Typhus Fever—A Diagnostic Dilemma

Abstract

Five cases with prolonged fever, marked toxemia, generalized lymphadenopathy, and abdominal distension presented to us at the Institute of Child Health, Kolkata, India. The clinical pictures mimicked enteric fever in that all of the cases had continuous fever, toxemia, apathy, and significant abdominal distension. A clinician encountering the cases would have thought of enteric fever except for the presence of generalized lymphadenopathy. Investigations revealed leukocytosis, elevated acute phase reactants (ESR and CRP), and negative blood cultures. The Weil–Felix reaction was positive in all the cases. Our case series is an important reminder to clinicians in developing countries that typhus fever, which is a reemerging disease, can closely mimic enteric fever. All the children made a full recovery after treatment with oral doxycycline or azithromycin.

Keywords

scrub typhus - enteric fever - rickettsia

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