PMID: 11840084

Issn Print: 0891-3668

Publication Date: 2002/02/01


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Management of typhoid fever in children

Ina Stephens; Myron M. Levine

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Typhoid fever is an acute generalized infection of the reticuloendothelial system, intestinal lymphoid tissue and gallbladder caused by Salmonella enterica serovar Typhi (S. Typhi), a human host-restricted enteric pathogen. Transmission occurs when susceptible individuals ingest fecally contaminated food or water vehicles containing S. Typhi. Typhoid fever is endemic in many developing areas where the incidence peaks in school age children, 5–19 years of age. Although bacteremic S. Typhi infection in children <24 months old is now recognized to be common in endemic areas, clinical manifestations are often quite mild in this age group.
The incubation period of typhoid fever is typically 8 to 14 days but can range from 3 to 60 days. Illness begins with fever (which increases in a stepwise manner) and constitutional symptoms, accompanied by headache and abdominal discomfort. 1, 2 Patients often manifest anorexia and lethargy. Clinical signs of typhoid fever include abdominal tenderness, hepatosplenomegaly and changes in mental status. Rose spots are seen in 5–20% of patients. 1, 2 Older children and adults often have a dry cough. Constipation is seen in adults and older children, whereas diarrhea (with thick green pea-soup-like stools) occurs in ∼20% of young children. Leukopenia and thrombocytopenia are often seen in older children and adults.
Sustained or intermittent bacteremia is a hallmark of typhoid fever. Complications, including intestinal perforation or hemorrhage, pleural effusion, meningitis, encephalopathy, hepatitis and nephritis, occur most often in those >5 years of age. 3 Risk factors predicting complications in blood culture-proved typhoid fever in adults include abdominal pain, systolic blood pressure <100 mm Hg, hypoalbuminemia and laboratory evidence of disseminated intravascular coagulopathy. 3 Complications are more prevalent in children with multidrug-resistant (MDR) S.
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