RN Y Van Zyl – Clinical Coordinator and Dr C Piek – Specialist Physician, Paarl Hospital
A 21-year old woman from Wellington presented dizziness, vomiting, diarrhoea, abdominal cramps and malaise for three days. She denied a travel history.
She was alert, but lethargic, febrile at 38.5oC, a tachycardia of 155 beats per minute, and hypotensive, BP 95/70 mmHg. The rest of her physical examination was unremarkable, except for increased bowel sounds.
A clinical diagnosis of bacterial gastro-enteritis complicated by dehydration was made.
A stool culture was requested and a blood culture was performed. She was admitted, started on oral ciprofloxacin 500 mg twice daily, intravenous Ringer’s lactate, oral rehydration, anti-emetics and anti-spasmodics. Her white cell count, creatinine, urea and electrolytes were normal. She tested HIV seronegative
The next morning she had improved, was rehydrated and discharged to complete the 3 day course of ciprofloxacin. Her blood cultured Salmonella typhi on day 4, sensitive to ciprofloxacin and ceftriaxone.