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Enteric Fever

  1. Typhoid in children
    1. Initial symptoms of fever, malaise, anorexia myalgia, headache, and abdominal pain,
    2. Although diarrhea having a pea soup consistency Q may be present during the early course of the diseases
    3. Constipation later become a more prominent symptoms
    4. Temperature which rise in a stepwise fashion Q, becomes an unremitting and high level within 1 weeks often reaching 40°C (104oF). Step Ladder fever is less seen in children.
During the 2nd week Q of illness, high fever is sustained and fatigue, anorexia, cough and abdominal symptoms increases in severity

Relative bradycardia, which is disproportionate to the high fever
  1. **Hepatomegaly, splenomegaly and distended abdomen with diffuse tenderness are very common
  2. Rose spot Q appear on about the 7th - 10th day
  3. Stool and urine cultures becomes positive after one weeks
  4. **A culture of bone marrow is the single most sensitive method of diagnosis (positive in 85-90%) and is less influenced by prior antimicrobial therapy
  5. *Blood leukocytes counts are frequently low in relation to the fever and toxicity, thrombocytopenia, may be striking and persist for as long as 9 week
  6. LFT often disturbed, proteinuria is common
  7. Fecal leukocytes and fecal blood are very common
  1. Chronic Carrier State Lasts For 3-4 Months
    1. Carrier of typhoid may be temporary or chronic carriers. 
    2. Persons who excrete the bacilli for more than a year after a clinical attack are known as chronic carriers. 
    3. In these carriers the .organism persists in gallbladder and biliary tract. 
    4. A chronic carrier may excrete bacilli for several years Q (may be up to 50 years). Fecal carriers are more frequent than urinary carriers. 
    5. Natural typhoid fever does not Provide solid immunity and second attacks may occur.

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