Concluded Case

Typhoid Fever Relapse

M/44, Wt. 94kg, C/o. Relapse of typhoid fever. P/H/O. Typhoid fever around 24 days back then having symptoms of anxiety, fever with chills, diarrhea, loss of appetite, abdominal fullness and body pain. He was treated with cefixime 400mg twice for 14 days and azithromycin 500mg twice on day one followed by 500mg once daily for 10 days. After this course within one week he show improvement. He was completely all right since 10 days with no fever no abdominal complaints no loose motions and good appetite. But suddenly on 11th day anxiety, loss of appetite again started with mild chills like feeling with hot flush in ears and mild fever. What all test should be done now and what will be the further course of management and treatment ORALLY if there is Relapse.

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Concluded answer
IgG igM Blood &Stool for CS CEFTAM 500mg bd orally. PCM SOS. Multivitamin and antioxidant orally. Pre and post biotics orally. Improve General health and personal hygiene.
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NEED'S.. CLINICOPATHOLOGICAL EVALUATION WITH.. * BLOOD./ BONE MARROW..CULTURE..S EXAMINATION.. * STOOL C AND S EXAMINATION * URINE C AND S EXAMINATION.. * WEIL FELIX TEST.. MEANWHILE TREAT WITH.. * ANTIBIOTICS COVERAGE & PCM AS PER REQUIREMENT.. * MULTIVITAMINS ANTIOXIDANTS.. * GLUCOSE SUPPLEMENTS.. * SYMPTOMATIC T/T.. * W/O .. VITAL PARAMETERS..TPR..BP..
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Stop all drugs including antibiotics. Cap Gut 0k 1od. Tab paracetamol 500mg 8hrly. Oral rehydration therpy-3days. Cap resplash(zinc +vit c) 1od×5days. Advise-1-blood culture. 2-typhi dot. 3-cbc. 4-x ray chest pa view Most likely dx is acute viral fever to start with.then antibiotic associated diarrhoea.
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Do paired blood culture. Stool culture. Repeat widal test ..along with repeat CBC,LFT, KFT ,urine routine Give I/ V Monocef 2 gm BD x 14 days with supportive treatment. Advice him to take typhoid vaccination after 3 months.
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IgG igM Blood &Stool for CS CEFTAM 500mg bd orally. PCM SOS. Multivitamin and antioxidant orally. Pre and post biotics orally. Improve General health and personal hygiene.
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After discharge, patients should be monitored for relapse or complications for 3 months after treatment has commenced. Pulmocef 500mg.BD.x 7 days. Rpt the studies.
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Overdose of medicine. Please check azithromycin 500 doses. Adv. CBC. Widal. MP. Dengue. Urine routine. Usg Abd
Blood & stool for CS Inj Ceftrioxone 2gm iv bd×10days Pre & probiotics PCM sos Multivitamin PPI
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Start gold standard treatment Chloromyctin 500 6hourly Tab pcm sos Multivitamins
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