Typhoid (enteric) fever

Case history

A 25-year-old man is admitted to the internal medicine department complaining of high fever that has lasted for 12 days. He has recently returned from travelling in Nepal and India. On his last day in New Delhi he had an acute episode of watery diarrhoea that lasted 24 hours and subsided without treatment. Two weeks after his return he started to feel feverish with headaches and anorexia. His temperature rose to 39.4°C (103°F) and his headache and general fatigue worsened. He visited the accident and emergency department, where his general check-up and FBC was normal. He was discharged home with a diagnosis of viral infection and not prescribed antibiotics. After 4 days with no improvement and appearance of dry cough, he was sent again to hospital and was admitted. His past vaccine history included routine childhood vaccination and hepatitis A, hepatitis B, and typhoid vaccine (Vi vaccine) before departing on his trip.