Prepared by……Wipada Pariyaprasert, M.D.
Thanyawee Puthanakit, M.D.
Chiang Mai University , Thailand
Thanyawee Puthanakit, M.D.
Chiang Mai University , Thailand
| Problem lists | |
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1.
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Prolonged fever for 14 days |
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2.
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B- thalassemia major |
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3.
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Anemia, thrombocytopenia |
| Differential diagnosis | ||
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1.
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Infectious cause | |
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systemic infection e.g. typhoid and nontyphiodal Salmonella
infection, leptospirosis, rickettsial infection, malaria, tuberculosis |
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localized infection e.g. sinusitis, deep abscesses | |
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2.
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Non infectious cause e.g. connective tissue disease | |
| Investigation: | |
| CBC: | Hct 14% WBC 3,700 cell/mm3 N 50% L 41% M 3% Plt 60,000 /mm3 |
| PBS: | no ring form of malaria |
| UA: | normal |
| Chest x-ray: | no definite infiltration |
| Hemoculture: | pending result |
| Clinical course: | |
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The patient was initially diagnosed as Salmonella sepsis. She was treated empirically with intravenous cefotaxime. |
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Two days later, she became afebrile( Figure
1). Hemoculture grew Salmonella enteritidis gr C1
, which susceptible to - ampicillin, cotrimoxazole, cefoxitin, cefotaxime, and gentamicin. |
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Cefotaxime was continued for 7 days and
then was switched to oral norfloxaxin for 7 days (total course of
treatment 14 days). She was discharged home without complication. |
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| Diagnosis : Nontyphoid salmonella bacteremia without focal infection in thalassemic pateint |