| disease | Pediatric Cold-damage Disease and Secondary Cold-damage Disease |
| alias | Typhoid, Paratyphoid |
Cold-damage disease (typhoid) and paracold-damage disease (paratyphoid) are intestinal pestilence diseases caused by cold-damage disease and paracold-damage disease bacilli, respectively. They mostly occur during the summer and autumn seasons.
bubble_chart Clinical Manifestations
The clinical manifestations of school-age children are similar to those of adults, generally including persistent high fever, loss of appetite, abdominal pain, constipation, apathy, drowsiness, dysphoria, epistaxis, thick and greasy tongue coating, abdominal distension and fullness, splenomegaly, etc. The symptoms in preschool children are milder, while those in infants and toddlers are often atypical.
- The typical clinical course can be divided into four stages: (1) Initial stage [first stage]: The first week of the illness, with a relatively gradual onset. Fever gradually rises, reaching 39–40°C within 5–7 days, accompanied by headache, anorexia, and fatigue. (2) Peak stage: During weeks 2–3 of the illness, the patient experiences persistent high fever, pale complexion, apathy, a red tongue with thick and greasy coating, abdominal distension and fullness, constipation, and some may have diarrhea. At this stage, scattered faint pink roseola (2–4 mm in diameter, irregular edges, fading upon pressure) may appear on the trunk. Hepatosplenomegaly and a relatively slow pulse are present. Severe cases may exhibit delirium, unconsciousness, and meningeal irritation signs. (3) Stage of remission: Weeks 3–4 mark the turning point in the natural course of cold-damage disease. A few patients become more debilitated, with persistent high fever and various symptoms from the peak stage, often leading to intestinal hemorrhage, intestinal perforation, or circulatory failure. Most patients recover smoothly, with fever declining in a remittent pattern and returning to normal within about a week, while other symptoms gradually improve. (4) Stage of convalescence: After weeks 4–5, body temperature normalizes, symptoms disappear, appetite returns, and full recovery is achieved in about 2 months. Due to the widespread use of antibiotics in recent years, mild or atypical cases are more common. If treatment is incomplete, relapse often occurs about a week after fever subsides.
- Cold-damage disease in infants and toddlers is often atypical, with an acute onset. High fever, vomiting, and convulsions occur in about one-third of cases, with convulsions mostly limited to infants. Fever typically peaks on the fifth day, accompanied by fatigue, headache, anorexia, and possibly cough, epistaxis, abdominal pain, or diarrhea. Roseola is less common in children (about 6–15%). Occasionally, papules, petechiae, or urticaria may appear. Hepatosplenomegaly is more pronounced. Respiratory infection symptoms often complicate bronchitis or pneumonia. Infants are prone to diarrhea, even leading to dehydration and acidosis. Leukocyte counts may not decrease and could even increase, with a left shift in granulocytes.
- Paratyphoid fever has a more acute onset, possibly with vomiting and diarrhea. Body temperature rises rapidly, often accompanied by fear of cold or chills. The course is shorter, about 2–3 weeks. Toxic symptoms are milder, with fewer complications. Rashes are also less common than in cold-damage disease.
bubble_chart Auxiliary Examination
- Blood Picture: Most leukocytes are reduced, with a decrease in neutrophils but a left shift. Eosinophils are reduced or absent.
- Etiological Examination (1) Blood Culture: The highest positive rate occurs in the first week of illness. It may also be positive during relapse. (2) Bone Marrow Culture: The positive rate is higher than that of blood culture. Even after starting antibiotic treatment, it may still yield positive results. (3) Stool and Urine Culture: These may become positive in the 3rd to 4th week of the disease course, with stool cultures having a higher positive rate than urine cultures.
- Widal Test: By the end of the first week of illness, the agglutination test begins to show positive results. The titer gradually rises with the disease course, peaking at 4–5 weeks. A diagnostic significance is indicated when the "O" antibody >1:80 and the "H" antibody >1:160. If only the "H" antibody is elevated while the "O" antibody remains low, it may suggest recent vaccination against cold-damage disease or a prior history of the disease. If only the "O" antibody is elevated while the "H" antibody remains low, it may indicate early-stage illness or Salmonella infection. In newborns with cold-damage disease, the Widal test may be negative, but it could turn positive if maternal antibodies are present. Early use of antibiotics, hormones, or immunosuppressants in cold-damage disease may also result in a negative Widal test.
Epidemiological history, including the season of onset, exposure history, vaccination history, and dietary hygiene status.
bubble_chart Treatment Measures
General treatment and symptomatic treatment: First, gastrointestinal isolation should be implemented until one week after the body temperature returns to normal and symptoms disappear. During the {|###|}fever{###|} period, bed rest is required. Provide nutritious, residue-free soft food or liquid diet. Closely monitor changes in the condition and the occurrence of complications. Avoid excessive use of antipyretics for high fever; physical cooling can be applied instead. Laxatives are prohibited for {|###|}constipation{###|}. For {|###|}diarrhea{###|}, a liquid diet should be given, and attention should be paid to maintaining water and electrolyte balance. For severe toxic symptoms, a short-term low-dose oral corticosteroid or intravenous hydrocortisone (25–50 mg) can be used, with the duration not exceeding 3–5 days.
. For chronic carriers, treatment with compound formula {|###|}SMZ-TMP{###|} (sulfamethoxazole-trimethoprim) can be used at a dose of SMZ 50 mg/(kg·d), with a course of 1–3 months; or ampicillin 100–200 mg/(kg·d), divided into multiple oral doses daily, with a course of 4–6 weeks. If {|###|}cholecystitis{###|} or gallstones are present, cholecystectomy should be performed, and medication should be continued before and after surgery.
- Regular vaccination against cold-damage disease and secondary cold-damage disease.
- Isolate patients and thoroughly treat them until symptoms disappear. After the treatment course is completed, stool culture must be negative ? times before lifting isolation.
- Strengthen food hygiene management and supervision, and pay attention to personal dietary hygiene.
Complication Management:
- Intestinal Perforation: Mostly occurs during the 2nd to 3rd day of the illness cycle, presenting with sudden abdominal pain, abdominal distension and fullness, nausea, vomiting, and diarrhea. There is tenderness and muscle rigidity in the abdomen, along with a rapid and thready pulse. X-ray examination may reveal free gas in the abdominal cavity. At this time, fasting, gastrointestinal decompression, fluid infusion, and antibiotic treatment for infection are required. Surgical consultation or consideration of surgery may be necessary.
- Intestinal Hemorrhage: Mostly occurs in the 3rd week. Symptoms include hematochezia or melena, pale complexion, dizziness, shortness of breath, rapid and thready pulse, drop in blood pressure, sudden drop in body temperature, and dysphoria. In severe cases, shock may occur. At this time, fasting, absolute bed rest, fluid infusion, and maintaining water and electrolyte balance are essential. Blood transfusion is required in cases of massive bleeding. Sedatives should be administered for dysphoria, while closely monitoring blood pressure and pulse. Hemostatic medications such as vitamin K, adrenochrome, and anti-fibrinolytic agents should be administered. Surgical intervention may be necessary.
It should be differentiated from subcutaneous nodules, malaria, and schistosomiasis.
