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Typhoid fever — RACP Paediatrics MCQ

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ModerateIDTyphoid feverRACP Paediatrics

A 12-year-old presents with insidious onset fever, headache, abdominal pain, constipation followed by diarrhoea, and relative bradycardia 2 weeks after returning from the Indian subcontinent. Examination reveals hepatosplenomegaly and rose spots on the abdomen. What is the most likely diagnosis?

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Correct answer: C — Typhoid fever

Step-ladder fever with relative bradycardia, abdominal symptoms, hepatosplenomegaly, and rose spots after travel to the Indian subcontinent is classic for typhoid fever (Salmonella typhi). Blood cultures are the gold standard for diagnosis (positive in ~60-80% in the first week). Treatment is with IV ceftriaxone or oral azithromycin. It is notifiable.

Reference: Australian Therapeutic Guidelines – 2024 – Antibiotic; RCH Melbourne – 2023 – Fever in Returned Traveller CPG