From the Guidelines
A coated tongue in typhoid (enteric) fever is a significant clinical finding that can help support a diagnosis of enteric fever, particularly when present alongside other typical symptoms such as step-ladder fever pattern, relative bradycardia, and abdominal tenderness.
Clinical Presentation
The coated tongue is characterized by a white or yellowish-white coating on the tongue's surface, which typically appears during the first week of illness and may gradually become thicker and more pronounced as the disease progresses. This distinctive appearance is caused by the systemic inflammatory response to Salmonella Typhi or Salmonella Paratyphi infection, leading to changes in oral mucosa, decreased salivation, poor oral hygiene due to illness, and alterations in the normal oral microbiome.
Diagnosis and Treatment
While not diagnostic on its own, the presence of a coated tongue can help support a clinical suspicion of enteric fever when present alongside other typical symptoms. The diagnosis of enteric fever is typically confirmed by blood culture, which has the highest yield within a week of symptoms onset 1. The treatment of enteric fever typically involves antibiotic therapy, which may include ceftriaxone, azithromycin, or fluoroquinolones depending on local resistance patterns and patient factors 1.
Management
The coating typically resolves gradually as the patient recovers with appropriate antibiotic treatment. It is essential to note that the choice of antibiotic should be guided by local resistance patterns and patient factors, and that fluoroquinolones may not be suitable in areas with high resistance rates 1. In such cases, ceftriaxone or azithromycin may be preferred as first-line agents.
Key Points
- A coated tongue is a common clinical finding in enteric fever
- The presence of a coated tongue can help support a diagnosis of enteric fever when present alongside other typical symptoms
- The diagnosis of enteric fever is typically confirmed by blood culture
- The treatment of enteric fever typically involves antibiotic therapy, which may include ceftriaxone, azithromycin, or fluoroquinolones depending on local resistance patterns and patient factors.
From the Research
Significance of a Coated Tongue in Typhoid (Enteric) Fever
There are no research papers provided that directly discuss the significance of a coated tongue in typhoid (enteric) fever.
Related Information on Enteric Fever
- Enteric fever is a bacterial illness caused by Salmonella Typhi or Paratyphi, typically acquired through contaminated food or water 2.
- The main symptom is fever, but stomach pain, diarrhea, muscle aches, rash, and other symptoms may occur 2.
- Enteric fever usually responds well to antibiotic treatment, but there has been an increase in resistance to antibiotics used to treat the infection 2.
- Extensively drug-resistant (XDR) enteric fever has been reported, which only responds to a limited number of antibiotics, such as carbapenems or azithromycin 3.
Treatment of Enteric Fever
- Ceftriaxone and azithromycin are commonly used to treat enteric fever, but resistance to these drugs has been reported 4, 5.
- The minimum inhibitory concentration (MIC) of ceftriaxone and azithromycin for blood culture isolates of Salmonella enterica spp. has been studied to evaluate drug susceptibility 5.
- Treatment guidelines for enteric fever recommend antibiotic therapy, and in some cases, hospitalization may be necessary 2.
Key Findings
- Azithromycin has been shown to be effective in treating extensively drug-resistant enteric fever 6.
- Ceftriaxone may be an effective treatment for adults and children with enteric fever, but its performance compared to other antimicrobials is uncertain 4.
- Resistance patterns vary by location and are changing over time, making it essential to consider local resistance patterns when choosing an antimicrobial 4.