Treatment of Severe Typhoid Fever in Children With High Dose Dexamethasone

Punjabi, Narain H.; Hoffman, Stephen L.; Edman, David C.; Sukri, Nono; Laughlin, Larry W.; Pulungsih, Sri Pandam; Rivai, Atti Rifajati; Sutoto,; Moechtar, Asril; Woodward, Theodore E.; Baltimore,

doi:10.1097/00006454-198808000-00002

Cited by 42 publications

(21 citation statements)

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“…Typhoid causes many complications of which gastrointestinal bleeding, intestinal perforation, and typhoid encephalopathy are the most important. Gastrointestinal bleeding is the most common, occurring in up to 10.0% of patients (Punjabi et al, 1988). It results from erosion of a necrotic Peyer's patch through the wall of an enteric vessel.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…The incidence of these neuropsychiatric presentations varies among countries. It ranges from 10.0% to 40.0% among hospitalized patients with typhoid in Indonesia (Hoffman et al, 1984;Punjabi et al, 1988) and Papua New Guinea (Rogerson et al, 1991) but is less than 2.0 percent in Pakistan (Bhutta, 1996) and Vietnam (Hoa et al, 1998). This geographic variation is unexplained.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…The classic signs of enteric fever include fever, toxemia, delirium, abdominal pain, constipation, and hepatosplenomegaly (Punjabi et al, 1988).…”

Section: Physical Findingsmentioning

confidence: 99%

“…Constipation often develops early and is likely due to obstruction at the ileocecal valve by swollen Payer patches. It may last for the entire duration of illness (Punjabi et al, 1988). End of first week: At approximately the end of the first week of illness, about a third of patients develop bacterial emboli to the skin known as rose spots.…”

Section: Physical Findingsmentioning

confidence: 99%

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Epidemiology and Clinical Features of Typhoid Fever: Burden in Bangladesh

Sattar

Jhora²,

Yusuf

et al. 2013

J Sci Found

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Typhoid fever is a systemic infection caused by Salmonella typhi or by the related but less virulent Salmonella paratyphi. The provision of clean water and good sewage systems led to a dramatic decrease in the incidence of typhoid in these regions. Early antibiotic therapy has transformed a previously life-threatening illness of several weeks' duration with an overall mortality rate approaching 20.0% into a short-term febrile illness with negligible mortality. Case fatality rates of 10.0-50.0% have been reported from endemic countries when diagnosis is delayed. Attack rates are highest in persons younger than 20 years or older than 70 years; however, the highest rate is found in infants. Neonates are at a greater risk to fecal-oral transmission secondary to relative decreased stomach acidity and buffering of ingested breast milk and formula. Elderly persons are at a relative greater risk to infection secondary to chronic underlying illness and weakened immunity. In endemic areas, children aged 1-5 years are at the highest risk of infection, morbidity, and mortality because of waning of passively acquired maternal antibody and a lack of acquired immunity. In young children, the clinical syndrome is often a nonspecific febrile illness that is not recognized as typhoid fever. Typhoid is usually contracted by ingestion of food or water contaminated by fecal or urinary carriers excreting S. enterica serotype typhi. It is a sporadic disease in developed countries that occurs mainly in returning traveler, with occasional point-source epidemics. In endemic areas, identified risk factors for disease include eating food prepared outside the home, such as ice cream or flavored iced drinks from street vendors, drinking contaminated water, having a close contact or relative with recent typhoid fever, poor housing with inadequate facilities for personal hygiene, and recent use of antimicrobial drugs. The infectious dose of S. enterica serotype typhi in volunteers varies between 1000 and 1 million organisms. Vi-negative strains of S. enterica serotype typhi are less infectious and less virulent than Vi-positive strains. S. enterica serotype typhi must survive the gastric acid barrier to reach the small intestine, and a low gastric pH is an important defense mechanism.

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Section: Clinical Featuresmentioning

confidence: 99%

Section: Clinical Featuresmentioning

confidence: 99%

“…The classic signs of enteric fever include fever, toxemia, delirium, abdominal pain, constipation, and hepatosplenomegaly (Punjabi et al, 1988).…”

Section: Physical Findingsmentioning

confidence: 99%

Section: Physical Findingsmentioning

confidence: 99%

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Epidemiology and Clinical Features of Typhoid Fever: Burden in Bangladesh

Sattar

Jhora²,

Yusuf

et al. 2013

J Sci Found

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“…11,13,14 Moreover, studies also suggest that delaying steroid administration may result in increased mortality 13 or a higher rate of relapse. 15 Thus, prompt recognition of typhoid encephalopathy before availability of culture data is important for initiation of appropriate therapy.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Encephalopathy in Patients with Salmonella enterica Serotype Typhi Bacteremia Presenting to a Diarrheal Hospital in Dhaka, Bangladesh

Leung

Bogetz

Itoh

et al. 2012

The American Society of Tropical Medicine and Hygiene

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Abstract. To characterize clinical correlates of typhoid fever-associated encephalopathy, we performed a retrospective chart review of patients with Salmonella enterica serotype Typhi bacteremia who were hospitalized at the International Centre for Diarrhoeal Disease Research, Bangladesh, from February of 2009 to June of 2011. Of 207 patients bacteremic with Salmonella Typhi who were 5 years of age, we identified 43 (21%) patients with encephalopathy. Univariate analysis revealed that patients with encephalopathy more often presented at ages of 10-24 years and had severe dehydration, low oxygen saturation, high respiratory rate, low leukocyte count, low platelet count, and Widal flagellar H agglutinin (TH) titer 1:640 compared with typhoid patients without encephalopathy. Multivariate analysis using logistic regression showed that age, dehydration, leukocyte count, and Widal TH titer were independently associated with encephalopathy. Our findings suggest that age, severity of disease, and immune responses are associated with encephalopathy during Salmonella Typhi bacteremia, perhaps reflecting the impact of prominent inflammatory responses.

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Life Threatening Tropical Infections

Botez

Doughty

2014

Pediatric Critical Care Medicine

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Infectious diseases are among the most common pediatric illnesses and are frequently encountered in the pediatric intensive care unit. Tropical infections, on the other hand, are relatively uncommon in children in developed countries, except those with pertinent travel histories or recent immigration. Clinicians who participate in mission work and disaster relief work also encounter these diseases as they are endemic in many developing nations. For the most part these infections do not result in critical illness however some do and this chapter will focus on a few of the more common infections with potential to be acutely life threatening. The epidemiology, pathophysiology, clinical manifestations, and current clinical management are presented for severe malaria, dengue fever, typhoid, and leptospirosis.

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Treatment of Severe Typhoid Fever in Children With High Dose Dexamethasone

Cited by 42 publications

References 0 publications

Epidemiology and Clinical Features of Typhoid Fever: Burden in Bangladesh

Epidemiology and Clinical Features of Typhoid Fever: Burden in Bangladesh

Factors Associated with Encephalopathy in Patients with Salmonella enterica Serotype Typhi Bacteremia Presenting to a Diarrheal Hospital in Dhaka, Bangladesh

Life Threatening Tropical Infections

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