Paeds Cases · infectious-diseases
Prolonged fever in a returned traveller — communication OSCE
OSCE on counselling a family through a suspected diagnosis of extensively drug-resistant enteric fever: blood culture before antibiotics, antibiotic stewardship, safety-netting for complications, and vaccine and public-health follow-up.
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Target exams
MRCPCH ClinicalRACP DCEABP General Pediatrics
Prompt
Parents of a 9-year-old boy who has had a stepwise fever for six days after returning from Pakistan are anxious and want antibiotics started now; he is constipated with vague abdominal pain.
Objectives
- Establish that the stepwise fever after travel to Pakistan makes enteric fever the leading diagnosis. [1]
- Explain why blood culture must be taken before antibiotics, without dismissing the parents' wish to start treatment. [1]
- Counsel on XDR-aware empiric therapy and antibiotic stewardship in plain language. [8] [4]
- Safety-net for the danger windows: perforation in weeks 3-4 and the red-flag abdomen. [1]
- Outline public-health notification, exclusion and the typhoid conjugate vaccine for the family and future travel. [14]
References4ShowHide
- [1]Wain J, Hendriksen RS, Mikoleit ML, et al. Typhoid fever Lancet (London, England), 2015.PMID 25458731
- [4]Parry CM, Qamar FN, Rijal S, McCann N What should we be recommending for the treatment of enteric fever? Open Forum Infectious Diseases, 2023.PMID 37274536
- [8]Carey ME, Dyson ZA, Ingle DJ, Amir A, Baker S, Holt KE Global diversity and antimicrobial resistance of typhoid fever pathogens: insights from a meta-analysis of 13,000 Salmonella Typhi genomes eLife, 2023.PMID 37697804
- [14]Bhutta ZA International travel and the risk of extensively drug-resistant typhoid: issues and potential solutions Clinical Infectious Diseases, 2021.PMID 32609356