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Typhoid Fever Manifestation, Diagnosis, and Treatment
- 1. Presentated by Don JayricV. Depalobos, MD Typhoid Fever
- 2. Objectives General Specific Determine thetemporal profile of patients having Typhoid Fever Review the Pathophysiology Typhoid Fever Treatment of Typhoid Fever Identify preventive measures for the occurrence of Typhoid Fever At the end of the session we should be able to: Have a general grasp on the management of typhoid fever with ileitis At the end of the session we should be able to:
- 3. 22 year old,female, from Aramaywan, Quezon, Palawan Source of Data: Patient Reliability: 90% Chief Complaint: Fever Patient’s Data Patient A.M.
- 4. 2 weeks priorto admission 1 weeks prior to admission Few hours prior to admission History of Present Illness Undocumented Fever Body Malaise Headache Occasional Chills Non-productive Cough Black tarry stool 2-3x/day approximately half glass per BM, lasted for 3 days Vague Abdominal Pain Persistent Fever, still undocumented Vomiting more than 10 bouts approximately half glass per bout Recurrence of black tarry stool, now with bright red streaks Generalized body weakness Easy fatigability Consulted at QMH Typhidot IgG IgM Positive
- 5. Past Medical History Noknown comorbids No previous hospitalization No known allergies to any medications of food O No previous surgeries No previous treatment for PTB/EPTB O No known pregnancy-related complication. O
- 6. Family Medical History Hypertension- Father’s Side O Mother died of unknown ause of death O No DM No BA No PTB No Stroke O
- 7. Personal/Social History O Bungalow with1 room, well ventilated Water Source is deep well with notable comfort room within 30 meters radius O Non-smoker Non-alcoholic Beverage Drinkerh A housewife and mother of 3. She is a highschool graduate, baptist and she belongs to the Palaw’an Tribe. O
- 8. OB History G3P3 (3003) LMP:August 30, 2023 O G1 - 2018 Male NSD NID G2 - 2020 Male NSD NID G3 - 2022 Male NSD Hospital O M - 14 years old I - Regular 28-30 days D - 2-3 days A - 2-3 apad, mild-moderately soaked/day S - occasional headache O
- 9. GI/GU Skin/MSK Neurologic General/HEENT CV/Respi Dysuria Constipation/Diarrhea Vague abdominal Pain Thirst YellowishDIscoloration of Eyes Body malaise Sweating Review of Systems Headache No syncope No changes in behavior/mood Headache No Weight Loss Chills Sweating Occasional palpitations Shortness of Breath Denies chest pain Occasional Cough, non productive No Blurring of Vision No hearing loss No tinnitus No loss of taste
- 10. Physical Examination ABDOMEN: Flabby, tympanitic, Soft,epigastric tenderness, non-distended. No palpable masses. EXTREMITIES: No edema. Non-tender. SKIN: No rashes or lesions. Warm. Jaundice. Negative Torniquet Test. NEUROLOGIC: No focal neurological deficits. CN I-XII grossly intact. PSYCHIATRIC: Cooperative. Appropriate mood and affect. GENERAL: Alert and oriented x 3. No acute distress. Well- nourished. Weight 40kgs Height 5 feet LUNGS: Clear breath sounds. SCWE. No accessory muscle use. CARDIOVASCULAR: Regular rate and rhythm. No murmur. No JVD. EYES: EOMI. Icteric, both eyes. HENT: Moist mucous membranes. No cervical lymphadenopathy
- 11. Typhoid Fever MalariaLeptospirosis Differential Diagnoses Abdominal Pain “step ladder” Remittent Fever more than 5 days GI Bleeding Headache Body Malaise/Myalgia Jaundice Rose spots Relapsing/ Periodic Fever Headache Body Malaise Abdominal Pain Endemic Area Intermitten/Biphasic Fever Headache Myalgia Calf Tenderness No history of wading
- 12. Dengue Fever HepatitisPulmonary Tuberculosis Differential Diagnoses Intermittent Fever Myalgia Melena Negative Torniquet Test Icteric Sclera Fever Melena Abdominal Pain No RUQ tenderness/pain Fever, Biphasic Cough for more than 2 weeks Weight Loss
- 13. TYPHOID FEVER ANEMIA PROB2 TO UGIB
- 14. Course in theWard S:Chills, Sweating, Body Malaise, Nausea, Melena O: BP: 100/70 HR: 103 RR: 22 T: 37.8 SpO2: 100% Awake, GCS 15, Not in distress Icteric sclera, pale skin diaphoresis SCWE, CBS, AP tachycardic, regular rhythm Soft, vague epigastric tenderness, tympanitic, no palpable mass, HABS FEP, <2s CRT, No edema Day of Admission Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut in faucibus leo, eleifend ultrices diam. Proin egestas porta ex, non facilisis nulla ultricies non. fHgb: 70 Hct: 19.8 WBC: 7.4 Plt: 80 Segmenter: 66 Lymphocytes: 26.4 BSMP: NMPS LDH: 238 ALP: 1,409 APTT: 42 PTT: 17 INR: 1.45 % Activity: 44.7% Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut in faucibus leo, eleifend ultrices diam. Proin egestas porta ex, non facilisis nulla ultricies non. 03 Diagnostics Plan IVF: PLR 1L x 70cc/hr Omeprazole 40mg IV q24 Paracetamol 300mg IV q4 PRN Metoclopramide 10mg IV q8 PRN Ceftriaxone 1.9gm IV q12 KCL tab; 1 tab TID x 3 doses then repeat serum K after correction For BT or 5 Units PRBC Hgb: 45 Hct: 13.1 WBC: 6.1 Plt: 164 Segmenter: 75.7 Lymphocytes: 22.2 BUN: 5.13 Crea: 107 Na: 137.8 K: 3.07 Pregnancy Test: Negative
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- 16. Course in theWard S:Body Malaise, Melena O: BP: 100/70 HR: 63 RR: 23 T: 39.4 SpO2: 100% Awake, GCS 15, Not in distress Icteric sclera, pale skin diaphoresis SCWE, CBS, AP tachycardic, regular rhythm Soft, vague epigastric tenderness, tympanitic, no palpable mass, HABS FEP, <2s CRT, No edema Hospital Day 1 Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut in faucibus leo, eleifend ultrices diam. Proin egestas porta ex, non facilisis nulla ultricies non. 02 Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut in faucibus leo, eleifend ultrices diam. Proin egestas porta ex, non facilisis nulla ultricies non. 03 f Whole Abdominal Ultrasound: -Hepatosplenomegaly Minimal Hepatorenal Ascites Gallbladder wall thickening -Renal Parenchymal Disease, Right -No gross pathology seen in the scan of the pancreas, left kidney, and urinary bladder K (post correction) 3.51 Diagnostics Plan IVF: PLR 1L x 80cc/hr Omeprazole 40mg IV q12 Paracetamol 300mg IV q4 PRN Metoclopramide 10mg IV q8 PRN Ceftriaxone 2gms IV q12 - D2
- 17. Course in theWard S:Body Malaise, Melena, chills O: BP: 100/70 HR: 60 RR: 23 T: 38.4 SpO2: 100% Awake, GCS 15, Not in distress Icteric sclera, pale skin diaphoresis SCWE, CBS, AP NRRR, regular rhythm Soft, vague epigastric tenderness, tympanitic, no palpable mass, HABS FEP, <2s CRT, No edema Hospital Day 2 Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut in faucibus leo, eleifend ultrices diam. Proin egestas porta ex, non facilisis nulla ultricies non. 02 Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut in faucibus leo, eleifend ultrices diam. Proin egestas porta ex, non facilisis nulla ultricies non. 03 f Urinalysis Yellow/Sl. Hazy/pH 6.5/SG 1.015 RBC TNTC WBC 1-2 SGPT 92 SGOT 200 Albumin 26.21 TB 2.09 IB 0.52 DB 1.57 Procalcitonin 32.2 T3 1.79 T4 112.21 TSH 1.02 FA: Pus Cells 3-4 RBC 1-2 NPS Diagnostics Plan IVF: PLR 1L x 80cc/hr Omeprazole 40mg IV q12 Paracetamol 300mg IV q4 PRN Metoclopramide 10mg IV q8 PRN Ceftriaxone 2gms IV q12 - D2
- 18. Course in theWard S:Melena, No chills, No abdominal pain, D1 afebrile O: BP: 100/80 HR: 88 RR: 20 T: 37.1 SpO2: 100% Awake, GCS 15, Not in distress Icteric sclera, pale skin, jaundice SCWE, CBS, AP NRRR Soft, vague epigastric tenderness, tympanitic, no palpable mass,NABS FEP, <2s CRT, No edema Hospital Day 3 Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut in faucibus leo, eleifend ultrices diam. Proin egestas porta ex, non facilisis nulla ultricies non. 02 Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut in faucibus leo, eleifend ultrices diam. Proin egestas porta ex, non facilisis nulla ultricies non. 03 f Diagnostics Plan IVF: PLR 1L x 80cc/hr Omeprazole 40mg IV q12 Paracetamol 300mg IV q4 PRN Metoclopramide 10mg IV q8 PRN Ceftriaxone 2gms IV q12 - D3 S/P 1/5 Unit PRBC Hgb: 70 Hct: 19.8 WBC: 7.4 Plt: 80 Segmenter: 66 Lymphocytes: 26.4 BSMP: NMPS LDH: 238 ALP: 1,409 APTT: 42 PTT: 17 INR: 1.45 % Activity: 44.7%
- 19. Course in theWard S:Melena, No chills, No abdominal pain, D2 afebrile O: BP: 100/80 HR: 88 RR: 20 T: 37.1 SpO2: 100% Awake, GCS 15, Not in distress Icteric sclera, pale skin, jaundice SCWE, CBS, AP NRRR Soft, no epigastric tenderness, no palpable mass,NABS FEP, <2s CRT, No edema Hospital Day 4 Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut in faucibus leo, eleifend ultrices diam. Proin egestas porta ex, non facilisis nulla ultricies non. 02 Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut in faucibus leo, eleifend ultrices diam. Proin egestas porta ex, non facilisis nulla ultricies non. 03 f Diagnostics Plan IVF: PLR 1L x 80cc/hr Omeprazole 40mg IV q12 Paracetamol 300mg IV q4 PRN Metoclopramide 10mg IV q8 PRN Ceftriaxone 2gms IV q12 - D4 Metronidazole 500mg IV q8 Vitamin K 1 amp IV q8 x 3 doses TB: 0.82 DB: 1.59 SGPT: 106 SGOT: 164 ALT/LDH Ratio: 0.44 Lepto IgM Nonreactive Lepto IgG Nonreactive PBS: Microcytic, hypochromic rbc with target cells; WBCs are mature looking mostyl neutrophils. No blast cells. Platelet appears decreased mostly in singles. Recitulocyte Count: 0.9%
- 20. Course in theWard S:No melena, abdominal pain, D3 afebrile O: BP: 100/70 HR: 86 RR: 20 T: 36.8 SpO2: 100% Awake, GCS 15, Not in distress ISlightly icteric sclera, pale skin SCWE, CBS, AP NRRR Soft, no epigastric tenderness, no palpable mass,NABS FEP, <2s CRT, No edema Hospital Day 5 Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut in faucibus leo, eleifend ultrices diam. Proin egestas porta ex, non facilisis nulla ultricies non. 02 Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut in faucibus leo, eleifend ultrices diam. Proin egestas porta ex, non facilisis nulla ultricies non. 03 f Diagnostics Plan IVF: PLR 1L x 80cc/hr Omeprazole 40mg IV q12 Paracetamol 300mg IV q4 PRN Metoclopramide 10mg IV q8 PRN Ceftriaxone 2gms IV q12 - D5 Azithromycin 500mg tab OD - D1 Metronidazole 500mg IV q8 Vitamin K 1 amp IV q8 x 3 doses S/P 2 Units PRBC Pelvic Ultrasound: -Normal sized anteverted uterus with intact endometrium. -Normal sized ovaries.
- 21. Course in theWard S:No melena, abdominal pain, D4 afebrile O: BP: 100/70 HR: 86 RR: 20 T: 36.8 SpO2: 100% Awake, GCS 15, Not in distress Anicteric sclera, pale skin SCWE, CBS, AP NRRR Soft, no epigastric tenderness, no palpable mass, NABS FEP, <2s CRT, No edema Hospital Day 6 Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut in faucibus leo, eleifend ultrices diam. Proin egestas porta ex, non facilisis nulla ultricies non. 02 Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut in faucibus leo, eleifend ultrices diam. Proin egestas porta ex, non facilisis nulla ultricies non. 03 f Diagnostics Plan IVF: PLR 1L x 80cc/hr Omeprazole 40mg IV q12 Paracetamol 300mg IV q4 PRN Metoclopramide 10mg IV q8 PRN Ceftriaxone 2gms IV q12 - D6 Azithromycin 500mg tab OD - D2 Metronidazole 500mg IV q8 - D2 S/P 3 Units PRBC Hgb: 109 Hct: 32.2 WBC: 5.6 Plt: 109 Segmenter: 56.3 Lymphocytes: 30.5 UA: Unremarkable
- 22. Course in theWard S:No melena, abdominal pain, D4 afebrile O: BP: 100/70 HR: 92 RR: 20 T: 36.6 SpO2: 100% Awake, GCS 15, Not in distress Anicteric sclera, pink skin SCWE, CBS, AP NRRR Soft, no epigastric tenderness, no palpable mass NABS FEP, <2s CRT, No edema Hospital Day 6 Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut in faucibus leo, eleifend ultrices diam. Proin egestas porta ex, non facilisis nulla ultricies non. 02 Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut in faucibus leo, eleifend ultrices diam. Proin egestas porta ex, non facilisis nulla ultricies non. 03 f Home Meds: Plan S/P 3 Units PRBC Patient was sent home improved Cefixime 200mg tab BID x 7 days Azithromycin 500mg tab OD x 3 days more to complete 5 days Omeprazole 40mg cap OD x 7 days FeSo4 tab OD x 2 month Tramadol 50mg tab TID PRN Follow-up after 1 week
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- 26. Bile Stool Concept Map Patient A.M. 22/F Ingestionof S. Typhi contaminated food/water Intestinal Invasion Clinical Symptom: Fever, headache, myalgia, constipation, nausea Dissemination and colonization of the Reticuloendothelial System (Replication within Macrophages) Liver Spleen Bone Marrow Blood Stream (Primary Bacteremia) Incubation Period 10-14 days Blood Stream (Secondary Bacteremia) Enterocytes Peyer’s Patches & Macrophages Mesenteric Lymph Nodes Thrombocytopenia Anemia, Jaundice, Icterisia Liver Enzymes/ Clotting factors Derrangement Typhidot Positive Elevated LDH Abdominal Pain Melena Hydration Ceftriaxone Paracetamol Metoclopramide PRBC 3 u Omeprazole Metronidazole Vitamin K
- 27. Take Away Message HealthEducation Proper Food Handling Accessible Health Care Vaccination
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- 29. THANK YOU 09472923883 [email protected]jayric depalobos