Enteric Fever

A previously healthy 14-month-old boy was brought by his parents with a history of fever with vomiting for 3 days and watery diarrhea for 2 days. There was no blood or mucus in the stool. He had received all the Indian Academy of Pediatrics recommended vaccines till date including the typhoid conjugate vaccine. On examination, his hydration was normal and no other focus of infection was found. A diagnosis of acute watery diarrhea with no dehydration was made. Oral rehydration solution, zinc, and paracetamol were started. Advice on diet, homemade fluids, also was given. The child revisited the clinic on the sixth day of fever onset with complaints of persisting high-grade fever despite the medication provided. The loose stools had subsided but vomiting off and on persisted. On examination, he was found to be lethargic and irritable and showed signs of some dehydration, but was passing urine normally. The pulse rate was 120 beats/min, and the axillary temperature was 104.2 °F. His skin perfusion was normal. There were no new findings on examination or evidence of hepatosplenomegaly. The differential diagnoses considered were urinary tract infection (UTI), dengue, enteric fever, scrub typhus, malaria, leptospirosis, brucellosis, influenza, chikungunya, COVID-19, and other viral infections. The child was hospitalized, investigated for the conditions listed above, and started on intravenous (IV) ceftriaxone after sending cultures suspecting UTI or enteric fever. The general condition of the child improved over the next few days but fever continued unabated even after 5 days of intravenous ceftriaxone. Laboratory investigations showed leukopenia, eosinopenia, a high C-reactive protein, and elevated transaminases. The blood culture grew Salmonella enterica serovar Paratyphi A (S. Paratyphi A). The fever subsided after 9 days of antibiotic treatment. He was discharged on oral cefixime and had fully recovered on follow-up.