Hidoc Bulletin

Typhoid fever can cause life-threatening conditions in patients, it requires proper diagnosis and treatment at the right time. The causative organism of typhoid is Salmonella typhi which can be detected by different clinical examinations performed in laboratory. As soon as the diagnosis is confirmed, it is mandatory to start the treatment and use of antibiotics is the only effective treatment against typhoid. It is the definitive treatment for typhoid fever (enteric fever) based on the susceptibility of the causative organism. Generally, in antimicrobial treatment intermediate susceptibility is considered as equivalent to resistance. Therefore, after confirming the organism it is important to check susceptibilities against different antibiotics based on which the treatment should be recommended. Basically the combination treatment with ceftriaxone and ciprofloxacin is recommended as first line treatment when the sensitivities of the bacteria and its geographical origin is unknown. Other than this, the use of oral rehydration therapy which has beenrediscovered back in the 1960s can also be used because of its potential to prevent many of the deaths due to diarrheal diseases. Moreover, if the causative organism does not show much resistance to the antibiotics the use of fluoroquinolones such as ciprofloxacin can be used as the treatment of choice. Otherwise, as mentioned, the use of third-generation cephalosporin such as ceftriaxone or cefotaxime is the first choice of treatment. Cefixime can serve as a suitable oral alternative in patients. The use of different antibiotics, such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, amoxicillin and ciprofloxacin, have been commonly used in the treatment of typhoid fever in microbiology depending on the susceptibility of the organism and this has given positive results by reducing the rate of fatalities of the cases to about 1%. Whereas, if the patients are kept untreated, they might develop sustained fever, bradycardia, hepatosplenomegaly, abdominal symptoms and occasionally, pneumonia but if proper treatment is provided no such fatalities are observed. In case of white-skinned patients it is noticed that pink spots (which fade on pressure) appear on the skin of the trunk. If the patients are left for three weeks in untreated condition gastrointestinal and cerebral complications might be seen which can prove to be highly fatal. The highest fatality rates are observed in children under 4 years. Patients who contract typhoid fever often become chronic carriers because persistence of the bacteria continues even after symptoms have resolved. The use of corticosteroids like dexamethasone may decrease the mortality in severe cases which may get complicated by delirium, obtundation, stupor, coma, or shock due to bacterial meningitis. Surgical interventions may also be preferred in the cases of intestinal perforation. Mostly, simple closure of the perforation with drainage of the peritoneum is preferred. Additionally, small-bowel resection may also be preferred in case of multiple perforations. In the case there is a failure in antibiotic treatment the gallbladder should be resected in order to eradicate the hepatobiliary carriage but cholecystectomy may also found to be associated with hepatic infections.