- Burkina Faso. You are told that a patient has elevated antibodies to Salmonella (Widal test). What do you do and what further information do you request?
- Sierra Leone. In view of the possible side effects of chloramphenicol this product is not acceptable in the treatment of typhoid fever in the tropics. What do you think?
- Your sister-in-law leaves Belgium for the first time to visit you in Bangladesh. Three days after her arrival she has a high fever, abdominal pain and diarrhoea. Should you treat this as typhoid fever?
- Mozambique. A 30-year-old woman has had fever for three weeks. She has a cough. Auscultation of the lungs is normal. When asked specifically, she has had diarrhoea a few times in the last year. Which of the following tests are sensible at the moment? Bronchoscopy, throat swab, CT of the thorax, Widal, gastric intubation, thick smear, full blood count, blood cultures, sputum for BK [Koch’s bacillus], a chest X-ray, serology for Trypanosoma cruzi, examination of urine or faeces for eggs of Schistosoma, pleural biopsy, X-ray of sinuses, open lung biopsy. Do you begin a test therapy with chloramphenicol, penicillin, tuberculostatics, Retrovir®, codeine cough syrup, or chloroquine?
- Ghana. A 33-year-old man has had fever and severe headache for 8 days. He is seriously ill. Auscultation of the lungs is normal, there is no neck stiffness. The spleen is just palpable. A thick smear shows some rare trophozoites of P. falciparum. Treatment with quinine is begun. The man’s general condition deteriorates. On the 6th day there is a sudden deterioration. His general condition is very poor, BP 70/40. He has abdominal pain, chiefly of the lower right abdomen. The fever is 39.5°
. What do you think?
- Egypt. A 13-year-old girl is admitted with fever. Blood cultures are positive for Salmonella typhi. What do you do? Is it also useful to examine a urine sediment?
- The girl mentioned above comes for a check-up one month after treatment. There are no symptoms. S. typhi is again isolated from the faeces. What next?
- Ivory Coast. A patient is admitted with typhoid fever. The stock of chloramphenicol has been used up. What next?
- Is typhoid fever a zoonosis? What is the reservoir?
- Liberia. You are told that a febrile patient cannot have typhoid fever if there is no enlargement of the spleen, or skin rash, and no constipation. What do you think?
- Java. An Italian agricultural engineer develops fever and abdominal pain. He is told that the Widal test is positive (1/80). The man is treated with chloramphenicol and a few days later is much better. One month later he again has abdominal pain and diarrhoea. Once more the Widal test is 1/80. The treatment is repeated and once more there is a swift improvement. Two months later the man is worried because at a check-up it has again been ascertained that he is "typhoid positive". What is your advice?
