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Suggest treatment for typhoid, seizures and bacterial infection

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Posted on Sat, 12 Dec 2015
Question: Hello Doctor,
My nephew got diagnosed with typhoid a week ago and since then he was going though medication. Today morning he started getting seizures and we rush to a near by hospital in XXXXXXX XXXXXXX currently he is in ICU. His MRI/CT Scan report came normal, doctor took a liquid sample from spine and told us, he has bacterial infection. I want to know how common is this kind of condition? Any extra precaution you have in mind? In your opinion what should be next steps?
doctor
Answered by Dr. Luchuo Engelbert Bain (3 hours later)
Brief Answer:
Normal Ct scan is reassuring. Broad spectrum antibiotherapy , await lab res

Detailed Answer:
Hi and thanks for the query,

It is good and reassuring that the CT scan came back normal. A sample taken for laboratory and culture, with a subsequent antibiogramme to identify the appopriate germ and drug is a perfect idea as was done.

I do think the most important thing at this point in time is appropriate broad spectrum antibiotics and monitoring of the patient. It is a great idea the patient is in an intensive care unit.

It is easier for young persons to get seizures with raised temperatures and altered blood parameters compared to elderly patients. If it is a child, considering that the CT scan was normal, I really do not think you need to worry very much. The most important thing now is temperature control, proper antibiotic therapy and monitoring of his general health status as the laboratory results are being awaited.

Thanks and kind regards as I wish the best of health and a rapid recovery.

Kind regards,

Dr Bain
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Luchuo Engelbert Bain (10 hours later)
Thank you Dr Bain. I am attaching current medical reports of my nephew. If someone can please have in depth look on them and tell us your inputs, it would be highly appreciated. These reports are from a XXXXXXX hospital so probably related background might be helpful. I will wait for further comments.

I am also attaching current case summary providing very good description of current condition. Please let us know your opinion/suggestions regarding in light of these reports.

Most concerning fact about current condition is that seizures are not stopping. Generally how long this kind of seizures lasts in children? Case Summary & attached reports provide complete details on ongoing treatment.
doctor
Answered by Dr. Luchuo Engelbert Bain (10 hours later)
Brief Answer:
Blood culture and an electrolyte panel

Detailed Answer:
Hi and thanks for the query

I went through the reports carefully.

I think the results are compartible with an infection from salmonella (typhoid). The antibiotic prescribed is appropriate.

However, I would suggest a blood culture and an antibiogramme . knowing the exact bacterium and required antibiotic sensitive to treat it could be very helpful. It is good a culture of the spinal fluid from the lumbar tap is underway and could help.

I think the latest treatment plan is ok. A blood culture and awaiting results of the spinal fluid culture are ok.

Controlling the child s blood glucose is of utmost importance to be monitors carefully. Doing an electrolyte panel (potassium, sodium, calcium) is also important. Disturbances in these electrolytes could entertain an altered mental status.

Thanks and kind regards

Dr Bain
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Luchuo Engelbert Bain (7 hours later)
Thank you so much Dr Bain having detailed look at the report. Our major worry right now is seizures, since they are not stopping after though fever went down, any comments/suggestions specific to seizures?
doctor
Answered by Dr. Luchuo Engelbert Bain (5 hours later)
Brief Answer:
Patience and caution

Detailed Answer:
Hi and thanks for the query

I understand this can be very disturbing. You however need to be reassured on other hand since the CT scan of the brain that was done is within normal limits. I suggest proper blood glucose control, appropriate blood oxygen monitoring and checking of blood sodium, calcium and magnesium levels that could permit continued or sustained seizures.

The anti seizure therapy instituted in my opinion is fine and, maybe we have to give some time, say a couple of days to cautiously wait and see how the seizures evolve. The opinion of the neurologist and doing an ekectroencephalogram (EEG) should be considered at some point in time.

Kind regards

Dr Bain
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Luchuo Engelbert Bain (13 hours later)
Thank you for response Doctor. Earlier my nephew was having seizures episode every 2-3 hour. Today, it happened after a gap of 12 hours just when he became little unconscious. Since last three days, he is mostly unconscious. They also took EEG report today, report was somewhat abnormal but doctor said it is expected due to seizures. I will provide more details later. I have a question regarding validity of CT scan, MRI and EEG reports. Are the method involve in collecting these reports are trivial? I mean is the outcome of these reports varies from lab to lab depending on qualification of person taking these reports. Any recommendation on good doctors/lab in XXXXXXX regarding related to this particular medical condition?
doctor
Answered by Dr. Luchuo Engelbert Bain (1 hour later)
Brief Answer:
Techniques and results depend on level of training and experience, patience

Detailed Answer:
Hi and thanks for the query,

Yes of course results can change from lab to lab with regards to the EEG. Findings can also change depending on the time of the day in which the test is done. However, key abnormalities will rarely be missed with a skilled interpreter. I strongly believe since the seizures have started improving and his regaining consciousness potential quite reassuring, we could be a bit patient.

CT scan and MRI results will be rarely missed under such circumstances. The techniques and generally very standardized. I would rarely think the issue should be at the level of missing key abnormal findings. Poor quality scans do exist, but would be a bit rare these days.

I agree that the quality of staff doing the test and interpreting results do matter. But I don't think this could be the case here, though there's always a possibility. We can just a be a bit patient for a couple of days as the child takes his treatment and is monitored.

Kind regards,

DR Bain
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Luchuo Engelbert Bain (21 hours later)
Thank you Dr Bain for detailed response. Since yesterday after 12 hours of gap, my nephew got 3 seizures with 4-5 hours time frame. Currently since last 11 hours no seizures came. I am attaching current case summary, along with blood & aerobic culture status report as of today, MRI report, EEG report showing diffuse cerebral dysfunction and lab results summary report as of now. Please let us know anything concerning related to cerebral dysfunction of EEG or any comments\suggestion keeping current condition in mind.
doctor
Answered by Dr. Luchuo Engelbert Bain (16 hours later)
Brief Answer:
Clinical status promising, normal MRI and spacing of seizures

Detailed Answer:
Hi and thank you for the update,

I have gone through his latest reports carefully as you did upload them. The child is increasingly becoming sensitive to touch from the clinical review and the gaps between the seizures is increasing. I think with these clinical parameters, there is much hope that the health status will get better.

It is good news that the MRI scan is within normal limits. Being in a state with continuous seizures could explain EEG abnormalities. It would be more interesting, and too early to worry so much about this. I think the child simply needs to be monitored clinical carefully and his treatment pursued.

Failure to identify any germ on the culture within two days might imply a sterile culture or germs that grow more slowly, that could require much time to be identified. It is good that an antiviral therapy has been associated, as well as continuing the antibiotics that the child was put on.

I think the treatment protocol the child is on is fine and the clinical course is promising.

Thanks and kind regards as I wish you the best of health.

Dr Bain
Above answer was peer-reviewed by : Dr. Sonia Raina
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Dr. Luchuo Engelbert Bain

General & Family Physician

Practicing since :2009

Answered : 3092 Questions

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Suggest treatment for typhoid, seizures and bacterial infection

Brief Answer: Normal Ct scan is reassuring. Broad spectrum antibiotherapy , await lab res Detailed Answer: Hi and thanks for the query, It is good and reassuring that the CT scan came back normal. A sample taken for laboratory and culture, with a subsequent antibiogramme to identify the appopriate germ and drug is a perfect idea as was done. I do think the most important thing at this point in time is appropriate broad spectrum antibiotics and monitoring of the patient. It is a great idea the patient is in an intensive care unit. It is easier for young persons to get seizures with raised temperatures and altered blood parameters compared to elderly patients. If it is a child, considering that the CT scan was normal, I really do not think you need to worry very much. The most important thing now is temperature control, proper antibiotic therapy and monitoring of his general health status as the laboratory results are being awaited. Thanks and kind regards as I wish the best of health and a rapid recovery. Kind regards, Dr Bain