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Updated: Mar 23 2022

Salmonella typhi

  • Snapshot
    • A 4-year-old girl presents to her pediatrician for diarrhea and fever. She recently flew back from India, where she spent a summer with her grandparents. She has had a low-grade fever since 3 days prior and had constipation followed by non-bloody diarrhea. On physical exam, she has a low grade fever, abdominal tenderness to palpation, and a faint pink macular rash on her trunk and upper arms. She is started on antibiotics.
  • Introduction
    • Classification
      • Salmonella typhi
        • a flagellated, non-lactose fermenting, gram - rod
        • a endotoxin-producing bacteria
      • transmission
        • fecal-oral route
    • Epidemiology
      • incidence
        • high in places of poor sanitation
        • India, China, Southeast Asia, and Africa
      • demographics
        • travelers
        • children
      • risk factors
        • travel to endemic area
    • Pathogenesis
      • inactivated by gastric acids, so a large inoculum is required
      • crosses intestinal epithelium track through invasion of Peyer patches M cells
      • the bacteria then spread via lymphatics and bloodstream
        • may colonize the gallbladder in chronic carriers
    • Associated conditions
      • typhoid fever
      • osteomyelitis
        • most common cause in sickle cell patients
    • Prevention
      • vaccines are recommended prior to traveling to endemic areas
      • oral live-attenuated vaccine
        • 6 years of age or older
      • parenteral vaccine containing Vi capsular polysaccharide
        • 2 years of age or older
  • Presentation
    • Symptoms
      • fever lasting several days
      • constipation initially
      • non-bloody diarrhea later
      • abdominal pain
      • malaise
      • anorexia
    • Physical exam
      • fever
      • relative bradycardia
      • pink macular rash that spreads from trunk to extremities
        • rose spots
      • abdominal tenderness
      • hepatosplenomegaly
      • signs of dehydration
  • Studies
    • Labs
      • culture of blood or stool
    • Making the diagnosis
      • based on clinical presentation and laboratory studies
  • Differential
    • Shigella infection
      • distinguishing factor
        • bloody diarrhea
  • Treatment
    • Management approach
      • antibiotics can increase the duration of gastrointestinal symptoms but are still recommended to prevent complications and relapse
      • choice of antibiotics should be guided by local resistance patterns
    • Conservative
      • supportive care
        • indication
          • all patients
        • modalities
          • rehydration
          • correction of any electrolyte imbalances
    • Medical
      • fluoroquinolones
        • indication
          • first-line for all patients
        • drugs
          • ciprofloxacin
          • ofloxacin
      • azithromycin
        • indication
          • resistance or intolerance of fluoroquinolones
  • Complications
    • Intestinal perforation
      • cause of mortality
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