Abstract

A case study of 8-year-old boy with typhoid fever (TF) is being reported who developed pediatric Acute respiratory distress syndrome (pARDS) after return from India, despite adequate antibiotic treatment. It was observed that four out of five people who were born or raised in a country where TF is endemic experienced the onset of ARDS within 48 to 72 hours of beginning antibiotic therapy, compared to one out of six domestic cases.

Introduction

Typhoid fever (TF) is seen in an estimated 12–22 million cases and causes around 130,000–225,000 deaths annually. Complications occur in 10 to 15 % of patients with gastrointestinal bleeding being the most common occurring in up to 10% of patients. Other complications include intestinal perforation, myocarditis, pneumonia, toxic encephalopathy, or shock. Intestinal perforation is the most serious complication, occurring in 1 to 3% of hospitalized patients. Typhoid is usually contracted by consuming food or water that has been contaminated by faecal or urinary carriers excreting S. enterica serotype typhi. It mostly affects travellers who are returning from occasional point-source epidemics.

Case report and discussion

Presently, a case study of a previously healthy 8-year-old male is being discussed with 7 days of fever, cough, and 2-day history of watery diarrhea, vomiting, and diffuse abdominal pain. Physical examination showed a moderately distressed child with fever (38.3°C), tachycardia (165 beats per minute), a wide pressure (111/45 mmHg), and distended abdomen with mild diffuse tenderness.

The results of the laboratory tests revealed a white blood cell count of 6,870/mm3 (neutrophils, 78%; bands, 4%; and lymphocytes, 16%), a platelet count of 120,000/mm3, a serum creatinine level of 0.4mg/dL, an aspartate aminotransferase level of 90 U/L, an alanine aminotransferase level of 70 U/L, a serum albumin level of 3.6 g An abdominal computed tomography scan revealed larger ileocolic lymph nodes.

The boy was admitted after experiencing frequent watery diarrhoea. Ceftriaxone was used to treat bacterial growth seen in the blood culture. Eventually, Salmonella enterica serovar typhi (S. Typhi) with fluoroquinolone resistance and susceptibility to ceftriaxone and azithromycin was discovered. 

Several observational studies stated that Azithromycin′s improved intracellular activity against S. Typhi may reduce the period to defervescence compared to monotherapy. Typhi. After the patient′s health worsened over night, the paediatric critical care unit was contacted to handle the patient′s septic shock and provide ventilator support. Here, the patient required 40% FiO2 and was put on non-invasive positive airway pressure ventilation (NPPV).

While still on NPPV, two days later the patient showed signs of severe respiratory distress due to increased bilateral opacities and newly appearing pleural effusions, necessitating endotracheal intubation and mechanical ventilation. At this point, azithromycin was included in the antibiotic treatment.

On day nine of the hospitalization, the patient responded well and was successfully extubated to room air, but altered mental status was noticed for three days. The patients clinical and mental condition improved for 10 days. The boy completed a 14-day ceftriaxone and azithromycin regimen and was discharged healthy after 19 days of hospitalization.

Conclusion

Typhoid Fever becomes difficult to treat due to the different complications especially in the second and third weeks of the illness even under treatment. Hence, one should be cautious while monitoring patients and use a multidisciplinary approach. A proper diagnosis and vigilant treatment with necessary medical facility and antibiotic regimen is helpful to recover early.

References

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