Exam Focus Points

Enteric Fever

• Bone marrow culture (90%) is the most sensitive diagnostic test — frequently asked
• Widal test is not recommended — understand why (false positives, endemic population)
• Rose spots appear in ~30% of children (not <5% as with adults)
• Dactylitis is a pediatric-specific feature
• Relative bradycardia is NOT discriminating in children
• XDR typhoid → azithromycin (oral/uncomplicated) or carbapenems (IV/severe)
• TCV (typhoid conjugate vaccine) is effective from infancy — key advantage over unconjugated vaccines
• Corticosteroids for severe disease: dexamethasone 3 mg/kg IV, then 1 mg/kg q6h × 48 h

Pediatric TB

• Children rarely develop cavitary disease (unlike adults) — a high-yield differentiator
• Children <12 months with any suspected TB → always do LP
• Gastric aspirate × 3 mornings is the specimen of choice in children with non-productive cough
• TST cutoffs: ≥5 mm (high-risk), ≥10 mm (moderate risk), ≥15 mm (low risk)
• BCG does NOT affect IGRA results (ESAT-6/CFP-10 not in BCG)
• M. bovis = always pyrazinamide resistant → treat with HRE only, 9 months
• BCG vaccine protects strongly against miliary TB and TB meningitis in children (~80%)