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 ::  Abstract
 ::  Introduction
 ::  Case report
 ::  Discussion
 ::  Acknowledgment
 ::  References
 ::  Article Figures

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CASE REPORT
Year : 1995  |  Volume : 41  |  Issue : 4  |  Page : 108-9

Typhoid fever in a 7 month old infant.


Department of Pediatrics, Seth GS Medical College, Parel, Bombay.,

Correspondence Address:
S C Karande
Department of Pediatrics, Seth GS Medical College, Parel, Bombay.

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PMID: 0010707733

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 :: Abstract 

The clinical profile of typhoid fever in an infant is variable and non-specific. A rare case of typhoid fever in a 7 month old infant is reported. The child presented with only a day's history of fever and loose motions which resulted in severe dehydration, acute tubular necrosis and death. The diagnosis of typhoid fever was made only on post-mortem study. The problem in diagnosing typhoid fever in a young infant is highlighted with a brief literature review on the subject.


Keywords: Case Report, Fatal Outcome, Female, Human, Infant, Typhoid Fever, diagnosis,pathology,


How to cite this article:
Karande S C, Desai M S, Jain M K. Typhoid fever in a 7 month old infant. J Postgrad Med 1995;41:108

How to cite this URL:
Karande S C, Desai M S, Jain M K. Typhoid fever in a 7 month old infant. J Postgrad Med [serial online] 1995 [cited 2014 Oct 20];41:108. Available from: http://www.jpgmonline.com/text.asp?1995/41/4/108/510





  ::   Introduction Top


Typhoid fever is endemic in developing countries like India where sanitation is poor. Its incidence is highest in 5 to 25 year olds[1]. We report a 7 month old infant who presented with fever an loose motions and died. A specific diagnosis of typhoid fever was possible only on post-mortem examination.


  ::   Case report Top


A 7 month old baby girl (weight 7.2 kg) was admitted with complaints of loose motions, vomiting, fever and breathlessness for 1 day. The child had passed 10- 12 large watery stools with mucus, but no blood and had 4 vomits in 24 hours. She had also developed moderate fever and had not passed any urine since, 8-10 hours. There was no history of altered sensorium or convulsions. The child was on bottle-feeds with poor hygiene.

On admission the child was pale and listless in a state of hypovolemic shock and Grade III dehydration. The pulse was 160/min, respiratory rate 80/min, temperature 100.4?C, and blood pressure 80/0 mm Hg. Liver was 2 cm palpable. Spleen was not palpable. Chest examination was normal. Resuscitative measures with Ringer lactate, intravenous fluids, sodium bicarbonate was started along with intravenous Ampicillin (100 mg/kg/24 hr qid.).

Laboratory investigations on admission showed Hb 8 gm/dl normal TLC count: 8.4 x 109/L (Polymorphs 50%. Lymphocytes 48%, Eosinophils 2%), BUN 50 mg/dl Serum Na+ 140 mmol/L, Serum K+ 3.2 mmol/L and arterial blood gas pH 7.394, pO2 89 mm Hg, pCO2 14.3 mm Hg, HCO3 8.7 mmol/L with 99.5% O2 saturation. Stool examination showed 18 - 20 leucocytes/HPF. Hanging drop preparation for  Vibrio cholerae Scientific Name Search  was negative. Chest X-ray was normal.

After blood transfusion and fluid therapy, small amounts of urine were passed 11 hrs after admission. She developed fever upto 104?F during her ward stay. A central venous cut down was done (central venous pressure 12 cm) and a dopamine drip 2 ?g/Kg/min started 4 hrs after admission. Laboratory investigations done 12 hrs after admission showed BUN 84 mg/dl, Serum Na+ 128 mmol/L, serum K+ 3.4 mmol/L and arterial blood gas pH 7.483. pO2 75 mm Hg, pCO2, 14.6 mm Hg, HCO3 11.1 mmol/L with 97.9% O2 saturation.

The child's condition worsened and she died 30 hrs after admission. A partial abdominal post-mortem was done. Gross examination of the small intestines revealed hypertrophied Peyer's patches, with few overlying oval ulcers. Microscopically they showed "typhoid" macrophages. The overlying mucosa was ulcerated [Figure - 1], [Figure - 2]. Spleen was enlarged with a tense capsule and soft congested red pulp, and microscopically revealed typhoid nodules, increased cellularity of the cords and sinusoidal congestion. Liver showed random focal necrosis. Aggregates of macrophages with erythrophagocytosis were seen in these areas. Kidneys showed necrosis of the tubular epithelial cells. The final diagnosis was typhoid enteritis with toxemia and acute tubular necrosis.


  ::   Discussion Top


The clinical profile of typhoid fever in infants is variable and non-specific[2],[3],[4], hence there is a high risk of missing the diagnosis. Classical signs and symptoms of typhoid fever viz. leucopenia, splenomegaly, rose spots, abdominal distention, bronchopneumonia and even fever may not be present[2],[3],[4]. Infants are often asymptomatic except for a mild gastroenteritis[5], while some present with severe septicemia[6]. Other features which may be present are convulsions and meningism, sometimes without diarrheal. Also there is a low incidence of haemorrhage and ileal perforation in children under 5 yrs of age, though anemia can be a pronounced feature[2].

In the few reported series of typhoid fever in young children, only 3 were less than 1 yr of age (youngest being 3 months old)[2], and in another series only 1 child was less than 2 yrs[3]. In a recent report of 18 children from Delhi below 2 yrs (mean age of 16.7 months) the youngest was 9 months[4]. Eleven neonates have been reported[8],[9].

The incidence of typhoid fever in infants in our country is now known. Also, infants are not immunised against typhoid fever as neither the parenteral heat-phenol or acetone- inactivated whole cell vaccine, oral live attenuated Ty 21a vaccine, nor the parenteral purified Vi polysaccharide vaccine is recommended for early use[10]. It is highly possible that many infants who die after a brief febrile illness with or without gastroenteritis are being missed as cases of typhoid. Only a high index of suspicion can diagnose typhoid fever in young infants. If blood culture isolates S. typhi it requires treatment with cefotaxime because of the possibility of a resistant strain[1].


  ::   Acknowledgment Top


We thank our Dean, Dr. P M Pai for granting us permission to publish this case report.

 
 :: References Top

1. Hayani KC, Pickering LK. Salmonella infections in Feigin RD, Cherry JD Eds. Textbook of Pediatric Infectious Diseases, 3rd ed. Philadelphia: WB Saunders, 1992; 620-36.  Back to cited text no. 1    
2.Mulligan TO. Typhoid fever in young children. Br Med J 1971; 41:665-7.  Back to cited text no. 2    
3.Pandey KK, Srinivasan S, Mahadevan S, Nalini P. Rao RS Typhoid fever below fiver years. Indian Pediatr 1990; 27:153-6.  Back to cited text no. 3    
4.Garg RA, Krashak R. Typhoid fever before two years of age Indian Pediatric 1993; 30:805-8.  Back to cited text no. 4    
5.Green M. Pediatric diagnosis: interpretation of symptoms and signs in infants, children and adolescents. 5th edd. Philadelphia: WB Saunders. 1992; 216-25.  Back to cited text no. 5    
6.Feigin RD. Typhoid fever. In: Behirman RE, Kliegman RM, Nelson WE, Vaughan VC ill Eds. Nelson Textbook of Pediatrics, 14th ed., Philadelphia: WB Saunders, 1992; 731-4.  Back to cited text no. 6    
7.Popkiss ME. Typhoid fever. A report on a point-source outbreak of 69 cases in Cape Town. South Afr Med J 1980; 57:325-9.  Back to cited text no. 7    
8.Chin KC, Simmons EJ, Tarlow MJ. Neonatal typhoid fever Arch Dis Child 1986; 61:1228-30.  Back to cited text no. 8    
9.Duggan MD, Beyerl. Enteric fever in young children Arch Dis Child 1975; 50:67-71.  Back to cited text no. 9    
10.Levine MM. Modern vaccines: enteric infections Lancet 1990; 335:958-61.   Back to cited text no. 10    


    Figures

[Figure - 1], [Figure - 2]

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2004 - Journal of Postgraduate Medicine
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