Typhoid fever associated with adult respiratory distress syndrome

Case Report: Typhoid Fever Complicated by Acute Respiratory Distress Syndrome in a Pediatric Traveler

Acute respiratory distress syndrome (ARDS) is seldom described as a complication of typhoid fever (TF). Only 13 cases have hitherto been reported in the English and non-English literature since 1990. We report an 8-year-old boy with TF after return from India who developed pediatric ARDS (pARDS) despite adequate antibiotic treatment. Among patients with available information including this case, we noted that most not born or raised in a TF-endemic country (4/6) compared with none (0/6) of the domestic cases in a TF-endemic country developed ARDS within 48 hours of starting the antibiotic treatment. Our case raises important questions regarding the frequency, pathophysiology, and appropriate management of ARDS and pARDS in patients with TF.

Salmonella Typhi-Induced Septic Shock and Acute Respiratory Distress Syndrome in a Previously Healthy Teenage Patient Treated With High-Dose Dexamethasone

Typhoid fever is commonly characterized by fever and abdominal pain. Rare complications include intestinal hemorrhage, bowel perforation, delirium, obtundation, and septic shock. Herein we describe the case of a previously healthy 16-year-old male without history of travel, diagnosed with typhoid fever complicated by septic shock and acute respiratory distress syndrome treated with high-dose dexamethasone. This case details severe complications of typhoid fever that are uncommonly seen in developed countries, and the successful response to high-dose dexamethasone as adjunct therapy. High-dose dexamethasone treatment has reportedly decreased Salmonella Typhi mortality, but controlled studies specifically performed in children are lacking, and most reports of its use are over 30 years old and all have originated in developing countries. Providers should include Salmonella Typhi in the differential diagnosis of the pediatric patient with fever, severe abdominal pain, and enteritis, and be aware of its potentially severe complications and the limited data on safety and efficacy of adjunctive therapies that can be considered in addition to antibiotics.

Avian influenza--a review for doctors in travel medicine

First identified in humans in Hong Kong, influenza A/H5N1, known commonly as avian influenza, has caused human disease in 15 countries around the world. Although the current number of confirmed patients is tiny compared to seasonal and the recently emerged H1N1 'swine' influenza, H5N1 remains a candidate for the next highly pathogenic influenza pandemic. Currently, H5N1 has very limited ability to spread from person-to-person but this may change because of mutation or reassortment with other influenza viruses leading to an influenza pandemic with high mortality. If this occurs travellers are likely to be affected and travel medicine doctors will need to consider avian influenza in returning febrile travellers. The early clinical features may be dismissed easily as 'the flu' resulting in delayed treatment. Treatment options are limited. Oral oseltamivir alone has been the most commonly used drug but mortality remains substantial, up to 80% in Indonesia. Intravenous peramivir has been filed for registration and IV zanamivir is being developed. This review will focus on the epidemiological and clinical features of influenza A/H5N1 avian influenza and will highlight aspects relevant to travel medicine doctors.

Salmonella panama and acute respiratory distress syndrome in a traveler taking a proton pump inhibitor

Acute respiratory distress syndrome (ARDS) is a rare complication of enteric fever. We present an immunocompetent traveler to Nicaragua who developed enteric fever from Salmonella panama complicated by ARDS. Unlike her fellow travelers who also became ill, she was taking a proton pump inhibitor, which may have contributed to the disease severity.

Adult respiratory distress syndrome in the tropics

Today ARDS is more frequently recognized and managed in tropical countries, although published data from most locations is meager. The spectrum of disorders causing ARDS in tropical countries includes virtually all conditions encountered in the West. Additionally, tropical infections and other disorders are seen far more commonly. In particular, malaria and TB are important infections that predispose patients to ARDS in the tropics. Both of these illnesses give lead to severe forms of disease, such as falciparum malaria, acute miliary TB or TB bronchopneumonia, and may cause ARDS. Awareness of the complications helps in early recognition and differential diagnosis from several similar manifestations. Although earlier reports painted a gloomy picture of the outcome of these patients in general--mainly due to financial and logistic constraints--the scenario is improving quickly with better and wider availability of newer diagnostic and management tools.