Typhoid Fever

Typhoid fever is one of the most common febrile illnesses encountered by the physicians in Bangladesh. Diagnosis is not difficult but has lately become a challenge due to changed clinical pattern of the disease, lack of adequate facilities for blood, stool, urine culture, excessive reliance on nonspecific Widal test and non availability of any reliable rapid diagnostic tests. Further, the indiscriminate and injudicious use of antibiotics for treating fever in undiagnosed febrile illnesses early has created problems to the physicians to reach to a diagnosis later on. This has also led to the emergence of high level resistance to many of the commonly used antibiotics in our country. Ciprofloxacin is often used empirically for treating the disease though there is already a high level resistance. In case the organism is in-vitro sensitive to ciprofloxacin but resistant to nalidixic acid, a much higher dose of drug is required to maintain the MIC which is 10 times higher than usual. Third generation cephalosporins (ceftriaxone and cefixime) are still the effective drugs for treating typhoid fever. The drug needs to be used in proper dose and duration to prevent emergence of resistance. Azithromycin though advocated by many as an alternative to ciprofloxacin in resistant cases, has recently lost its credibility due to emergence of resistance. We should not rely on Widal test in diagnosing typhoid fever. In a suspected case, the patient should not be prescribed any antibiotic without sending blood sample for culture sensitivity.     

Typhoid hepatitis.

Liver involvement in typhoid fever is uncommon. Typhoid hepatitis is now being recognized as a definite entity. Over a period of 4 years, we have observed 10 cases (4.8%) of typhoid hepatitis out of 210 cases of typhoid fever. Jaundice, anaemia, hepatomegaly and abnormal biochemical tests were present in all cases. Liver biopsy was done in 8 cases and was found to be abnormal in 5. Two of the 10 cases of typhoid hepatitis died. Recognition of typhoid hepatitis is important since it has to be differentiated from other common ailments in the tropics such as viral, malarial or amoebic hepatitis. Early institution of specific therapy in cases of typhoid hepatitis carries a good prognosis.