Typhoid Fever Dept. Infectious Disease 2nd Affiliated Hospital CMU.

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    17-Jan-2016

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  • Typhoid FeverDept. Infectious Disease2nd Affiliated HospitalCMU

  • 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

  • DefinitionClinical feature sustained fever relative slow pulse toxic symptoms a rose-color rash splenomegaly and hepatomegaly leukopenia Complication hemorrhage & perforation

  • EtiologyCausative organism: Typhoid bacillus genus salmonella group DPathogenicity: endotoxinResistance: Stable in environment, sensitive to heat, acid, common disinfectants

  • EtiologyAntigenicity:O antigen: lipopolysaccharide group-specialH antigen: protein, strain-specialVi antigen: polysaccharide

  • 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 & summer

  • 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

  • PathologyProliferation of large mononuclear cell

    1st week 2nd 3rd week 4th weekproliferation necrosis heal edema ulceration no scar

  • Clinical manifestationIncubation period: 7-23 day(average 10 to 14 days)Typical typhoid fever:Initial periodFastigiumDefervescenceConvalescence

  • Clinical manifestationInitial periodonset: insidious, gradualfever: T stepwise fashion risingnon-special symptoms:

  • Clinical manifestationFastigiumsustained fevertoxic symptoms: NS apathy, tinnitus, delirium,lethargy, coma DS anorexia, abdominal Pain, diarrhea Constipation CS relative slow pulse, bradycardia, myocarditis

  • Clinical manifestationFastigiumrose-colored rash: erythematous macules or papules occur on 6~13 days upper abdomenhepatomegaly and splenomegaly

  • Clinical manifestationDevervescenceConvalescence

  • Clinical manifestationClinical type:Mild typecommon typeprolonged type,ambulatory typefulminate type

  • 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.

  • ComplicationsIntestinal hemorrhageIntestinal perforationToxic hepatitis and myocarditisPneumonia

  • Laboratory FindingsBlood picture: leukopenia Bacteria culture: blood bone morrow urine and stool

  • Laboratory FindingsWidal test: agglutination of serum reaction 5 Ag: O H, HABC titer:O>=1:80 H>=1:160 results analysis:

  • DiagnosisEpidemiological dataClinical manifestationLaboratory findingsDefinitive diagnosis: bacteria culture positive

  • Differential DiagnosisTyphusrickettsisesmalariadisseminated TB

  • TreatmentGeneral therapyEtiologic therapyguinolone: first choicecephalosporins: 2nd and 3rd generationchloromycetin

  • PreventionControl of source of infection:isolationInterruption of route of transmissionProtection of susceptible population : Vaccinated with vaccine

  • ParatyphoidParatyphoid A & B are the same as typhoid feverParatyphoid C: septics or gastro-interitis

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