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Patient case: Typhoid and Paratyphoid Fever

Patient case: Typhoid and Paratyphoid Fever

Discussion

A 27-year-old female presents to the clinic with a one-week history of persistent fever, fatigue, and abdominal discomfort. She also reports headaches, poor appetite, and occasional nausea. Over the past two days, she has developed diarrhea, which she describes as loose and foul-smelling. She recently returned from a month-long trip to a densely populated urban area with limited access to clean drinking water.

On examination, her temperature is 39.5°C (103.1°F), and she appears mildly dehydrated. She has a slow heart rate relative to her fever (relative bradycardia) and mild right upper quadrant tenderness on abdominal palpation. There is no jaundice, but her spleen is slightly enlarged.

Laboratory investigations reveal mild anemia, leukopenia, and mildly elevated liver enzymes. Blood cultures return positive for Salmonella enterica serotype Typhi. She is admitted for intravenous antibiotic therapy and supportive care, including hydration and fever management. Her symptoms gradually improve, and she is discharged with oral antibiotics and strict hygiene advice to prevent transmission.

Questions
1. What is the most likely diagnosis in this patient?

a) Malaria

b) Typhoid fever

c) Viral hepatitis

d) Amebic dysentery

2. Which clinical feature is characteristic of typhoid fever?

a) Jaundice and dark urine

b) Severe muscle pain and rash

c) Persistent fever with relative bradycardia

d) Sudden onset of high fever with chills

3. What is the most useful test for confirming the diagnosis of typhoid fever?

a) Stool microscopy

b) Blood culture

c) Abdominal ultrasound

d) Rapid antigen test

4. What is the best initial treatment for this patient?

a) Intravenous antibiotics and supportive care

b) Corticosteroids

c) Antiviral therapy

d) Symptomatic treatment only

Reveal answers

Answers

1. Answer: b) Typhoid fever

The patient’s prolonged fever, abdominal discomfort, diarrhea, and travel history to an area with poor sanitation strongly suggest typhoid fever. Other options like malaria and hepatitis present with different patterns of symptoms.

2. Answer: c) Persistent fever with relative bradycardia

Relative bradycardia (a slower heart rate than expected for the level of fever) is a classic sign of typhoid fever. This distinguishes it from infections that typically cause a high fever with a rapid pulse.

3. Answer: b) Blood culture

Blood culture is the gold standard for diagnosing typhoid fever, as it detects Salmonella enterica serotype Typhi or Paratyphi. Stool and urine cultures may be helpful but are less reliable in early disease.

4. Answer: a) Intravenous antibiotics and supportive care

Severe typhoid fever is best managed with IV antibiotics like ceftriaxone or fluoroquinolones, along with hydration and fever control. Without treatment, complications like intestinal perforation or sepsis can occur.