Enteric fever in a child of immigrant parents to USA

A boy of 8 years, a child of immigrant parents to USA, who recently came to visit Bangladesh presented with fever, abdominal pain and vomiting.
He had no definite tenderness in the abdomen and no other abnormal finding. Other members of the family had viral fever in the recent past.

Initially the child was thought to be a case of viral fever. But as the fever was not subsiding as that of others, investigations were done. Widal test showed strongly positive (TO 1:320), in ICT for Salmonella IgM was positive but not the IgG, MP in blood film and in ICT was negative.

The Patient was treated with Injection Ceftriaxone and supplemented by oral Azithromycin Response was slow. Initially vomiting stppped, then the abdominal pain, fever took 6 days to come to the base line after introduction of Ceftraixone. He had fever for total 11 days

We continue Ceftriaxone for 4 afebrile days and Azithromycin for 5 afebrile days.


Bdoza

Enteric fever with hepatitis and ASD

A 7 year old child from Sandvip, an Island west of Chittagong came to our hospital with fever for 22 days, jaundice and abdominal pain.

On examination, his jaundice was moderate, abdomen was tender on the epigastric, right lumber and Rt hypochondriac region. His liver was 5 cm enlarged, tender.

Ausculatation of the heart reveals a murmur which is systolic in nature at the left upper sternal border.

We thought it could be a) a case of Infective Endocarditis out of a noncyanotic congenital heart disease
b) Enteric fever with hepatitis
c) Hepatic abcess


We started treating the patient with Injection Ceftrixone and Inj penecillin.

In the meantime , the investigation reveals normal widal test, normal blood culture and X-ray shows mild cardiomegaly and Echocardiography suggests ASD.

The fever started to subside and sense of wellbeing improved on the 4th day and by 9th day, the patient become afebrile.

After review, we settled our final diagnosis as Enetric Fever with hepatitis and ASD.

Enteric fever with hypothermia, shock and myocarditis

A child of 6 years presented with 14 days fever and rt upper abdominal tenderness. He was lebelled as 'Enteric Fever' and admitted in hospital for parenteral medication(30/5/07). Among lab test, widal test was found positive. On the second day of hospital, he developed hypothermia and shock. Pt was transfered to critical care unit and managed. Pt recovered from hypothermia and shock after 48 hours of intensive manuevre with blood, fluid, dopamine, dulbutamine, nasogastric suction and oxygen. Ceftrixone was contuied but oral Azithromycin has to replaced with IV ciprofloxacin.

When the patient become stable and we were feeling a little relaxed, the patient developed respiratory distress and little puffiness of the face. We vealuate the renal funtions- his output was normal, serum creatinine and electrolytes was found normal.

On auscultation, pt had bilateral crepitaions and tender hepatomegaly. Pulse was 142/m, BP 105/70, Ultrasonograpgy of the abdomen was found normal. Xray shows mild pulmonary edema. Myocarditis with heart was suspected and pt improved after giving Inj Lasix and lasix prescribed for twice a day.

Pt's fever was persisting and oral Azithromyecin was added. But the patient develops hypothermia again in late hours of the day(5/5/07). To raise the temparature, blanket was used and pt was given steroid in Inj form. His pulse, BP,bowel was normal. So, is the hypothermia is a beacuse of toximia?Pt was also irritable and restless then.

By morning the patient become a bit settled, distress decreased and temparature normalised.

We are still fighting for the patient.(6/6/07). Not yet sure about the outcome.

Bdoza