Typhoid fever is a systemic bacterial infection caused by Salmonella Typhi, transmitted through contaminated food or water. In Ghana, it is a prevalent public health issue, particularly in areas with poor sanitation, requiring prompt diagnosis and treatment to prevent complications like intestinal perforation or sepsis.
🦠 Overview and Pathophysiology
Typhoid results from ingestion of S. Typhi, leading to systemic invasion via the lymphatic system:
Causes
- Organism: Salmonella Typhi
- Transmission: Fecal-oral route (contaminated water/food)
- Risk Factors: Poor hygiene, travel to endemic areas
Pathogenesis
- Invasion: Penetrates intestinal mucosa, spreads via lymphatics
- Complications: Intestinal perforation, hepatitis, encephalopathy
- Key Point: Chronic carriers can perpetuate transmission
🔍 Clinical Presentation
Symptoms evolve over stages, with a stepwise progression:
Symptoms
Early (1-7 days): Fever, headache, malaise, constipation
Peak (2-3 weeks): High fever (39-40°C), abdominal pain, diarrhea (in children)
Late: Confusion, rose spots, relative bradycardia
Signs
Vital: Fever, tachycardia, hypotension (late stage)
Abdominal: Distension, tenderness, hepatosplenomegaly
Skin: Rose spots (faint pink macules on trunk)
- Persistent vomiting, severe abdominal pain
- Altered consciousness, shock
- Signs of perforation (e.g., peritonitis)
🧪 Diagnosis
Confirm with laboratory tests, as clinical diagnosis alone is unreliable:
Investigations
First-Line: Widal test (titers ≥1:160 suggestive), blood culture
Supportive: Full Blood Count (leukopenia), stool culture, urine culture
Imaging: Abdominal ultrasound (if perforation suspected)
💊 Treatment
Antibiotics are the cornerstone, with supportive care to manage complications.
Non-Pharmacological
Hydration: Oral rehydration or IV fluids if dehydrated
Diet: Light, easily digestible food
Rest: Bed rest during acute phase
Ciprofloxacin
- Dose: 500 mg orally 12 hourly x 7-10 days
- Route: Oral (IV if severe)
- Indication: First-line in adults
Ceftriaxone
- Dose: 1-2 g IV daily x 7-14 days
- Route: Intravenous
- Indication: Severe cases or resistance
Azithromycin
- Dose: 500 mg orally daily x 5-7 days
- Route: Oral
- Indication: Alternative, especially in children
- Adjust for resistance patterns (e.g., multidrug-resistant strains)
- Monitor for complications like perforation or relapse
- Avoid antipyretics alone; treat the infection
🤰 Special Populations
Tailor management for vulnerable groups:
Children
Dose: Ceftriaxone 50-75 mg/kg IV daily, Azithromycin 10 mg/kg daily
Focus: Monitor for dehydration and complications
Pregnancy
Preferred: Ceftriaxone (safe in pregnancy)
Avoid: Ciprofloxacin unless benefits outweigh risks
Support: Obstetric consultation
🚨 Referral Criteria
- Suspected perforation or peritonitis
- Severe dehydration or shock
- Failure to respond to treatment after 48-72 hours
Transfer to a facility with surgical capabilities if needed.
🧠 Key Takeaways
- ✅ Diagnose Early: Use Widal and blood culture
- ✅ Treat Promptly: Ciprofloxacin or ceftriaxone as first-line
- ✅ Hydrate: Manage dehydration aggressively
- ✅ Monitor: Watch for complications like perforation
- ✅ Special Care: Adjust for children and pregnancy
- ✅ Refer: For severe cases or treatment failure