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Abstract: A 42-year-old patient, Lao Li, recently developed persistent high fever for 1 week due to unclean diet with nausea, vomiting, abdominal distension, diarrhea and poor appetite. After detailed examination, he was diagnosed with Salmonella typhi infection, which is a common type of Salmonella infection. After active medication, the patient was cured with no clinical discomfort, and the blood routine and C-reactive protein were restored to normal.
Basic information】Male, 42 years old
Disease Type】Salmonella typhi infection
Hospital】Huashan Hospital of Fudan University
Date of consultation】December 2021
Treatment plan】Medication (metoclopramide hydrochloride injection, ibuprofen extended-release capsule, ceftriaxone sodium for injection, levofloxacin hydrochloride injection, levofloxacin tablets)
[Treatment period] 2 weeks of hospitalization, 2 weeks of review after discharge
Treatment effect】The patient was cured, no clinical symptoms, blood routine and C-reactive protein were normalized.
I. Initial consultation
42-year-old Li developed diarrhea 1 week ago after eating unclean hot pot and barbecue, which lasted for 2 days, with diarrhea 3-5 times a day, and the stool was dilute and watery in nature. He was given antipyretic treatment for 2 days but his condition did not improve. He went to the local hospital again and was given intravenous rehydration with cefuroxime sodium for injection for 3 days.
II. Treatment history
Since the cause of the patient’s acute fever was unknown, a comprehensive examination was performed after the patient was admitted to the hospital, and the routine blood tests revealed that the white blood cells had further decreased to 2.6×10^9/L and the C-reactive protein had increased to 138 mg/L. A CT examination of the lungs showed no abnormality, and a CT examination of the abdomen showed that the patient had hepatosplenomegaly. The patient was given metoclopramide hydrochloride injection for antiemetic treatment and ibuprofen extended-release capsule for antipyretic treatment, and blood culture test was performed. On the second day, the patient’s blood culture was positive, and on the third day, the blood culture was positive for Salmonella typhi infection, and the patient was treated with ceftriaxone sodium for injection, combined with levofloxacin hydrochloride injection for intravenous rehydration. After 2 weeks of intravenous medication, the treatment was changed to oral levofloxacin tablets, and the decision was made to discharge.
III. Treatment effect
After treatment with ceftriaxone sodium for injection, combined with levofloxacin hydrochloride injection for intravenous rehydration, the patient’s body temperature dropped significantly, and by 5 days after the drug was administered, the body temperature dropped to normal, and the patient’s symptoms improved significantly. After 1 week of medication, the patient was basically free of nausea, vomiting, diarrhea and abdominal distension, and his appetite was obviously restored. After 2 weeks of medication, intravenous rehydration was stopped and replaced by levofloxacin tablets. 2 weeks later, the patient was cured and had no clinical discomfort, and the blood routine and C-reactive protein were all back to normal.
IV. Notes
We are glad that the patient recovered after active treatment, and all indicators are back to normal. However, since the patient’s gastrointestinal function had not fully recovered at the time of discharge, the following points still need to be noted after discharge.
1.After discharge from the hospital, we need to pay attention to a light diet, mainly based on dregs-free fluids, and avoid eating foods that are too oily, too greasy, too spicy and stimulating.
2. Since there is still a possibility of serious complications such as intestinal obstruction and intestinal perforation after discharge, patients should pay close attention to abdominal signs and general condition. If symptoms such as persistent high fever, increased abdominal pain, obvious pressure and rebound pain in the abdomen occur, medical treatment should be sought promptly.
3. Patients can increase exercise appropriately to enhance body resistance and prevent diseases after their physical condition is stabilized.
V. Personal insight
Salmonella typhi infection is a relatively common intestinal infectious disease, the vast majority of anti-infective treatment can be cured, most patients come to the clinic for “acute fever, unknown cause”, but the disease actually has specific clinical manifestations, such as gastrointestinal discomfort, reduced white blood cells, relatively slow pulse, and later may also appear typhoid rose rash and other symptoms. The diagnosis is usually confirmed by blood culture, stool culture, and bone marrow culture of typhoid or non-typhoid Salmonella. In this case, the patient had gastrointestinal symptoms such as nausea, vomiting and abdominal distension along with fever, and the routine blood leukocytes were reduced, so the possibility of Salmonella typhi infection should be alerted.