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Typhoid fever in children
Last reviewed: 04.07.2025
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Typhoid fever is an acute infectious disease, a typical anthroponosis with an enteric mechanism of infection, caused by typhoid bacilli and characterized by predominant damage to the lymphatic apparatus of the small intestine, high fever, severe intoxication and bacteremia, roseola rash, hepatosplenomegaly, often with a wave-like course and prolonged bacterial excretion.
ICD-10 code
- A01.0 Typhoid fever (infection caused by Salmonella typhi).
- A01.1 Paratyphoid A.
- A01.2 Paratyphoid B.
- A01.3 Paratyphoid C.
- A01.4 Paratyphoid fever, unspecified (Salmonella paratyphi infection, NOS).
Epidemiology
The source of infection is a patient or a bacteria excretor, from whom the pathogen enters the external environment with feces and urine. The role of preschool and school-age children excreting the pathogen is especially great, since they more easily infect surrounding objects and the environment. After typhoid fever, bacterial carriage develops in 2-10% of children.
The pathogen is transmitted by contact, water, food, and flies. The contact-household route of infection transmission is of primary importance for young children.
- In one way of infection with typhoid fever remains important mainly in rural areas. Children can become infected when swimming in polluted water bodies, when drinking poor-quality water, especially if there are problems with the water supply and sewerage system (wastewater entering rivers, closed reservoirs, wells, etc.). Waterborne outbreaks are relatively easier than foodborne ones.
- Foodborne outbreaks of typhoid fever occur mainly when consuming infected milk and dairy products - salmonella typhi is able to multiply and accumulate in large quantities in food products (especially in milk). Sometimes outbreaks of typhoid fever occur when consuming confectionery, ice cream, salads, pates, and shellfish. Young children rarely get typhoid fever, which is explained by their greater isolation, stricter hygiene regime, nutritional control, etc.
Classification of typhoid fever
The disease is classified by type, severity and course.
- Typical diseases include those with characteristic clinical symptoms (fever, typhoid status, rash, hepatosplenomegaly, etc.). Individual clinical manifestations of the disease may be absent, but the overall picture of the disease remains typical.
- Atypical typhoid fever includes latent and subclinical forms, as well as forms with predominant damage to individual organs - pneumotyphus, meningotyphus, nephrotyphus, etc. These forms are extremely rare in children, and their diagnosis is especially difficult.
According to the severity of clinical manifestations, mild, moderate and severe forms are distinguished.
Depending on the course of the disease, typhoid fever can be acute, smooth, with exacerbations, relapses, complications and the formation of chronic typhoid fever carriage.
Causes of typhoid fever
Typhoid bacillus, or Salmonella typhi, belongs to the family of enterobacteria, is gram-negative, does not form spores or capsules, is mobile, grows well on conventional nutrient media, especially with the addition of bile, and is a facultative anaerobe.
The pathogenicity of typhoid bacteria is determined by endotoxin, as well as “aggressive enzymes”: hyaluronidase, fibrinolysin, lecithinase, hemolysin, hemotoxin, catalase, etc., secreted by bacteria during the process of colonization and death.
Pathogenesis of typhoid fever
The gastrointestinal tract serves as the entry point for the infection. Through the mouth, stomach and duodenum, the pathogen reaches the lower part of the small intestine, where primary colonization occurs. Penetrating into the lymphoid formations of the intestine - solitary follicles and Peyer's patches, and then into the mesenteric and retroperitoneal lymph nodes, typhoid bacilli multiply, which corresponds to the incubation period.
Symptoms of typhoid fever
The incubation period ranges from 3 to 30 days, in rare cases it lasts up to 50 days (on average 10-14 days). In the clinical course of the disease, it is possible to conditionally distinguish a period of increasing clinical symptoms (5-7 days), a period of peak (8-14 days), a decline (14-21 days) and a period of convalescence (after the 21-28th day of the disease). The dynamics of clinical manifestations significantly depends on the age of the children.
Diagnosis of typhoid fever
Typhoid fever is diagnosed on the basis of prolonged fever, headache, increasing intoxication with the development of typhoid status, typical changes in the tongue, the appearance of flatulence, roseola rash, hepatosplenomegaly and changes in the peripheral blood.
Laboratory diagnostics is based on the detection of the pathogen in the biomaterial and specific antibodies in the patient's blood. Of decisive importance is the detection of the pathogen in the blood (blood culture), urine (urine culture), feces (coproculture), bile (biliculture), as well as in the bone marrow, cerebrospinal fluid, roseola, pus or exudate.
Treatment of typhoid fever
In case of diarrhea syndrome, the diet is based on the same principles as in case of other intestinal infections. In case of toxicosis with exsicosis, oral rehydration is performed, and in case of severe dehydration (II-III degree) - rehydration infusion therapy in combination with detoxification (1.5% reamberin solution, isotonic, electrolyte solution with antihypoxant activity) and syndrome-based treatment.
Prevention of typhoid fever
Consists of compliance with sanitary and hygienic requirements: proper water supply, sewerage construction, strict adherence to the technology of procurement, transportation and sale of food products, especially those that are not subjected to heat treatment before consumption.
Those who have recovered from typhoid fever are subject to dispensary observation and laboratory testing. Bacteriological examination is carried out no later than the 10th day after discharge from the hospital 5 times, with an interval of 1-2 days. In the following 3 months, feces and urine are examined once a month, then (for 2 years) - once a quarter three times. If the results of these studies are negative (except for decreed categories of the population), those who have recovered from typhoid fever are removed from the SES register.
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