Enteric Fever (Typhoid) in Children: Model Clinical Case and Viva Q&A

Clinical Case of Enteric Fever in Children

A 7-year-old boy is brought to the pediatric clinic with a 5-day history of high-grade fever (up to 40°C), accompanied by abdominal pain, headache, and malaise. The child's mother reports that he has been refusing food but drinking water frequently. She also mentions loose stools for the past 2 days.

On examination:

• Temperature: 39.5°C
• Pulse: 110 beats/min
• Respiratory rate: 24 breaths/min
• Blood pressure: 100/60 mmHg

The child appears lethargic and has a coated tongue. Abdominal examination reveals a slightly distended abdomen with tenderness in the right lower quadrant. The liver is palpable 2 cm below the costal margin, and the spleen is just palpable. No rose spots are visible on the trunk.

Laboratory investigations show:

• WBC count: 4,500/μL with relative lymphocytosis
• Hemoglobin: 10.5 g/dL
• Platelet count: 140,000/μL
• ESR: 35 mm/hr
• ALT: 65 U/L
• AST: 70 U/L

Blood culture is positive for Salmonella Typhi, confirming the diagnosis of enteric fever. The isolate is sensitive to ceftriaxone and azithromycin but resistant to ciprofloxacin.

The child is admitted for intravenous ceftriaxone therapy and supportive care. After 5 days of treatment, the fever subsides, and the patient's condition improves significantly.

Clinical Presentations of Enteric Fever in Children

1. Classical Presentation

   • Gradual onset of fever over several days
   • Fever reaching 39-40°C by the end of the first week
   • Headache, malaise, and anorexia
   • Relative bradycardia (pulse-temperature dissociation)
   • Abdominal pain and constipation (more common than diarrhea in older children)
   • Coated tongue and hepatosplenomegaly
   • Rose spots on trunk (may be difficult to see in dark-skinned children)

2. Atypical Presentation in Young Children

   • More abrupt onset of fever
   • Predominant gastrointestinal symptoms (diarrhea, vomiting)
   • Respiratory symptoms (cough, respiratory distress)
   • Neurological manifestations (febrile seizures, meningismus)

3. Severe or Complicated Presentation

   • High fever with altered mental status
   • Severe dehydration and electrolyte imbalances
   • Intestinal perforation or hemorrhage
   • Hepatitis with jaundice
   • Myocarditis or shock

4. Mild or Subclinical Presentation

   • Low-grade fever
   • Mild gastrointestinal symptoms
   • Fatigue and decreased appetite
   • May be mistaken for viral illness

5. Relapse Presentation

   • Recurrence of symptoms after initial clinical improvement
   • Usually milder than the initial episode
   • Occurs 2-3 weeks after completion of treatment

6. Chronic Carrier State

   • Asymptomatic or with minimal symptoms
   • Intermittent shedding of bacteria in stool or urine
   • More common in children with underlying biliary tract abnormalities

Knowledge Check: Question and Answers for Medical Students & Professionals

This interactive quiz component covers essential viva questions and answers. It includes 30 high-yield viva questions with detailed answers.

Question 1 of 30

Disclaimer

The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.