Typhoid fever: a rare etiology of prolonged febrile illness in Pediatrics.
Abstract
Introduction: Infections are the most frequent etiology of prolonged febrile illness (PFI). Although enteric fevers are a possible cause, their prevalence has significantly diminished in Uruguay, due to improved socio-sanitary conditions.
Objective: To communicate the case of an adolescent with was is currently an exceptional etiology for PFI
Clinical case: 14 years old, healthy, suburban area. Two days prior to admission the patient has pain in upper hemi abdomen. Adds mild holocranial headache and occasional vomiting. 5 days prior to admission axilary temperature of 40°C, one daily peak, with no other symptoms. Normal lower digestive and urinary transit. Physical examination: lucid, good general aspect, pain at deep palpation in epigastrium. No peritoneal irritation. Rest is normal. Laboratory: leukocytes 5200mm3, Reactive C protein 71.4mg/dL, hemoculture shows no growth. Abdominal sonogram, thoracic X-ray and echocardiogram are normal. Negative serology for Epstein Barr Virus, Cytomegalovirus and Bartonella Henselae. Normal urine, urine culture with no growth. Fever persists, adds evanescent macropapular exanthema in trunk, with no other symptoms. On the 7th day in hospital a new hemoculture shows Salmonella Typhi sensitive to ampiciline, which he receives for 14 days. Good evolution.
Discussion: Typhoid fever is an infectious contagious disease, acute and potentially deathly. Socioeconomic conditions are determinant in its transmission. Hemoculture sensitivity is greater during the first week of the disease, which is why it must occasionally be repeated. Its unspecific clinical manifestations and low incidence make this etiology not be usually suspected in our environment. It is therefore important to increase our suspicion and to consider it amongst differential diagnosis in PFI.
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References
2. Sótero del Río C, Viviani Salgado T, Sandoval C, Pinochet C, Peña A, Rabello M, et al. Experiencia Clínica Síndrome febril prolongado: un desafío para el infectólogo pediatra [Internet]. Rev Chilena Infectol 2104; 31(1):87-91. Obtenido de https://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0716-10182014000100013. [consulta:10 oct 2021]
3. L. Attard, D. Umberto, M. Tadolini, M. Cattallini. Overview of fever of unknown origin in adult and paediatric patients [Internet]. Clin Exp Reumathol 2018; 36 (Suppl. 110): S10-S24. Available from: https://www.researchgate.net/publication/325066562. [consulta: 10 oct 2021]
4. Chien YL, Huang FL, Huang CM, Chen PY. Clinical approach to fever of unknown origin in children. Journal of Microbiology, Immunology and Infection. 2017 Dec 1;50(6):893–8. Obtenido de https://www.sciencedirect.com/science/article/pii/S1684118215008300?via%3Dihub. [consulta: 10 oct 2021]
5. Escosa-García L, Baquero-Artigao F, Méndez-Echevarría A. Fiebre de origen desconocido. Pediatr Integral 2018; XXII (5): 229 – 235. Obtenido de: https://www.pediatriaintegral.es/publicacion-2018-07/fiebre-de-origen-desconocido-en-ninos/. [consulta: 10 oct 2021]
6. Asociación Española de Pediatría. Comité Asesor de Vacunas. Fiebre tifoidea [Internet].Available from: https://vacunasaep.org/print/profesionales/enfermedades/fiebre-tifoidea. [consulta 28 nov 2021]
7. Salmonelosis en pediatría by Sociedad Colombiana de Pediatría - Issuu [Internet]. Available from: https://issuu.com/precopscp/docs/25_5. [consulta: 28 nov 2021]
8. Cabello A, Bayona JF, Fernández-Roblas R, Fernández-Guerrero M, Ramos JM, de Górgolas M. Fiebre entérica en Madrid. Una revisión de los últimos 30 años. Enfermedades Infecciosas y Microbiologia Clinica. 2013;31(5):313–5.
9. División Epidemiología Dirección General de la Salud Ministerio de Salud Boletín epidemiológico Mayo 2017.7. Disponible en https://www.gub.uy/ministerio-salud-publica/sites/ministerio-salud-publica/files/documentos/publicaciones/Bolet%C3%ADn%20epidemiol%C3%B3gico%20Mayo%202017_0.pdf. [Consulta: 27 oct 2021]
10. Smith AM, Mthanti MA, Haumann C, Tyalisi N, Boon GPG, Sooka A, et al. Nosocomial outbreak of Salmonella enterica serovar typhimurium primarily affecting a pediatric ward in South Africa in 2012. Journal of Clinical Microbiology. 2014 Feb;52(2):627–31.
11. Fica A, Acosta G, Dabanch J, Perret C, Torres M, López J, et al. Punto de Vista Brotes de salmonelosis y el tamaño y rol del Estado en Chile. Rev Chil Infect 2012; 29 (2): 207-214.
12. Kirchhelle C, Pollard AJ, Vanderslott S. Typhoid-From Past to Future. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2019 Oct 15;69:S375–6.
13. Alarcon TD, SaelzerW E. Complicaciones digestivas de la Fiebre Tifoidea. Rev. chil. pediatr. 1981; 52 (5) 378-381.
14. Khanam F, Ross AG, McMillan NAJ, et al. Towards Typhoid Fever Elimination. IInt J Infect Dis. 2022, 119:41.43.
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