Typhoid Fever
Abstract
A 26-year-old presented to the ER with symptoms of unknown infection. Upon admission and hospitalization, the patient’s vitals, labs, and hemodynamic function decreased; therefore, he was placed in the ICU for further management. After blood cultures came back positive for Salmonella typhi, the patient was started on strong antibiotics and eventually stabilized and was released home. This case represents an atypical presentation and the further management of Salmonella typhi infection in the primary care setting.
The patient presented to the clinic as a recent traveler to America from India, where Salmonella typhi is considered endemic. A few hours from initial presentation, the patient deteriorated and was admitted to the ICU, where further workup was done, including imaging, cultures, and labs. After blood cultures came up positive for non-lactose fermenting gram-negative rods, later identified to be the Salmonella typhi organism, the patient was put on tobramycin and levofloxacin for 10 days; he eventually stabilized and was discharged home.
Primary care physicians see everything from standard follow-up for hypertension to acute and/or chronic exacerbations of heart failure. It is vital that the physician is prepared for anything that accompanies a patient through the door. The case represented below indicates that, for primary care physicians in ambulatory, urgent care, emergency and inpatient settings, typhoid fever should be considered in the differential diagnosis for patients with a history including recent travel to or from endemic areas, as the early diagnosis of typhoid fever could be the difference between life and death for the person infected.
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Accepted 2014-08-21
Published 2014-09-04