Enteric (Typhoid) Fever: A Commonest Major Infectious Disease

Enteric fever continues to be one of the commonest major infectious diseases prevalent in India, Pakistan, and other tropical countries. During the past quarter century, its course has been completely modified and prognosis vastly improved by the introduction of chloramphenicol and other therapeutic measures. Nevertheless, serious complications still occur and of these, severe toxaemia often terminating in peripheral circulatory failure, intestinal perforation and intestinal hemorrhage constitute the three grave life threatening emergencies. Less important complications during the acute phase of illness include encephalopathy, paralytic ileus and severe diarrhoea.

Clinical Features

By the time of patient of enteric fever comes under medical care, some degree of toxaemia is invariably present. The patient has a moderate to high remittent of continuous fever, looks ill, and may have congested conjunctivae, sordes, cracked lips and furred tongue. Some cases however develop marked toxaesion, dullness, or delirium. The abdomen may show a variable degree of distension. Severe dehydration is often present, pulse is soft and rapid and the blood pressure is precarious. Unless energetic measures are instituted peripheral circulatory failure (PCF) supervenes. This may be heralded by sudden fall in temperature which, in a case of enteric, is always ominous. The patient develops cold clammy skin and running thread pulse, very low or unrecordable blood pressure and severe oligura. Death is invariable if shock has lasted for more than a few hours.

Diagnosis

Any pyrexia of more then a week’s duration associated with above mentioned clinical picture and without evidence of any infection should suggest a diagnosis of enteric fever. A leucopenia, or at any rate, absence of leucocytosis is highly suggestive. The diagnosis is confirmed by a positive blood pressure for enteric group of organisms. The result of widal test are unreliable.

Management

Every patient of typhoid fever with more than minimal toxaemia and especially threatened PCF should be hospitalized.