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Salmonella typhi [/paratyphi]
persistent fever, abdominal pain, anorexia, constipation or mild diarrhoea, delirium
clinical within 1-3 weeks,
BC+, stool cultures, pain, diarrhoea, bleeding, occas. perforation
Hx: travel, gradual onset sy: constitutional: fever, chills, heasdache, sore throat, muscle pain, weakness; skin rash, cervical adenopathy; GI: N&V, anorexia, diarrhoea, constipation, abdo pain; Neuro: altered mental status, occas. seizures; if ocular manifest.: pain and dcrd vision; recovery: dcring fevers by 4th week (w/o ABx);
O/E: rel. bradycardia; faint erythematous maculopapules or rose spots on trunk (+- haemorrhagic); often cervical adenopathy and hepatosplenomegaly; intestinal bleeding may occur; altered mental status and seizures; rarely ocular manifestations;
Ix: new rapid IgM adn IgG Ab test; [Widal: low sens/spec]; blood/urine/stool cultures (yield 70%); FBC: +-lo Hb/lo Plt; LFT: often hi; U&E: +- renal dysfx; Img: AXR if ? perforation; [sometimes: bone marrow Bx if affected]
Tx: BNF: ciprofloxacin [500bd x 10..14d] or cefotaxime [from Indian subcontinent may be resistant (then azithromycin (unlicensed) may be option), sensitivity to be tested]