1. Typhoid Fever in Children: a hospital based follow-up of recent outbreak Hem Sagar Sharma Abhisek Tiwari Prakash Rana Parag Bhattarai Fakir C gami Pushpa R Sharma Department of Child Health

2. History In the mid-nineteenth century, Sir William Jenner undertook the first successful definition of typhoid, clearly delineating it from typhus, which is spread by lice and has differing symptoms. Karl J. Erberth isolated the first causal organism for typhoid fever in 1880, thus providing the basis for a definitive diagnosis. Typhoid bacilli in culture plate The genus is named for the pathologist Salmon, who first isolated Salmonella choleraesuis from porcine intestine.

3. History (contd) The best known carrier was "Typhoid Mary"; Mary Mallon was a cook in Oyster Bay, New York in 1906 who is known to have infected 53 people, 5 of whom died. Five years after her release, she was found to have been the source of 25 cases of typhoid at the Women's Hospital in Manhattan.

4. Typhoid and paratyphoid fevers are endemic in the Indian subcontinent. Typhoid fever affects 17 million people worldwide every year, with approximately 600,000 deaths. Case fatality rates of 10-50% children aged 1-5 years are at the highest risk The incubation period range 3-56 days. Epidemiology

5. 0-4'10-1420-2445-54 0% 5% 10% 15% 20% 25% 0-4'10-1420-2445-54 years of age % of typhoid fever cases Typhoid fever strikes mostly children Mean age at KCH is 7.8 yrs (n=32)

6. Symptomatology (contd) Long and constraining clinical features 37°C 40°C D 0D7D21 D3-56 IncubationInvasionStatus periodRecovery Long convalescence Asymptomatic Headache Abdominal pain Cough Constipation, diarrhoea Diarrhea Splenomegaly Toxic look Hepatomegaly Abdominal distension Crackles Diseases do not follow the text book picture

7. Symptoms (contd) Symptoms Typhoid fever (%) KCH 2002 (n=32) Paratyphoid A & B (%) Fever89-100 100%92-100 Headache43-90 32%60-100 Nausea23-3633-58 Vomiting24-35 3.1%22-45 Abdominal pain Distension 8-52 21.8% 29-92 Diarrhoea30-57 25%17-68 Constipation10-79 9.3%2-29 Cough11-36 8.4%10-68

8. Total leukocytes count (n=32) Total counts are not helpful

9. Pattern of antibiotics being used n=32

10. Antibiotic Sensitivity

11. Approach to a child with fever Fever in the first week without treatment Fever in the first week with antibiotics Fever in the second week with various antibiotics A child with fever without any localizing signs Observe for the general condition, look for the specific signs Work-up for investigations, counsel the parents

12. Treatment (contd) Temperature subsides when drugs are withheld

13. Problem with i.v. ceftriaxone Drug fever Cost Single daily dose by syringe for three days only. 1 Reduces the cost and fever 1.Am J Trop Med Hyg., 52(2), 1995. 162-165.

14. Ceftriaxone fever in Typhoid through i.v drip Through syringe

15. Thank you