Complete Blood Count Neutropenia/leukopenia/leukocytosis/thrombocytopenia Normochromic anemia; hypochromia with blood loss Blood Culture Gold standard: should be taken from at least two different sites Can be taken anytime during the illness but yield is highest during the first 2 weeks Stool Culture May be positive during the 3rd week of illness in untreated patients Bone Marrow Culture Not usually done, but indicated in highly suspicious cases or if negative blood/stool culture Can be done anytime during the illness Yield is high (~90%): yield not reduced by up to 5 days of prior antibiotic therapy Widal Test (Serology) Not specific, false positives may occur MANAGEMENT OF TYPHOID FEVER INDICATION AGENTS DOSAGE & ROUTE DURATION (DAYS) Empirical Treatment Ceftriaxone 2 g/d IV 10 14 Azithromycin 1 g/d PO 5 Fully Susceptible Ciprofloxacin (first line) 500 mg BID PO or 57 400 mg q12h IV Azithromycin 1 g/d PO 5 Amoxicillin 1 g TID PO or 2 g q6h IV 14 Chloramphenicol 25 mg/kg TID PO or IV 14 21 TMP-SMX 160/800 mg BID PO 7 14 Multidrug-resistant Ceftriaxone 2 g/d IV 10 14 Azithromycin 1 g/d PO 5
Quinolone-resistant Ceftriaxone 2 g/d IV 10 14
Azithromycin 1 g/d PO 5 PREVENTION Food and water Safe food and water precautions and frequent handwashing Vaccination For travelers to areas with increased risk of exposure to S. enterica serotype Typhi Vi capsular polysaccharide vaccine (ViCPS) (Typhim Vi) for intramuscular use Oral live attenuated vaccine (Vivotif, from the Ty21a strain of serotype Typhi) Available typhoid vaccins offer no protection against paratyphoid fever VACCINATION AGE DOSE, NUMBER OF DOSING BOOSTING MODE OF ADMINISTRATION DOSES INTERVAL INTERVAL
ORAL, LIVE ATTENUATED Ty21a VACCINE (VIVOTIF)1
Primary Series 6 1 Capsule, PO 4 48 hours Not applicable Booster 6 1 Capsule, PO 4 48 hours Every 5 years
Vi CAPSULAR POLYSACCHARIDE VACCINE (TYPHIM Vi)
Primary Series 2 0.50 mL, IM 1 Not applicable Not applicable Booster 2 0.50 mL, IM 1 Not applicable Every 2 years