Typhoidal & Non-typhoidal Salmonellosis, 5TH MBBS, By Dr Gideon Anigbo, M4

A 24-year-old male presents with 10 days of fever, headache, anorexia, and constipation. He has no diarrhoea. On examination: temperature 39.8°C, pulse 92 bpm, blood pressure 110/70 mmHg. He has a coated tongue and mild splenomegaly. Malaria smear is negative. What is the most appropriate next step?

1. Start oral ciprofloxacin empirically for typhoid fever
2. Send blood culture and start ceftriaxone
3. Send Widal test and wait for result before treating
4. Start oral rehydration and paracetamol only

A 32-year-old woman with HIV (CD4 count 120 cells/µL) presents with 3 days of fever, watery diarrhoea, and abdominal cramps. She ate undercooked chicken 2 days ago. Her roommate is well. On examination: temperature 38.5°C, pulse 110 bpm, blood pressure 100/60 mmHg. What is the most likely diagnosis and appropriate management?

1. Typhoid fever; start ceftriaxone
2. Non-typhoidal Salmonella gastroenteritis; oral fluids only
3. Invasive non-typhoidal salmonellosis; blood culture and IV ceftriaxone
4. Viral gastroenteritis; supportive care only

A 19-year-old student in a typhoid-endemic area has a fever for 12 days. A single Widal test shows O antigen titre of 1:320. Blood culture is negative because she took amoxicillin for 3 days last week. What should you do?

1. Diagnose typhoid fever and start ciprofloxacin
2. Repeat Widal test in 5–7 days for paired titres and obtain bone marrow culture
3. Stop all antibiotics and discharge home
4. Treat for malaria only

A 45-year-old man presents with fever for 14 days, diffuse abdominal pain, and distension. He was diagnosed with typhoid fever 10 days ago but could not afford antibiotics. Today his blood pressure is 85/50 mmHg, pulse 120 bpm, abdomen is rigid with absent bowel sounds. What is the most likely complication?

1. Intestinal haemorrhage
2. Ileal perforation with peritonitis
3. Acute pancreatitis
4. Cholecystitis

A 60-year-old diabetic man develops fever, vomiting, and profuse watery diarrhoea 24 hours after eating at a restaurant. Three friends who ate the same meal have similar symptoms. He has no bloody stools. What is the best management?

1. Oral ciprofloxacin for 5 days
2. Oral rehydration solution and close follow-up; no antibiotics
3. IV ceftriaxone and admission
4. Stool culture and azithromycin empirically

A 3-year-old child with sickle cell disease presents with fever, refusal to walk, and diarrhoea for 2 days. Temperature 39.5°C. He is lethargic. What is the most important next step?

1. Stool culture only
2. Oral rehydration and paracetamol
3. Blood culture and IV ceftriaxone
4. X-ray of the painful leg

A 28-year-old pregnant woman at 32 weeks gestation has fever for 8 days, headache, and abdominal pain. She lives in an area with unsafe drinking water. What is the most appropriate antibiotic regimen for suspected typhoid fever in pregnancy?

1. Ciprofloxacin
2. Doxycycline
3. Ceftriaxone
4. Chloramphenicol