Typhoid fever

Clinical features

Symptoms
Fever ( usually high grade)
        has a step ladder pattern i.e. temperature keeps on increasing and does not come down.
Vomiting
Abdominal pain

Signs
the patient has a coated tongue 

There is relative bradycardia( meaning high temperature but the heart rate is low)
hepatomegaly
The child usually presents with failure to thrive

Causative agent: Salmonella Typhi, Salmonella Paratyphi A, B, C

Diagnosis

Blood culture is the gold standard

positivity is 80% -90% in 1st week of fever
60%-70% in the 2nd week
<50% in 3rd week
 Bone marrow culture is most sensitive

Widal test Antibody detection( non- specific test)
it is positive by the end of 1st week
Urine culture is positive by the 3rd week of fever

Treatment
Third-generation cephalosporins are the drug of choice
(Tab.cefexime 200 mg twice daily for 7 days )

Complications
Intestinal hemorrhage and perforation
Septicemia
Meningitis