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Understand Typhoid for Better Pediatric Care During a Pandemic

Typhoid is a bacterial infection caused by Salmonella typhi. It spreads through contaminated food and water. The disease is quite common in adults and children, and the typhoid bug gets more opportunities to spread during the rainy

Typhoid is a bacterial infection caused by Salmonella typhi. It spreads through contaminated food and water. The disease is quite common in adults and children, and the typhoid bug gets more opportunities to spread during the rainy season.

What is Typhoid fever?

Dr Anamika Dubey, Senior Consultant, Pediatrics and Neonatology, Madhukar Rainbow Children’s Hospital said, “Typhoid fever also known as enteric fever is caused by S. Typhi bacteria. It is caused by ingestion of organism, commonest source being fecal contamination of water reservoirs and street food. The bacteria invade the body through the gut mucosa in terminal ileum (the distal end of the small intestine that intersects with the large intestine) and into the blood. The inflammatory response in intestine may sometimes cause ulcers which may bleed.”

The infection can occur at any age. The expression of disease is less prominent in infants than in older children. The host factors and immunity play an important role in predisposition of infection. Typhoid tends to affect children most, with peak incidence occurring in children aged 5-15 years.

Clinical features of Typhoid

“The incubation period varies from three-30 days (usually seven-14 days). The clinical presentation varies from a mild illness with low grade fever, malaise and slight dry cough to a severe clinical picture with abdominal discomfort and multiple complications. In children diarrhea may occur in the earlier stages of the illness   followed by constipation. In 25 percent of cases a maculopapular rash may be seen on 7-10th day. In South Asian countries the presentation of typhoid fever may be more dramatic in children less than five years of age, with comparatively high rates of hospitalization and complications,” added Dr Dubey.

Complications

If no complications occur, the symptoms and physical findings gradually resolve within two-four weeks, however the illness may be associated with malnutrition in several affected children. Altered liver functions are common in typhoid fever, but in some cases hepatitis, jaundice and gall bladder infection may occur. Intestinal perforation and hemorrhage may occur which is preceded by severe abdominal pain, tenderness, and vomiting.

Diagnosis

Dr Dubey said, “The clinical presentation of the disease may be confirmed by blood, urine, and stool culture. Results of blood culture are positive in 40-60 per cent of cases early in the course of disease. Stool and urine culture become positive after one week. Other investigations are supportive like leucopenia, thrombocytopenia, altered liver function test and positive widal test.”

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