ESTABLISH DIAGNOSIS:- INVESTIGATIONS:-

As for acute undifferentiated fever 80% +ve Blood culture in 1st week

BM Cultures have 90% Sensitivity, not changed by a previous course of chemotherapy. Bloos C/S are50-70% sensitive in the 2nd week, its sensitivity further being decreased by prior antibiotic therapy.

WIDAL 2nd week

INTERPRETATION OF WIDAL

1.      High / rising titre of 0(>/=1:160)= active infection

2.      High titre of H(>/=160)= Past immunization / infection

3.      High titres of antibody to Vi Ag=carrier state Stool + urine C/s in 3rd week

TREATMENT

ENTERIC FEVER or Salmonella Bacteremia (Systemic Febrile illness)

·       Ciprofloxacin 500-750 mg bd x 10 Afebrile days OR

·       Ceftriaxone 2.0 gm/D IV x 5 days                  OR

·       Chloramphenicol 500mg QID PO/IV x 14 days

·       Ofloxacin 15mg/kg /QD x 7days

·       Other FQs can also be used

SALMONELLA DIARRHOEA (MILD ILLNESS)

·       Any of the following for 3-7 days

·       Ciprofloxacin 500-750mg Q12 hrly

·       Norfloxacin 400mg Q 12 hrly

·       Bactrim DS 1 BD

·       Chloramphenicol 500mg QID

CARRIER STATE

DIAGNOSIS AND DEFINITION

Persistence of Salmonella in stools for a period exceeding 1 year.

LABORATORY INVESTIGATIONS

Vi antigen (high titres in carriers) Stool cultures positive for Salmonella.

TREATMENT REGIMENS

Ciprofloxacin 750mg BD x 4 weeks ( Drug of choice) ( Ref: CMDT 1999) Norfloxacin 400mg BD x 4 weeks

Ampi/ amoxicillin 100mg/kg/day in divided doses x 6 weeks Bactrim DS 2 BD x 6 weeks

OR Cholecystectomy (for those with abnormal gall bladder)