Is it normal – Orris AI

1001601130.jpg

1001601129.jpg

Is it normal

analyse_media

Here is a clear breakdown of D. Ramadevi's (45F) reports and what is abnormal:

Hematology Report - Abnormal Values

Parameter	Result	Reference Range	Status
WBC	2.41	4.00-10.00 × 10⁹/L	🔴 LOW
Lym#	0.32	0.80-4.00 × 10⁹/L	🔴 LOW
Mid#	0.06	0.10-1.80 × 10⁹/L	🔴 LOW
Lym%	0.131	0.200-0.400	🔴 LOW
Gran%	0.856	0.500-0.700	🟡 HIGH
MCH	25.1 pg	27.0-34.0 pg	🔴 LOW
MCHC	273 g/L	320-360 g/L	🔴 LOW
PDW-CV	0.136	0.150-0.170	🔴 LOW

Normal values: RBC (4.82), HGB (12.1), HCT (0.443), MCV (91.9), PLT (224), MPV (10.4), Gran# (2.03 - just within range)

Second Report - Key Findings

Test	Result	Significance
Widal - S. Typhi O	1:160	🔴 SIGNIFICANT
Widal - S. Typhi H	1:160	🔴 SIGNIFICANT
Widal - Para Typhi AH	1:80	Borderline
Widal - Para Typhi B	1:40	Low/borderline
Blood Sugar (Random)	132 mg%	✅ Normal (80-160)
Malaria (MP)	Negative	✅
Dengue NS1Ag, IgG, IgM	Non-Reactive	✅

Summary - No, This is NOT Normal

Several things are abnormal here:

Low WBC (leukopenia) - WBC of 2.41 is significantly below normal. This is a key feature of typhoid fever (Salmonella typhi infection).
Widal test positive at 1:160 for both S. Typhi O and H - a titer of ≥1:160 is considered significant and strongly suggestive of active typhoid fever, especially combined with the leukopenia.
Low MCH and MCHC - suggests hypochromic anemia, likely iron deficiency on top of the acute illness.
Lymphopenia (low lymphocytes) - consistent with typhoid and/or the overall picture of illness.

What This Likely Means

The combination of low WBC + positive Widal at 1:160 + a febrile illness is a classic presentation of typhoid fever. The treating doctor (Dr. V.M. Tayudu, M.S.) is already involved.

She should be on or started on antibiotics appropriate for typhoid (typically azithromycin, ciprofloxacin, or ceftriaxone depending on local resistance patterns). The iron-deficiency picture (low MCH/MCHC with normal MCV) can be addressed after the acute illness.

Important: This report should be reviewed promptly with the treating doctor. Do not self-medicate. Typhoid can worsen quickly without proper treatment.

Create a quick reference PDF on typhoid diagnosis and management

Reading File

Finding Sources

Reading File

Running Command

mkdir -p /tmp/workspace/typhoid-pdf && ls /tmp/workspace/typhoid-pdf/

Writing File

~/typhoid-pdf/generate_typhoid_pdf.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import cm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.lib.enums import TA_LEFT, TA_CENTER, TA_JUSTIFY
from reportlab.platypus import PageBreak

OUTPUT_PATH = "/tmp/workspace/typhoid-pdf/Typhoid_Quick_Reference.pdf"

# ── Colour palette ──────────────────────────────────────────────────────────────
DARK_RED   = colors.HexColor("#B71C1C")
RED        = colors.HexColor("#D32F2F")
LIGHT_RED  = colors.HexColor("#FFCDD2")
ORANGE     = colors.HexColor("#E65100")
AMBER      = colors.HexColor("#FFF8E1")
DARK_BLUE  = colors.HexColor("#1A237E")
BLUE       = colors.HexColor("#1565C0")
LIGHT_BLUE = colors.HexColor("#E3F2FD")
TEAL       = colors.HexColor("#00695C")
LIGHT_TEAL = colors.HexColor("#E0F2F1")
GREEN      = colors.HexColor("#2E7D32")
LIGHT_GREEN= colors.HexColor("#E8F5E9")
YELLOW_BG  = colors.HexColor("#FFFDE7")
GREY_DARK  = colors.HexColor("#212121")
GREY_MED   = colors.HexColor("#757575")
GREY_LIGHT = colors.HexColor("#F5F5F5")
WHITE      = colors.white

# ── Styles ──────────────────────────────────────────────────────────────────────
styles = getSampleStyleSheet()

def S(name, **kw):
    return ParagraphStyle(name, **kw)

title_style = S("DocTitle",
    fontSize=26, leading=32, textColor=WHITE,
    fontName="Helvetica-Bold", alignment=TA_CENTER)

subtitle_style = S("DocSubtitle",
    fontSize=13, leading=17, textColor=colors.HexColor("#FFCDD2"),
    fontName="Helvetica", alignment=TA_CENTER)

section_header_style = S("SectionHeader",
    fontSize=13, leading=17, textColor=WHITE,
    fontName="Helvetica-Bold", alignment=TA_LEFT,
    leftIndent=6)

sub_header_style = S("SubHeader",
    fontSize=10, leading=13, textColor=DARK_BLUE,
    fontName="Helvetica-Bold", alignment=TA_LEFT)

body_style = S("Body",
    fontSize=9, leading=13, textColor=GREY_DARK,
    fontName="Helvetica", alignment=TA_JUSTIFY)

bullet_style = S("Bullet",
    fontSize=9, leading=13, textColor=GREY_DARK,
    fontName="Helvetica", leftIndent=12, bulletIndent=4,
    alignment=TA_LEFT)

small_style = S("Small",
    fontSize=8, leading=11, textColor=GREY_MED,
    fontName="Helvetica", alignment=TA_CENTER)

alert_style = S("Alert",
    fontSize=9.5, leading=13, textColor=DARK_RED,
    fontName="Helvetica-Bold", alignment=TA_LEFT)

green_style = S("Green",
    fontSize=9, leading=13, textColor=GREEN,
    fontName="Helvetica-Bold", alignment=TA_LEFT)

table_header_style = S("TableHeader",
    fontSize=9, leading=12, textColor=WHITE,
    fontName="Helvetica-Bold", alignment=TA_CENTER)

table_cell_style = S("TableCell",
    fontSize=8.5, leading=12, textColor=GREY_DARK,
    fontName="Helvetica", alignment=TA_LEFT)

table_cell_bold = S("TableCellBold",
    fontSize=8.5, leading=12, textColor=GREY_DARK,
    fontName="Helvetica-Bold", alignment=TA_LEFT)

# ── Helper builders ─────────────────────────────────────────────────────────────
def section_block(title, bg_color, text_color=WHITE):
    """A coloured section header row."""
    data = [[Paragraph(title, section_header_style)]]
    t = Table(data, colWidths=[17.5*cm])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg_color),
        ("TOPPADDING",    (0,0), (-1,-1), 6),
        ("BOTTOMPADDING", (0,0), (-1,-1), 6),
        ("LEFTPADDING",   (0,0), (-1,-1), 10),
        ("RIGHTPADDING",  (0,0), (-1,-1), 8),
        ("ROUNDEDCORNERS", [4]),
    ]))
    return t

def bp(text):
    return Paragraph(f"<bullet>&bull;</bullet> {text}", bullet_style)

def body(text):
    return Paragraph(text, body_style)

def bold_body(text):
    return Paragraph(f"<b>{text}</b>", body_style)

def sp(h=4):
    return Spacer(1, h)

def hr():
    return HRFlowable(width="100%", thickness=0.5, color=colors.HexColor("#E0E0E0"))

# ── Two-column helper ────────────────────────────────────────────────────────────
def two_col(left_items, right_items, col_widths=(8.5*cm, 8.5*cm), valign="TOP"):
    """Wrap two lists of flowables into a 2-column table."""
    from reportlab.platypus import KeepInFrame
    # We use nested tables via KeepInFrame trick - just use normal Table cells
    left_frame  = [i for i in left_items]
    right_frame = [i for i in right_items]
    data = [[left_frame, right_frame]]
    t = Table(data, colWidths=list(col_widths))
    t.setStyle(TableStyle([
        ("VALIGN",        (0,0), (-1,-1), valign),
        ("TOPPADDING",    (0,0), (-1,-1), 0),
        ("BOTTOMPADDING", (0,0), (-1,-1), 0),
        ("LEFTPADDING",   (0,0), (-1,-1), 0),
        ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ]))
    return t

# ── Box wrapper ──────────────────────────────────────────────────────────────────
def box(items, bg=GREY_LIGHT, border_color=colors.HexColor("#BDBDBD"), col_w=17.5*cm):
    t = Table([[items]], colWidths=[col_w])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), bg),
        ("BOX",           (0,0), (-1,-1), 0.75, border_color),
        ("TOPPADDING",    (0,0), (-1,-1), 8),
        ("BOTTOMPADDING", (0,0), (-1,-1), 8),
        ("LEFTPADDING",   (0,0), (-1,-1), 10),
        ("RIGHTPADDING",  (0,0), (-1,-1), 10),
    ]))
    return t

# ── Page template with header/footer ────────────────────────────────────────────
def on_first_page(canvas, doc):
    pass  # header drawn inline

def on_later_pages(canvas, doc):
    canvas.saveState()
    canvas.setFont("Helvetica", 7.5)
    canvas.setFillColor(GREY_MED)
    canvas.drawString(2*cm, 1.2*cm, "Typhoid Fever - Quick Reference Guide")
    canvas.drawRightString(19*cm, 1.2*cm, f"Page {doc.page}")
    canvas.restoreState()

# ── BUILD PDF ────────────────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT_PATH,
    pagesize=A4,
    leftMargin=1.8*cm, rightMargin=1.8*cm,
    topMargin=1.5*cm, bottomMargin=2*cm,
)

story = []

# ════════════════════════════════════════════════════════════
# TITLE BANNER
# ════════════════════════════════════════════════════════════
banner_data = [[
    Paragraph("TYPHOID FEVER", title_style),
    Paragraph("Quick Reference Guide", subtitle_style),
    Paragraph("Diagnosis &amp; Management", subtitle_style),
]]
banner = Table(banner_data, colWidths=[17.5*cm])
banner.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,-1), DARK_RED),
    ("TOPPADDING",    (0,0), (-1,-1), 14),
    ("BOTTOMPADDING", (0,0), (-1,-1), 14),
    ("LEFTPADDING",   (0,0), (-1,-1), 16),
    ("RIGHTPADDING",  (0,0), (-1,-1), 16),
    ("ROUNDEDCORNERS", [6]),
]))
story.append(banner)
story.append(sp(10))

# ════════════════════════════════════════════════════════════
# AT A GLANCE strip
# ════════════════════════════════════════════════════════════
glance_items = [
    ["Causative\nOrganism", "Salmonella\ntyphi/paratyphi"],
    ["Transmission", "Faeco-oral\n(food/water)"],
    ["Incubation", "10-20 days\n(range 1-3 wk)"],
    ["Mortality\n(untreated)", "10-20%"],
    ["Endemic\nRegions", "South Asia,\nAfrica, S.E. Asia"],
]
glance_data = [[Paragraph(k, S("glk", fontSize=7.5, fontName="Helvetica-Bold", textColor=GREY_MED, alignment=TA_CENTER)) for k,v in glance_items],
               [Paragraph(v, S("glv", fontSize=8.5, fontName="Helvetica-Bold", textColor=DARK_BLUE, alignment=TA_CENTER)) for k,v in glance_items]]
glance_t = Table(glance_data, colWidths=[3.5*cm]*5)
glance_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), LIGHT_BLUE),
    ("BACKGROUND",    (0,1), (-1,1), WHITE),
    ("BOX",           (0,0), (-1,-1), 0.75, colors.HexColor("#90CAF9")),
    ("INNERGRID",     (0,0), (-1,-1), 0.4, colors.HexColor("#90CAF9")),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("ALIGN",         (0,0), (-1,-1), "CENTER"),
]))
story.append(glance_t)
story.append(sp(10))

# ════════════════════════════════════════════════════════════
# SECTION 1 - PATHOPHYSIOLOGY (compact)
# ════════════════════════════════════════════════════════════
story.append(section_block("1.  PATHOPHYSIOLOGY", BLUE))
story.append(sp(4))
patho_items = [
    bp("Oral ingestion of S. typhi (infective dose ~10<super>3</super>-10<super>5</super> organisms)"),
    bp("Organisms penetrate small bowel mucosa → lymphatics → systemic bacteraemia"),
    bp("Reticuloendothelial hyperplasia: lymph nodes, liver, spleen"),
    bp("Peyer's patches in terminal ileum become hyperplastic → ulcerate → risk of perforation/haemorrhage"),
    bp("Endotoxin release drives systemic inflammation and fever"),
]
story.append(box(patho_items, bg=LIGHT_BLUE, border_color=colors.HexColor("#90CAF9")))
story.append(sp(8))

# ════════════════════════════════════════════════════════════
# SECTION 2 - CLINICAL FEATURES
# ════════════════════════════════════════════════════════════
story.append(section_block("2.  CLINICAL FEATURES BY WEEK", BLUE))
story.append(sp(4))

weeks_data = [
    [Paragraph("Week", table_header_style),
     Paragraph("Symptoms & Signs", table_header_style),
     Paragraph("Key Features", table_header_style)],
    [Paragraph("Week 1\n(Bacteraemia)", table_cell_bold),
     Paragraph("Fever (stepwise rise), headache, malaise, dry cough, constipation", table_cell_style),
     Paragraph("Relative bradycardia (Faget sign)", table_cell_bold)],
    [Paragraph("Week 2\n(Enteric phase)", table_cell_bold),
     Paragraph("High fever, abdominal distension, splenomegaly, diarrhoea OR constipation (30%)", table_cell_style),
     Paragraph("Rose spots (trunk) - pink macules, fair skin only", table_cell_bold)],
    [Paragraph("Week 3\n(Complications)", table_cell_bold),
     Paragraph("Prostration, delirium; risk of perforation/haemorrhage", table_cell_style),
     Paragraph("Most dangerous period", table_cell_bold)],
    [Paragraph("Week 4+\n(Recovery)", table_cell_bold),
     Paragraph("Slow defervescence, fatigue; 10% relapse", table_cell_style),
     Paragraph("Carrier state may develop", table_cell_bold)],
]
weeks_t = Table(weeks_data, colWidths=[3.2*cm, 9*cm, 5.3*cm])
weeks_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), BLUE),
    ("BACKGROUND",    (0,1), (-1,1), LIGHT_BLUE),
    ("BACKGROUND",    (0,2), (-1,2), WHITE),
    ("BACKGROUND",    (0,3), (-1,3), LIGHT_RED),
    ("BACKGROUND",    (0,4), (-1,4), LIGHT_GREEN),
    ("ROWBACKGROUNDS", (0,0), (-1,-1), []),
    ("BOX",           (0,0), (-1,-1), 0.75, colors.HexColor("#BDBDBD")),
    ("INNERGRID",     (0,0), (-1,-1), 0.4, colors.HexColor("#E0E0E0")),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story.append(weeks_t)
story.append(sp(8))

# ════════════════════════════════════════════════════════════
# SECTION 3 - DIAGNOSIS
# ════════════════════════════════════════════════════════════
story.append(section_block("3.  DIAGNOSIS", TEAL))
story.append(sp(4))

# Left: lab tests | Right: Widal interpretation
left_diag = [
    Paragraph("<b>Culture (Gold Standard)</b>", sub_header_style),
    sp(2),
    bp("<b>Blood culture</b> - Week 1 (yield ~60-80%)"),
    bp("<b>Bone marrow culture</b> - Most sensitive (90%), positive even after antibiotics"),
    bp("<b>Stool/urine culture</b> - Week 2 onwards"),
    sp(6),
    Paragraph("<b>Serology</b>", sub_header_style),
    sp(2),
    bp("Widal test: O ≥1:160 and H ≥1:160 significant"),
    bp("Rapid antigen tests (NS1-type): used in endemic areas"),
    bp("IgM/IgG ELISA: useful for confirmation"),
    sp(6),
    Paragraph("<b>Other Tests</b>", sub_header_style),
    sp(2),
    bp("PCR: high specificity but costly; unpredictable sensitivity"),
    bp("CBC: <b>leukopenia</b> is classic (as seen in this case)"),
    bp("LFTs: mildly elevated transaminases common"),
    bp("Anaemia, thrombocytopenia in severe cases"),
]

right_diag = [
    Paragraph("<b>Widal Interpretation</b>", sub_header_style),
    sp(2),
    box([
        Paragraph("<b>Titre</b>     |  <b>Interpretation</b>", S("h", fontSize=8.5, fontName="Helvetica-Bold", textColor=DARK_BLUE)),
        sp(3),
        Paragraph("&lt; 1:80      |  Insignificant", table_cell_style),
        Paragraph("1:80-1:160  |  Borderline / possible", table_cell_style),
        Paragraph("<b>≥ 1:160</b>  |  <b>Significant - typhoid likely</b>", S("w", fontSize=8.5, fontName="Helvetica-Bold", textColor=DARK_RED)),
    ], bg=YELLOW_BG, border_color=ORANGE, col_w=7.5*cm),
    sp(6),
    Paragraph("<b>Limitations of Widal Test</b>", sub_header_style),
    sp(2),
    bp("Cross-reactivity with other Salmonella species"),
    bp("Prior vaccination or infection elevates baseline titres"),
    bp("Single titre less reliable than paired titres (4x rise)"),
    bp("Now considered <b>non-specific</b> per current guidelines"),
    sp(6),
    Paragraph("<b>Recommended Approach</b>", sub_header_style),
    sp(2),
    box([
        Paragraph("Culture + clinical picture is preferred over Widal alone. In resource-limited settings, Widal at ≥1:160 with compatible symptoms justifies empirical treatment.", 
                  S("rec", fontSize=8.5, fontName="Helvetica", textColor=DARK_BLUE)),
    ], bg=LIGHT_BLUE, border_color=BLUE, col_w=7.5*cm),
]

story.append(two_col(left_diag, right_diag, col_widths=(9*cm, 8.5*cm)))
story.append(sp(8))

# ════════════════════════════════════════════════════════════
# SECTION 4 - MANAGEMENT
# ════════════════════════════════════════════════════════════
story.append(section_block("4.  MANAGEMENT", GREEN))
story.append(sp(4))

# Antibiotics table
abx_data = [
    [Paragraph("Antibiotic", table_header_style),
     Paragraph("Dose (Adult)", table_header_style),
     Paragraph("Duration", table_header_style),
     Paragraph("Notes", table_header_style)],
    [Paragraph("Azithromycin\n(1st line, uncomplicated)", table_cell_bold),
     Paragraph("500 mg OD orally", table_cell_style),
     Paragraph("7 days", table_cell_style),
     Paragraph("Preferred in areas with fluoroquinolone resistance (S. Asia). Safe in pregnancy.", table_cell_style)],
    [Paragraph("Ceftriaxone\n(severe/hospitalised)", table_cell_bold),
     Paragraph("2-3 g IV once daily", table_cell_style),
     Paragraph("10-14 days", table_cell_style),
     Paragraph("Drug of choice for severe typhoid. Use when oral not tolerated.", table_cell_style)],
    [Paragraph("Ciprofloxacin\n(if susceptible)", table_cell_bold),
     Paragraph("500 mg BD orally\nor 400 mg IV BD", table_cell_style),
     Paragraph("10-14 days", table_cell_style),
     Paragraph("Increasing resistance (S. Asia). Check nalidixic acid sensitivity as proxy.", table_cell_style)],
    [Paragraph("Cefixime\n(oral, uncomplicated)", table_cell_bold),
     Paragraph("200 mg BD orally", table_cell_style),
     Paragraph("7-14 days", table_cell_style),
     Paragraph("Good for outpatient management. 3rd-gen cephalosporin.", table_cell_style)],
    [Paragraph("Chloramphenicol\n(historical)", table_cell_bold),
     Paragraph("500 mg QID orally", table_cell_style),
     Paragraph("14 days", table_cell_style),
     Paragraph("Widely resistant. Avoid as first-line. May still be used where resistance not common.", table_cell_style)],
]
abx_t = Table(abx_data, colWidths=[3.8*cm, 3.5*cm, 2.3*cm, 7.9*cm])
abx_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), GREEN),
    ("BACKGROUND",    (0,1), (-1,1), LIGHT_GREEN),
    ("BACKGROUND",    (0,2), (-1,2), WHITE),
    ("BACKGROUND",    (0,3), (-1,3), LIGHT_GREEN),
    ("BACKGROUND",    (0,4), (-1,4), WHITE),
    ("BACKGROUND",    (0,5), (-1,5), LIGHT_GREEN),
    ("BOX",           (0,0), (-1,-1), 0.75, colors.HexColor("#BDBDBD")),
    ("INNERGRID",     (0,0), (-1,-1), 0.4, colors.HexColor("#E0E0E0")),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story.append(abx_t)
story.append(sp(6))

# Supportive care
story.append(Paragraph("<b>Supportive Care</b>", sub_header_style))
story.append(sp(3))
supportive = [
    bp("IV rehydration - correct electrolyte imbalances (especially Na, K)"),
    bp("Antipyretics - paracetamol preferred; avoid NSAIDs (bleeding risk)"),
    bp("Blood transfusion if significant GI haemorrhage"),
    bp("Nutritional support - soft diet; resume normal diet as tolerated"),
    bp("Dexamethasone 3 mg/kg loading + 1 mg/kg 6-hourly x 8 doses - for severe typhoid with shock or meningitis/encephalitis"),
    bp("Strict enteric precautions: hand hygiene, isolation, decontamination of excreta"),
]
story.append(box(supportive, bg=LIGHT_GREEN, border_color=GREEN))
story.append(sp(8))

# ════════════════════════════════════════════════════════════
# SECTION 5 - COMPLICATIONS
# ════════════════════════════════════════════════════════════
story.append(section_block("5.  COMPLICATIONS & SURGICAL EMERGENCIES", RED))
story.append(sp(4))

comp_left = [
    Paragraph("<b>GI Complications (Surgical)</b>", sub_header_style),
    sp(3),
    bp("<b>Intestinal perforation</b> (~2%) - typically single perforation in terminal ileum; occurs Week 3"),
    bp("Signs: sudden abdominal pain, peritonism, free gas on AXR/CT"),
    bp("Management: emergency laparotomy - simple closure (single) OR resection (multiple)"),
    sp(4),
    bp("<b>GI Haemorrhage</b> (~5-10%) - from ulcerated Peyer's patches"),
    bp("Management: transfusion usually sufficient; laparotomy rarely needed"),
    sp(4),
    bp("<b>Paralytic ileus</b> - bowel rest, NG decompression"),
    bp("<b>Cholecystitis</b> - may become chronic carrier"),
]

comp_right = [
    Paragraph("<b>Systemic Complications</b>", sub_header_style),
    sp(3),
    bp("<b>Toxic encephalopathy / meningitis</b>"),
    bp("<b>Myocarditis</b> - arrhythmias, CCF"),
    bp("<b>Pneumonia</b>"),
    bp("<b>Septic arthritis / osteomyelitis</b>"),
    bp("<b>DIC</b> - haemorrhagic manifestations"),
    bp("<b>Renal failure</b>"),
    bp("<b>Mycotic aneurysm</b>"),
    sp(4),
    Paragraph("<b>Sequelae</b>", sub_header_style),
    sp(2),
    bp("Deafness, psychosis, ataxia, seizures"),
    bp("<b>Chronic carrier state</b> - organisms shed >1 yr (gallbladder reservoir); cholecystectomy may be required"),
]

story.append(two_col(comp_left, comp_right))
story.append(sp(8))

# ════════════════════════════════════════════════════════════
# SECTION 6 - WIDAL TEST REFERENCE (quick box)
# ════════════════════════════════════════════════════════════
story.append(section_block("6.  LAB PATTERNS & WIDAL QUICK REFERENCE", TEAL))
story.append(sp(4))

lab_data = [
    [Paragraph("Test", table_header_style),
     Paragraph("Typical Finding in Typhoid", table_header_style),
     Paragraph("Significance", table_header_style)],
    [Paragraph("WBC", table_cell_bold),
     Paragraph("LOW - Leukopenia (2-4 × 10⁹/L)", table_cell_style),
     Paragraph("Classic feature; helps exclude pyogenic infection", table_cell_style)],
    [Paragraph("Neutrophils", table_cell_bold),
     Paragraph("Elevated % (Gran% high, absolute count normal-low)", table_cell_style),
     Paragraph("Relative neutrophilia despite overall leukopenia", table_cell_style)],
    [Paragraph("Lymphocytes", table_cell_bold),
     Paragraph("Absolute lymphopenia", table_cell_style),
     Paragraph("Consistent with systemic bacterial infection", table_cell_style)],
    [Paragraph("Haemoglobin", table_cell_bold),
     Paragraph("Mild-moderate anaemia possible", table_cell_style),
     Paragraph("From haemolysis or GI loss", table_cell_style)],
    [Paragraph("Platelets", table_cell_bold),
     Paragraph("Usually normal; thrombocytopenia in severe disease", table_cell_style),
     Paragraph("Thrombocytopenia signals severity", table_cell_style)],
    [Paragraph("Liver enzymes", table_cell_bold),
     Paragraph("Mildly elevated ALT/AST (2-3x ULN)", table_cell_style),
     Paragraph("Typhoid hepatitis; not always present", table_cell_style)],
    [Paragraph("CRP/ESR", table_cell_bold),
     Paragraph("Elevated", table_cell_style),
     Paragraph("Non-specific acute phase response", table_cell_style)],
    [Paragraph("Widal O titre", table_cell_bold),
     Paragraph("≥1:160 significant (rising 4x more specific)", table_cell_style),
     Paragraph("O antigen - earlier response, shorter duration", table_cell_style)],
    [Paragraph("Widal H titre", table_cell_bold),
     Paragraph("≥1:160 significant", table_cell_style),
     Paragraph("H antigen - persists longer (vaccination also raises)", table_cell_style)],
]
lab_t = Table(lab_data, colWidths=[3.5*cm, 7*cm, 7*cm])
lab_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), TEAL),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [LIGHT_TEAL, WHITE]),
    ("BOX",           (0,0), (-1,-1), 0.75, colors.HexColor("#BDBDBD")),
    ("INNERGRID",     (0,0), (-1,-1), 0.4, colors.HexColor("#E0E0E0")),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story.append(lab_t)
story.append(sp(8))

# ════════════════════════════════════════════════════════════
# SECTION 7 - PREVENTION & PUBLIC HEALTH
# ════════════════════════════════════════════════════════════
story.append(section_block("7.  PREVENTION & PUBLIC HEALTH", colors.HexColor("#5E35B1")))
story.append(sp(4))

prev_left = [
    Paragraph("<b>Vaccination</b>", sub_header_style),
    sp(3),
    bp("<b>Vi polysaccharide vaccine</b> (ViPS): IM, single dose, ≥2 years, ~60-70% efficacy, revaccinate every 2-3 years"),
    bp("<b>Ty21a (Vivotif)</b>: oral live attenuated, 3-4 capsules on alternate days, ≥6 years; good for travellers"),
    bp("<b>Vi-TT conjugate vaccine (Typhoid Conjugate Vaccine)</b>: preferred for children >6 months; longer lasting immunity"),
    bp("Vaccination does not replace food/water precautions"),
]

prev_right = [
    Paragraph("<b>Notification & Isolation</b>", sub_header_style),
    sp(3),
    bp("Notifiable disease in most countries"),
    bp("Hospitalise where possible - prolonged infectious course"),
    bp("Stool/urine precautions until 3 consecutive negative stool cultures"),
    sp(4),
    Paragraph("<b>Carrier Management</b>", sub_header_style),
    sp(2),
    bp("Treat chronic carriers with ciprofloxacin 750 mg BD x 4 weeks OR ampicillin"),
    bp("Cholecystectomy if gallstones present with carrier state"),
    bp("Food handlers must not work until declared free of infection"),
]

story.append(two_col(prev_left, prev_right))
story.append(sp(8))

# ════════════════════════════════════════════════════════════
# SECTION 8 - RED FLAGS
# ════════════════════════════════════════════════════════════
story.append(section_block("8.  RED FLAGS - ADMIT & ESCALATE", DARK_RED))
story.append(sp(4))

red_flag_data = [
    [
        [
            Paragraph("&#9888; IMMEDIATE CONCERN", alert_style),
            sp(3),
            bp("Sudden severe abdominal pain (perforation)"),
            bp("Haematemesis or melaena"),
            bp("Altered consciousness / delirium"),
            bp("Hypotension / shock"),
            bp("WBC < 2.0 × 10⁹/L (severe leukopenia)"),
        ],
        [
            Paragraph("&#9888; HIGH RISK FEATURES", alert_style),
            sp(3),
            bp("Fever persisting >10 days"),
            bp("Abdominal distension + rigidity"),
            bp("Splenomegaly (risk of rupture)"),
            bp("Jaundice (typhoid hepatitis/cholangitis)"),
            bp("Respiratory compromise (pneumonia)"),
        ],
        [
            Paragraph("&#9888; RESISTANT TYPHOID", S("rt", fontSize=9.5, fontName="Helvetica-Bold", textColor=ORANGE)),
            sp(3),
            bp("Nalidixic acid resistant = likely fluoroquinolone reduced susceptibility"),
            bp("MDR typhoid: resistant to chloramphenicol + ampicillin + TMP-SMX"),
            bp("XDR typhoid: MDR + fluoroquinolone + cephalosporin resistant"),
            bp("XDR: use <b>azithromycin</b> or <b>carbapenems</b>"),
        ],
    ]
]
rf_t = Table(red_flag_data, colWidths=[5.8*cm, 5.8*cm, 5.9*cm])
rf_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (0,0), colors.HexColor("#FFEBEE")),
    ("BACKGROUND",    (1,0), (1,0), colors.HexColor("#FFF8E1")),
    ("BACKGROUND",    (2,0), (2,0), colors.HexColor("#FFF3E0")),
    ("BOX",           (0,0), (-1,-1), 0.75, colors.HexColor("#BDBDBD")),
    ("INNERGRID",     (0,0), (-1,-1), 0.5, colors.HexColor("#BDBDBD")),
    ("TOPPADDING",    (0,0), (-1,-1), 8),
    ("BOTTOMPADDING", (0,0), (-1,-1), 8),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("RIGHTPADDING",  (0,0), (-1,-1), 8),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]))
story.append(rf_t)
story.append(sp(8))

# ════════════════════════════════════════════════════════════
# SECTION 9 - DIFFERENTIAL DIAGNOSIS
# ════════════════════════════════════════════════════════════
story.append(section_block("9.  DIFFERENTIAL DIAGNOSIS", colors.HexColor("#6A1B9A")))
story.append(sp(4))

diff_data = [
    [Paragraph("Condition", table_header_style),
     Paragraph("Distinguishing Features", table_header_style),
     Paragraph("Key Test", table_header_style)],
    [Paragraph("Malaria", table_cell_bold),
     Paragraph("Cyclic fever, rigors; travel to endemic area; splenomegaly", table_cell_style),
     Paragraph("Thick/thin blood film, RDT", table_cell_style)],
    [Paragraph("Dengue", table_cell_bold),
     Paragraph("Thrombocytopenia, petechiae, rash, bone pain, positive tourniquet test", table_cell_style),
     Paragraph("NS1Ag, IgM/IgG serology", table_cell_style)],
    [Paragraph("Viral hepatitis", table_cell_bold),
     Paragraph("Jaundice, very elevated LFTs, dark urine", table_cell_style),
     Paragraph("Hepatitis serology (HBsAg, anti-HCV)", table_cell_style)],
    [Paragraph("Brucellosis", table_cell_bold),
     Paragraph("Animal exposure, undulant fever, joint pain, lymphadenopathy", table_cell_style),
     Paragraph("Brucella serology, blood culture", table_cell_style)],
    [Paragraph("Tuberculosis", table_cell_bold),
     Paragraph("Prolonged cough, weight loss, night sweats; slower course", table_cell_style),
     Paragraph("CXR, sputum AFB, Gene Xpert", table_cell_style)],
    [Paragraph("Infective endocarditis", table_cell_bold),
     Paragraph("Heart murmur, Osler nodes, Janeway lesions, embolic phenomena", table_cell_style),
     Paragraph("Blood cultures x3, echocardiogram", table_cell_style)],
]
diff_t = Table(diff_data, colWidths=[4*cm, 9*cm, 4.5*cm])
diff_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), colors.HexColor("#6A1B9A")),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [colors.HexColor("#F3E5F5"), WHITE]),
    ("BOX",           (0,0), (-1,-1), 0.75, colors.HexColor("#BDBDBD")),
    ("INNERGRID",     (0,0), (-1,-1), 0.4, colors.HexColor("#E0E0E0")),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
]))
story.append(diff_t)
story.append(sp(10))

# ════════════════════════════════════════════════════════════
# FOOTER DISCLAIMER
# ════════════════════════════════════════════════════════════
disclaimer = Table([[
    Paragraph(
        "<b>Clinical Disclaimer:</b> This quick reference is for educational purposes only. "
        "All clinical decisions must be made by a qualified healthcare professional based on individual "
        "patient assessment, local antibiogram data, and current institutional guidelines. "
        "Drug doses shown are for average adults; adjust for renal/hepatic impairment, pregnancy, and paediatric patients. "
        "Sources: Tintinalli's Emergency Medicine, Sabiston Textbook of Surgery, Bailey & Love's Surgery, Goldman-Cecil Medicine.",
        S("disc", fontSize=7.5, fontName="Helvetica", textColor=GREY_MED, alignment=TA_JUSTIFY)
    )
]], colWidths=[17.5*cm])
disclaimer.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,-1), GREY_LIGHT),
    ("BOX",           (0,0), (-1,-1), 0.5, GREY_MED),
    ("TOPPADDING",    (0,0), (-1,-1), 6),
    ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("RIGHTPADDING",  (0,0), (-1,-1), 8),
]))
story.append(disclaimer)

# ── Build ────────────────────────────────────────────────────────────────────────
doc.build(story, onFirstPage=on_later_pages, onLaterPages=on_later_pages)
print(f"PDF saved: {OUTPUT_PATH}")

Running Command

cd /tmp/workspace/typhoid-pdf && python generate_typhoid_pdf.py 2>&1

Editing File

~/typhoid-pdf/generate_typhoid_pdf.py

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/typhoid-pdf/generate_typhoid_pdf.py'

Searching Content

"ROWBACKGROUNDS" in ~/typhoid-pdf

Reading File

Editing File

~/typhoid-pdf/generate_typhoid_pdf.py

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/typhoid-pdf/generate_typhoid_pdf.py'

Editing File

~/typhoid-pdf/generate_typhoid_pdf.py

Successfully replaced 1 instance(s) of the string in '/tmp/workspace/typhoid-pdf/generate_typhoid_pdf.py'

Running Command

cd /tmp/workspace/typhoid-pdf && python generate_typhoid_pdf.py 2>&1

Running Command

ls -lh /tmp/workspace/typhoid-pdf/Typhoid_Quick_Reference.pdf

Your PDF is ready for download:

Typhoid Quick Reference

PDF Document · PDF

What's inside the PDF:

Section	Content
At a Glance	Organism, transmission, incubation, mortality, endemic regions
Pathophysiology	Step-by-step from ingestion to Peyer's patch ulceration
Clinical Features by Week	Color-coded week-by-week progression table (rose spots, bradycardia, perforation risk)
Diagnosis	Blood/bone marrow/stool cultures, Widal interpretation table (with titer cutoffs), PCR, rapid tests - and their limitations
Management	Antibiotic table: azithromycin, ceftriaxone, ciprofloxacin, cefixime with doses, duration, and resistance notes; supportive care including dexamethasone indications
Complications	GI (perforation, haemorrhage) and systemic; surgical management criteria
Lab Patterns	WBC, lymphocytes, Hb, platelets, LFTs, Widal O vs H - what to expect
Red Flags	Three-column alert box: immediate danger signs, high-risk features, and MDR/XDR typhoid
Differential Diagnosis	Malaria, dengue, hepatitis, brucellosis, TB, endocarditis - distinguishing features and key tests
Prevention	ViPS, Ty21a, Vi-TT conjugate vaccines; carrier management

Sourced from Tintinalli's Emergency Medicine, Sabiston Textbook of Surgery, Bailey & Love's Surgery, and Goldman-Cecil Medicine.

This is a shared conversation. Sign in to Orris to start your own chat.