Post on 17-Jan-2016
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Typhoid Fever
Dept. Infectious Disease
2nd Affiliated Hospital
CMU
Definition
Typhoid fever is an acute infectious disease of di
gestive tract caused by typhoid bacillus.
Place of lesson lymphatics in the terminal ileum
Pathological feature proliferation of large m
ononuclear cells derived from MPS
Definition Clinical feature sustained fever relative slow pulse toxic symptoms a rose-color rash splenomegaly and hepatomegaly leukopenia Complication hemorrhage & perforation
Etiology Causative organism: Typhoid bacillus
genus salmonella group D
Pathogenicity: endotoxin
Resistance: Stable in environment, sensitive to hea
t, acid, common disinfectants
Etiology Antigenicity:
O antigen: lipopolysaccharide group-special H antigen: protein, strain-special Vi antigen: polysaccharide
Epidemiology Source of infection Patient, Carrier, shed bacteria in feces Route of transmission Fecal-oral route:
contaminated food or water contagious spread spread by insect
Susceptibility Epidemic features sporadic cases high incidence in fall & summer
Pathogenesis Bacillus Stomach killed by gastric acid incubation 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 lymphotics Clinical symptoms absces inflammation
Pathology Proliferation of large mononuclear cell
1st week 2nd 3rd week 4th week proliferation necrosis heal edema ulceration no scar
Clinical manifestationIncubation period: 7-23 day(average 10 to
14 days)
Typical typhoid fever: Initial period Fastigium Defervescence Convalescence
Clinical manifestation Initial period
onset: insidious, gradual fever: T stepwise fashion rising non-special symptoms:
Clinical manifestation Fastigium
sustained fever toxic symptoms:
NS apathy, tinnitus, delirium,lethargy, coma DS anorexia, abdominal Pain, diarrhea Constipation CS relative slow pulse, bradycardia, myocarditis
Clinical manifestation Fastigium
rose-colored rash: erythematous macules or papules occur on 6~13 days upper abdomen
hepatomegaly and splenomegaly
Clinical manifestation Devervescence Convalescence
Clinical manifestation Clinical type:
Mild type common type prolonged type, ambulatory type fulminate type
Clinical manifestation Relapse: 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.
Complications Intestinal hemorrhage Intestinal perforation Toxic hepatitis and myocarditis Pneumonia
Laboratory Findings Blood picture: leukopenia Bacteria culture:
blood bone morrow urine and stool
Laboratory Findings Widal test: agglutination of serum reaction 5 Ag: “O” “H”, “HABC”
titer:O>=1:80 H>=1:160 results analysis:
Diagnosis Epidemiological data Clinical manifestation Laboratory findings Definitive diagnosis: bacteria culture
positive
Differential Diagnosis Typhus rickettsises malaria disseminated TB
Treatment General therapy Etiologic therapy
guinolone: first choice cephalosporins: 2nd and 3rd generation chloromycetin
Prevention Control of source of infection: isolation Interruption of route of
transmission Protection of susceptible
population : Vaccinated with vaccine
Paratyphoid Paratyphoid A & B are the same as typhoid
fever Paratyphoid C: septics or gastro-interitis