Case Presentation

BY DR. ZULFIQAR ALI KHAN

BIODATA:
PRESENTING COMPLAINS:
HOPC:
PAST MEDICAL AND SURGICAL HISTORY:
FAMILY HISTORY:

Cousin marriage
Marriage period 15 years
No anemia, Thalassemia, G6PD Sickle cell anemia
No History of HTN and DM in parents. Mother is having Hep C
and she going under treatment.
No history ofTuberculosis in family.

12yrs 10yrs 7yrs 5yrs 3yrs 9mn

Socioeconomic History:

8 Family members
House is well ventilated, drinks boiled water.
Two rooms
One big Lounge

Personal History:

Decrease appetite
Disturb sleep
Stool passing is normal
Urine passing is normal
General Physical Examination:

12 years old boy looking lethargic and lying comfortable in bed.

Cannula attached on dorsum of left hand.

Anthropometric Measurements:

Weight: 29 kg (On 10th centile)

Expected weight Age(12) * 7-5/2 = 39.5 kg
Height: 149 cm (25th centile) (12*6+77)
Vitals:

Pulse: 84 beats/min
Temperature: 105° F
Respiratory rate: 22 breaths/min

Sub Vitals:
Anemia negative. No signs of jaundice, dehydration, cyanosis,
clubbing, edema. No palpable lymph nodes.
Examination:

Abdominal: No abdominal distension on Inspection. No scar marks or striae.

Abdomen soft and non-tender on palpation.
No visceromegally.
CNS: GCS (15/15), All cranial nerves intact. Motor and Sensory system intact.
CVS: S1 + S2 + 0
Respiratory: No scars or chest wall deformity on inspection. No signs of respiratory distress.
Trachea centrally placed on palpation. Bilateral equal chest expansion.
On Auscultation normal air entry bilaterally.
Differential Diagnosis:

• Enteric Fever (Typhoid)

• TB
• UTI
• Dengue
Investigations:

 CBC
 UCE
 CRP
 Blood Culture
 Urine D/R
 MP – ICT (-ve)
 Typhi dot (-ve)
 Ultrasound (Whole Abd)
CBC 31st Jan 3rd Feb 2020 4th Feb 5th Feb
2020 2020 UCE 31st Jan 4th Feb
HB 12.6 11.3 10.9 11.2 2020 2020

TLC 3100 2200 Urea 19 10

2100 3200
CR 0.7 0.5
PLT 74000 47000 47000 70000 Na 134 140
CRP 94.5 99.4 100 K 3.8 4.4
Cl 97 105
HCO3 23 22
Urine D/R:

 Colour Dark Yellow

 SP.Gravity 1.015
 PH 6.0
 PUS CELLS 2-3
 RBC Nill
 EPI CELL Occasional
Management:

Inj. Plab.m 1700 ml I/V in 24 hrs

Inj. Falgan 300 mg I/V 8hr
Syrup Dolar 5 ml PO TDS
Syrup Citralka with water 1 tsf P/O BD
Syrup Azomax 7.5 ml PO OD (1st Feb)
Inj. Meronem 870 mg I/V TDS (1st Feb)
Inj. Rocephian 1 gm I/V BD was initially started but after blood
CS report it was stopped.
EPIDEMIOLOGY OF TYPHOID
Pathophysiology:
Supportive Treatment:
Corticosteroids
Such as dexamethasone: if severe toxaemia 3mg/kg followed by 1mg/kg for 48hrs
Blood transfusion in case of anemia or sever intestinal perforation
Adequate nutrition n hydration n electrolytes balance is essential
Surgical intervention in cases of perforation
Platelets transfusion in case of thrombocytopenia
Treatment of chronic carrier:
Chronic carriage of S.Typhi can be eradicated with 4-6 weeks course of high dose ampicillin or
amoxicillin plus probenecid or TMP-SMX. Ciprofloxacin may also be used
Prognosis: