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Typhoid Fever

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					‘MARY’ KK UNDORU TYPHOID
       DIRECTED BY BHARATH PRAVEEN.V.S




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                             Dr.Praveen


    ing

MARY MALLON




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                 Mary Mallon
• Born 9-23-1869 in Cookstown, Ireland
• Emigrated to the US 1884, like many other Irish
  women of her generation
• Worked in a variety of domestic positions prior to
  settling into her career as a cook
• Worked for many wealthy families of Manhattan
• Carried the distinction of being the first “healthy
  carrier” of Typhoid Fever discovered in the US
• Spent 26 years in forced quarantine by the
  Department of Health, City of New York
• Lived in isolation in a cabin on North Brother Island,
                       Rykers Island
  near the Bronx and www.similima.com                    3
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               Typhoid Mary
• Mary Mallon’s nickname of “Typhoid Mary” has
  become synonymous with the spread of
  disease—it became such legend that she was
  “credited” with having infected hundreds,
  maybe thousands
• Was forced into quarantined on two separate
  occasions on North Brother Island for a total of
  26 years---without ever having been tried or
  convicted of any crime!
• Died—11-11-1938



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        TYPHOID
pathogen: Salmonella Typhi




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                 Organism
• Salmonella typhi, a Gram-negative bacteria.
• Similar but often less severe disease is caused
  by Salmonella serotype paratyphi A.
• Polysaccharide capsule Vi: present in about 90%
  of all freshly isolated S. typhi and has a
  protective effect against the bactericidal action
  of the serum of infected patients.




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            The Spread
• Solely a human disease
• Carrier has S. Typhi in blood &
  intestinal tract
• Shed the pathogen in stool
• Get disease from eating foods handled
  by someone who is shedding or
  infected sewage gets in the water used
  for drinking or washing food.
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          Pathogenesis
• Entry in GIT  localisation in Gut
  associated lymphoid tissue 
  Lymphatic channel  thoracic duct 
  circulation  primary silent
  bacteremia  localisation in
  macrophages of RES in spleen, liver,
  bone marrow (incubation period 8-14
  days)  secondary bacteremia
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                 Symptoms
•   Sustained fever as high as 103° to 104° F
•   Feel weak
•   Stomach pains
•   Headache
•   Loss of appetite
•   In some cases, patients have a rash of flat,
    rose-colored spots.


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  Acute non-complicated
         disease
Characterized by
   Prolonged fever,
   Disturbances of bowel function
   Headache, malaise and anorexia.
   Bronchitic cough
   Exanthem (rose spots), on the
chest, abdomen and back.
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       Complicated disease
• 10% of typhoid patients
• GIT: occult blood in 10-20% of patients, and
  malena in up to 3%. Intestinal perforation has
  also been reported in up to 3% of hospitalized
  cases.
• CNS: Encephalopathy, Typhoid meningitis,
  encephalomyelitis, Guillain-Barré syndrome,
  cranial or peripheral neuritis and psychotic
  symptoms
• Others: Hepatitis, myocarditis, pneumonia,
  disseminated intravascular
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        REALLY Knowing
 The only way to
 confirm a typhoid
fever diagnosis is to
  have the stool or
 blood tested for S.
       typhi.




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                   Widal Test
• O antibodies appear on days 6-8 and H antibodies on days
  10-12
• Negative in up to 30% of culture-proven cases of typhoid
  fever
• S. typhi shares O and H antigens with other Salmonella
  serotypes and has cross-reacting epitopes with other
  Enterobacteriacae, and this can lead to false-positive
  results. Such results may also occur in other clinical
  conditions, e.g. malaria, typhus, bacteraemia caused by
  other organisms, and cirrhosis
• This is acceptable so long as the results are interpreted
  with care in accordance with appropriate local cut-off
  values for the determination of positivity.

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      New serological test
• Specific antibodies usually only appear
  a week after the onset of symptoms
  and signs. This should kept in mind
  when a negative serological test result
  is being interpreted.
• New serological tests
  • IDL Tubex
  • Typhidot (better), high negative
    predictive value
  • Dipstick test,
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          Your Chances
• Fewer than 1% of patients who receive
  prompt treatment die
• The mortality rate is higher among the
  young and old and people who are
  suffering from malnutrition



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Treatment


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             MURPHY’S
• Fevers - TYPHOID, fever
• AGAR. APIS ARN. ARS. ARUM-T. BAPT.
  BELL. CALC. CARB-V. CHIN. CHLOR.
  COLCH. CROT-H. ECHI. GELS. HYOS.
  LACH. LYC. MERC-CY. MUR-AC. NIT-
  AC. OP. PH-AC. PHOS.RHUS-T.
  STRAM. SULPH. TER. VALER. VERAT.
  ZINC.
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           SYNTHESIS
• Fevers - TYPHOID, fever
• AGAR. APIS ARN. ARS. ARUM-T..
  BAPT. BELL. BRY. CALC. CARB-V.
  CHIN.. CHLOR. COLCH. CROT-H..
  ECHI.. FERR. GELS. HYOS. LACH..
  LYC.. MERC-CY.. MUR-AC. NIT-AC...
  OP.. PH-AC. PHOS.. RHUS-T..
  STRAM.. SULPH. TER.. VALER.
  VERAT. ZINC. www.similima.com       20
          COMPLETE
• Fevers - TYPHOID, fever
• AGAR. APIS ARN. ARS. ARUM-T.
  BAPT. BELL. BRY. CALC. CARB-V.
  CHIN.. CHLOR. COLCH. CROT-H.
  ECHI. FERR. GELS. HYOS. LACH..
  LYC. MERC-CY. MUR-AC. NIT-AC.
  OP.. PH-AC. PHOS. RHUS-T. STRAM.
  SULPH. TER. VALER. VERAT. ZINC.
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               PHATAK
• T - Typhoid
• ars. bapt. bell. Bry. kali-c. mur-ac. op.
  ph-ac. phos. pyrog. Rhus-t. sulph.
  tarax.




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                 KENT
• CONTINUED fever,typhus,typhoid
• Ars, arum-t, bapt, bry, carb-v, chin,
  chlor, colch, crot-h, echi, gels, hyos,
  lach, phos, rhus-t, stram




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               RISK AREA




Typhoid Fever is still common in the
  developing world. It affects about 21.5
  million people worldwide every year.
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             Prevention

• If it looks risky don’t eat or drink it!
• Get vaccinated!
• The vaccines wear off after a few
  years so you will probably have to get
  it multiple times.


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posted:11/4/2011
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