Typhoid fever in Malaysian children

A prospective study of 102 children with bacteriologically confirmed typhoid fever, admitted to Hospital Universiti Sains Malaysia over 5 years was conducted. The average age at presentation was 91.3 (range 6 - 159) months. Fever (900%), abdominal pain (56%) and diarrhoea (44%) were common symptoms. Findings included: hepatomegaly (85.3%), splenomegaly (27.5%), anaemia (31%), leukopenia (15%). thrombocytopenia (26%), positive Widal (62.5%) and Typhidot test (96%). Patients were treated with ampicillin (n = 54) or chloramphenicol (n = 49) and 1/3 developed complications like hepatitis (n = 19), bone marrow suppression (n = 8) and paralytic ileus (n = 7). A patient with splenomegaly, thrombocytopenia or leukopenia was at higher risk of developing complications.     

Typhoid fever: present and future

Typhoid fever (TF), a systemic prolonged febrile illness, continues to be a worldwide health problem especially in developing countries where there is poor sanitation and poor standards of personal hygiene. The worldwide incidence of TF is estimated to be approximately 16 million cases annually with 7 million cases occurring annually in SE Asia alone. More than 600,000 people die of the disease annually. The pathogenesis of TF is beginning to be understood. The clinical features and diagnosis of TF are well known. New diagnostic methods have yet to gain universal acceptance. Traditional treatment with the first-line antibiotics (i.e. chloramphenicol, ampicillin and trimethoprim-sulphamethoxazole) though still being used in most developing countries are gradually being replaced with shorter courses of treatment with third generation cephalosporins or fluoroquinolones especially with the growing incidence of multi-drug resistant S typhi strains (MDR-ST). MDR-ST strains are particularly common in the Indian subcontinent; Pakistan and China. The presently available vaccines are far from satisfactory in terms of safety, efficacy and costs. Newer vaccines have been developed and are presently undergoing clinical trials in human volunteers.     

Typhoid fever with severe pancytopenia.

A patient suffering from typhoid fever with severe pancytopenia is presented. Bone marrow examination revealed extensive haemophagocytosis which possibly contributed to the pancytopenia.     

小儿伤寒的临床与治疗

本文对18例小儿伤寒进行分析，（1）临床表现不典型，轻症化，多变异，并发症多，且累及多系统，易延误诊断．（2）用氯霉素加复方新诺明治疗．全部治愈，平均退热天数为4．5天。为提高本病诊治水平，作者指出凡发热持续5－8天，并且有伤寒特征1－2项者，应考虑伤寒的可能．作伤寒的有关检查，及早明确诊断．虽然有耐药菌株的出现，而目前国内不少地区流行的伤寒仍以氯霉素敏感株为主，结合本组病例的治疗经验，作者认为首选药物为氯霉素加复方新诺明治疗伤寒比较妥当。无条件作细菌培养和药敏的基层医疗单位，若治疗5天左右，病情无明显改善，则可选用新型抗菌药物治疗耐药株伤寒．     

Typhoid fever presenting as acute cerebellar ataxia and severe thrombocytopenia

Typhoid fever being a systemic infection can present in a multitude of ways, involving various systems. Here we describe a case of typhoid fever presenting with acute cerebellar ataxia and marked thrombocytopenia. This atypical presentation is not common in typhoid fever and can lead to misdiagnosis as well as a delay in the initiation of appropriate therapy. Prompt clinical improvement and the return of platelet counts to normal were noted after the patient was started on IV Ceftriaxone.