Write the clinical features, investigations & treatment of typhoid fever

Q. 04. Write the clinical features, investigations & treatment of typhoid fever?
 Clinical features of typhoid fever :-
A. First Week :-
1. Fever- insidious onset.
2. Temperature rises in step ladder pattern for 4-5 days associated with malaise with increasing headache.
3. Drowsiness and aching in the limbs.
4. Constipations
5. Diarrhea and vomiting in children.
6. Relative bradicardia.
B. End of first week :-
1. Rose spots on trunk
2. Splenomegaly.
3. Cough and epistaxis.
4. Abdominal distension with tenderness.
5. Diarrhoea.
C. End of second weeks :-
1. Delirium
2. Complication
3. Then coma & death of (if untreated).

 Investigation :-
A. First weeks:-
1. Blood cultures for salmonella typhi is positive in over 75% of patients.
2. Blood count- Leucopenia with relative lymphocytosis.
B. End of first weeks (2nd weeks)
1. Vidal test detects antibodies to the causative organisms. However, it is not a reliable diagnostic test and should be interpreted with caution.
C. Second Weeks.
1. Urine culture may be positive.
D. Second to third weeks :-
1. Stool culture may be positive.

 Treatment :- Several antibiotics are effective in enteric fever.
1. Ciprofloxacin 500mg 12 hourly
2. Cotrimoxazole 96mg 12 hourly.
3. Amoxycillin 75mg 6 hourly.
4. Chloramphenicol 500mg 6 hourly.
5. Azithromycin 1mg daily single or 2 divided dose (now a days drug of choice).
Treatment should be continued for 14 days. Carrier state is treated with ciprofloxacin for 4 weeks.