Answer 14
In enteric fever
True a. severe cases should receive high dose dexamethasone
True b. ciprofloxacin is the treatment of choice in the UK. for adults
True c. jaundice is a recognised complication
True d. myocarditis is a recognised complication
False e. if perforation of the bowel occurs it should be managed conservatively because surgery carries too high a mortality.
Severe typhoid is recognised by either marked mental confusion (or a lower level of consciousness), or hypotension with evidence of impaired organ perfusion. In such cases, high dose dexamethasone has been shown to reduce mortality.
Treatment with chloramphenicol, co-trimoxazole or amoxycillin was previously standard. Cases from the Indian subcontinent show that resistance to these antibiotics is now widespread; quinolones have become the first line treatment. Ciprofloxacin has caused cartilage damage in beagle puppies. The BNF recommends that ciprofloxacin should be used with caution in children, pregnant women and breast-feeding mothers. It should also be used with caution in patients with epilepsy.
Jaundice may arise in typhoid fever as a result of haemolysis, hepatitis, cholecystitis or cholangitis
Myocarditis may occur in the third week of fever and may be fatal.
Perforation occurs in 5% of cases in the third week and has a high case fatality rate. Surgical intervention is thought to improve prognosis.
