Interesting case by our PGY3 resident Dr. Aaron Adler
18 y/o 👱🏼♀️w/ fever, watery diarrhea 💩, N/V 🤮 after recent 4-wk trip to Karachi, Pakistan
First let’s look at how to approach infection in a traveler by the amazing @ID_fellows
👇🏼schema by @CPSolvers is extremely helpful
Back to the case 👇🏼Approach inspired by @ID_fellows
#adventure: South Central Asia
#body: fever, diarrhea, N/V
#chronology: sxs ~7-10 days after return
#defense: no vaccine prior to travel
#exposure: street food/water
At OSH: told pt had K. Pneumonia bacteremia
💩 T-max: 104.1, HR: 149, RR: 38, BP: 130/70
💩 PE: jaundice, ⬆️❤️ rate, ⬆️WOB, somnolent
💩 Labs: Na+ 133, K+ 2.9, HCO3 16, Cr 2.91, ALP 201, AST 909, ALT 377, Bili 6.7
💩 CT: enteritis
Not improving on broad abx
Resident team asked OSH to re-visit 🩸 cx results and 👇🏼
Dx: Typhoid fever 🥵
1️⃣S. typhi: gram – rods
2️⃣Source: contam water and food. ⬆️susp in travelers from endemic area
3️⃣Dx:🩸 cxs (+ in 40-80% of pts) gold std
4️⃣Tx: azithro/ceftriaxone. ⬆️FQ resistance in travelers 👇🏼
5️⃣Watch out for GI🩸, GI perf, typhoid enceph
Let’s end it w/ some hx
💩#TyphoidMary typhoid outbreak in NYC
💩Emigrated from 🇮🇪 and asx carrier
💩Was a cook for the wealthy
💩Outbreak traced to Mary’s 🍑 🍨 due to poor 🤚 washing
💩26 yrs in forced isolation
@BIDMC_IDFellows @IUIDfellowship @MayoClinicINFD
Originally tweeted by BUMC Internal Medicine (@BUMCMedicine) on 13 August, 2020.