Typhoid fever

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.

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