • Blood

  • Stool (particularly within the first week of acute infection)

OR

• Salmonella stool antigen test

Serological Tests

• Indirect fluorescent Vi antibody test

• ELISA for:

  • IgM antibodies against S. typhi

  • IgG antibodies against S. typhi polysaccharide

Pharmacological treatment

Uncomplicated Typhoid Fever

Ciprofloxacin

• Dose: 500 mg

• Route: Oral (PO)

• Frequency: Every 12 hours

• Duration: 10–14 days

OR

Azithromycin

• Dose: 500 mg

• Route: Oral (PO)

• Frequency: Every 24 hours

• Duration: 7 days

OR

Cefixime

• Dose: 400 mg

• Route: Oral (PO)

• Frequency: Every 24 hours

• Duration: 7–14 days

Complicated Typhoid fever

Ciprofloxacin

• Dose: 200–400 mg

• Route: Intravenous (IV)

• Frequency: Every 12 hours

• Duration: 7 days

OR

Ceftriaxone

• Dose: 1–2 g

• Route: Intravenous (IV)

• Frequency: Every 24 hours

• Duration: 4–7 days

Treatment considerations

• Definitive treatment should be guided by antimicrobial susceptibility testing whenever available.

• Patients with severe or complicated disease should initially receive parenteral therapy.

Features suggesting severe disease

• Systemic toxicity

• Depressed level of consciousness

• Prolonged fever

• Organ dysfunction

• Need for hospitalization

Possible complications

• Intestinal haemorrhage

• Bowel perforation

• Delirium

• Obtundation

• Neuropsychiatric complications

• Sepsis

• Multi-organ dysfunction

Follow-up

• Monitor clinical response to treatment.

• Review culture and susceptibility results when available.

• Assess for complications in patients with persistent fever, abdominal symptoms, altered mental status, or systemic toxicity.