TYPHOID FEVER_1_

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					TYPHOID FEVER

Also known enteric fever
Systemic illness
Caused by
    salmonella typhi
    salmonella paratyphi (less virulent)

Transmission
    fecal-oral transmission
    S typhi shed in stools and then ingested
    Contaminated food drinks and water
    More common in developing nations-related to poor sanitation

Highest risk of infection is in children 1-5 years
    Maternal antibodies are waning at this age
    Immune system not well developed

Incubation period
    Depends on size of infecting dose(more organism cause smaller IP)
    Children – 3-4 days
    Adults 7-14 days

Symptoms
    Sustained fever (39-40 degrees)
    Severe headache (common in adults)
    Dry cough
    Malaise
    Rash (rose spots)erythematous, maculopapular, appear on the lower chest and
      abdomen, occur in a third of the patients.
    Loss of appetite
    Bloody stools
    Constipation initially, then diarrhea
    Abdominal pain
    Delirium (typhoid state)

Signs
       weak lethargic and dehydrated
       relative bradycardia (high temp with around normal pulse)
       abdomen distended and right lower quadrant tenderness
       borborygmi (hyperactive bowel sounds)
       hepatosplenomegaly
       maculopapular rash over chest and abdomen
       diarrhea- foul smelling and greenish yellow (pea soup diarrhea)
Pathophysiology
The host sheds S. typhi in feces which contaminates food and water. This is ingested and
once in the GIT, S. typhi is absorbed into the blood. It then moves into the
reticuloendothelial system ( liver, spleen, lymph nodes, peyers patches) where it
multiplies. This leads to:
      hyperplasia of peyers patches causing mechanical obstruction thus constipation.
      Necrosis of the wall of GIT can lead to ulcer formation and haemorrhage( bloody
         stool)
      Infection in RE system causes release of cytokines which causes fever.
      Hepatosplenomegaly
      S. typhi from blood and liver enter bile ( cholecystitis) and secreted into GIT,
         which is then shed in stool
      S.typhi in GIT gets phagocytosed by guts inluminal dendritic cells causing
         inflammation and diarrhea.

Diagnosis
    Based on blood and stool culture (isolate organism).
    Gram negative, flagellate, nonsporing, facultative non aerobic bacilli.

Prevention
    Avoid risky food and drinks.
    Get vaccinated against typhoid.
“Boil it, Cook it, Peel it, or forget it”

Treatment
     Antibiotic
Chloremphenicol- 25mg/kg (8 hourly) for 14 days.
If response poor
     1. add Ampicillin
     2. 3rd generation Cephalosporin (ceftriaxone & ciprofloxacin).

Prognosis
Prompt treatment with antibiotics- 1% fertility
If untreated, usually last 4 weeks, recur later- 10-20% mortality.

Complications
Meningitis
Cholecystitis

Notes
Widals test- test for antibodies against S. Typhi. No longer used because of high
incidence of false negative.
Typhoid Mary- first known human carrier.

Abhitesh Raj
S040307 MBBS 4

				
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