Sabahat Fatima, Zoya Yaseen, Aisha Nazeer, Saima Salman, Syed Ghazanfar Saleem.
An unusual case of extensive drug-resistant (XDR) enteric fever with ARDS.
South Asian J Emerg Med Jan ;3(1):55-8.

Enteric fever is an infection caused by Salmonella enterica serovar Typhi (gram-negative bacteria). Its incidence is increasing globally and South Asia has highest incidence and burden of disease.Enteric fever has a case-fatality rate of 10-30%. This number has been reduced to 1-4% with appropriate management.The common gastrointestinal manifestation of enteric fever includes hepatosplenomegaly, jaundice, GI hemorrhage, intestinal perforation and acalculous cholecystitis. Septic shock and acute respiratory distress syndrome (ARDS) are one of the rarely reported. Following is the case report of ARDS and pulmonary hemorrhage in XDR enteric fever. 25 years old female, presented in our Emergency department with complaint of: upper abdominal pain and vomiting for 15 days followed by fever and acute onset of Shortness of breath for 1 day. On arrival she was hemodynamically unstable. Spo2 82% at room air, was initally taken on CPAP then electively intubated for mechanical ventilation. CT scan chest showed diffused alveolar hemorrhage and blood cultures showed growth of extended resistant salmonella typhi sensitive to carbapenems and azithromycin. Patient remained admitted in ICU for 33 days, improved and discharged.The case highlights significance of early recognition of respiratory symptoms in patient with enteric fever.

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