Why my mother has got typhoid for the 12th time?

Question

Hi doctor,

I am an MBBS student. My mother aged 47 years is suffering of typhoid which is a case of relapse and this is the 12th time. She is having a temperature around 38 - 39 °C. Three years before, she was given Ceftriaxone IV 2 g twice (BD) and after that she was given Ampicillin 500 mg thrice daily for the treatment of typhoid. Now, after three years she is again detected with typhoid. Kindly suggest me how we should proceed.

Answer 1

Hello,

Welcome to icliniq.com. First, I would like to know how she was diagnosed with typhoid. Since you know that culture is the gold standard I would be interested in seeing a blood, stool, bone marrow or any sort of culture which was done to diagnose her with Salmonella typhi. If this is a culture proven Salmonella typhoid, I would suggest looking for a source that is harboring the infection. The most common being endocarditis, splenic abscesses, liver abscesses and arthritis or hardware store and bone marrow involvement. It would be helpful to know if your mom is having any issues with chest pain, palpitations, shortness of breath, joint pain or abdominal pain. Usually, if you have a onetime sensitivity, the Salmonella typhi with relapses has the same sensitivity profile. You can always use third generation Cephalosporin again in this situation since your mom was sensitive to it in the first place. Again, as I mentioned earlier, we should look for a source where the Salmonella is anchoring and is emerging again and again as the full blown infection. In case she does not have the sensitivity, we would have to treat this as fever of unknown original and look into different possibilities what can cause her repetitive fevers.