Typhoid Fever Dept. Infectious Disease 2nd Affiliated Hospital CMU

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<ul><li><p>Typhoid FeverDept. Infectious Disease2nd Affiliated HospitalCMU</p></li><li><p> DefinitionTyphoid fever is an acute infectious disease of digestive tract caused by typhoid bacillus.Place of lesson lymphatics in the terminal ileumPathological feature proliferation of large mononuclear cells derived from MPS</p></li><li><p> DefinitionClinical feature sustained fever relative slow pulse toxic symptoms a rose-color rash splenomegaly and hepatomegaly leukopenia Complication hemorrhage &amp; perforation </p></li><li><p> EtiologyCausative organism: Typhoid bacillus genus salmonella group DPathogenicity: endotoxinResistance: Stable in environment, sensitive to heat, acid, common disinfectants</p></li><li><p> EtiologyAntigenicity:O antigen: lipopolysaccharide group-specialH antigen: protein, strain-specialVi antigen: polysaccharide </p></li><li><p>EpidemiologySource of infection Patient, Carrier, shed bacteria in fecesRoute of transmission Fecal-oral route:contaminated food or watercontagious spread spread by insectSusceptibility Epidemic features sporadic cases high incidence in fall &amp; summer </p></li><li><p>Pathogenesis Bacillus Stomach killed by gastric acidincubation Small intestine penetrate mucosa period Regional lymphatics Blood stream - first bacteremia initial MPS in liver, spleen, bone marrow Blood stream -second bacteremia endotoxin liver spleen regional lymphoticsClinical symptoms absces inflammation</p></li><li><p> PathologyProliferation of large mononuclear cell</p><p> 1st week 2nd 3rd week 4th weekproliferation necrosis heal edema ulceration no scar</p></li><li><p> Clinical manifestationIncubation period: 7-23 day(average 10 to 14 days)Typical typhoid fever:Initial periodFastigiumDefervescenceConvalescence</p></li><li><p>Clinical manifestationInitial periodonset: insidious, gradualfever: T stepwise fashion risingnon-special symptoms:</p></li><li><p>Clinical manifestationFastigiumsustained fevertoxic symptoms: NS apathy, tinnitus, delirium,lethargy, coma DS anorexia, abdominal Pain, diarrhea Constipation CS relative slow pulse, bradycardia, myocarditis</p></li><li><p>Clinical manifestationFastigiumrose-colored rash: erythematous macules or papules occur on 6~13 days upper abdomenhepatomegaly and splenomegaly</p></li><li><p>Clinical manifestationDevervescenceConvalescence</p></li><li><p>Clinical manifestationClinical type:Mild typecommon typeprolonged type,ambulatory typefulminate type </p></li><li><p>Clinical manifestationRelapse: It occur 1~3week after T has reached normal. The illness follows a similar pattern to the primary attach. Blood culture positive.Recurrence: It occur 3~4 after the illness. T begin to fall, then rise again. Blood culture positive.</p></li><li><p>ComplicationsIntestinal hemorrhageIntestinal perforationToxic hepatitis and myocarditisPneumonia </p></li><li><p>Laboratory FindingsBlood picture: leukopenia Bacteria culture: blood bone morrow urine and stool</p></li><li><p>Laboratory FindingsWidal test: agglutination of serum reaction 5 Ag: O H, HABC titer:O&gt;=1:80 H&gt;=1:160 results analysis:</p></li><li><p> DiagnosisEpidemiological dataClinical manifestationLaboratory findingsDefinitive diagnosis: bacteria culture positive</p></li><li><p> Differential DiagnosisTyphusrickettsisesmalariadisseminated TB</p></li><li><p> TreatmentGeneral therapyEtiologic therapyguinolone: first choicecephalosporins: 2nd and 3rd generationchloromycetin</p></li><li><p>PreventionControl of source of infection:isolationInterruption of route of transmissionProtection of susceptible population : Vaccinated with vaccine </p></li><li><p>ParatyphoidParatyphoid A &amp; B are the same as typhoid feverParatyphoid C: septics or gastro-interitis</p></li></ul>