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salmonella. Pathogenesis. PATHOGENICITY OF SALMONELLAE. Clinical syndromes caused by Salmonellae in human beings: A. Enteric fever B. Gastroenteritis (food poisoning) C. Salmonella septicemia. ENTERIC FEVER.
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salmonella Pathogenesis..
PATHOGENICITY OF SALMONELLAE • Clinical syndromes caused by Salmonellae in human beings: A. Enteric fever B. Gastroenteritis (food poisoning) C. Salmonella septicemia
ENTERIC FEVER • The term ENTERIC FEVER includes 1. TYPHOID FEVER – caused by S typhi 2. PARATYPHOID FEVER – caused by S paratyphi A, B & C
Contd.. • Enteric fever is endemic in all over India. • With a proportion of TYPHOID to PARATYPHOID A about 10 : 1. • Paratyphoid B is rare andParatyphoid C is very rare.
Typhoid Fever • Typhoid fever, also known as typhoid • Other names:abdominal typhus, infantile remittant fever, slow fever, nervous fever, pythogenic fever, etc.
Contd.. • Typhosin Greek means, smoke and typhus fever got its name from smoke that was believed to cause it. • Typhoid means typhus-like and thus the name given to this disease. • The term Typhoid was given by Louis (1829) to distinguish it from typhus fever. • Eberth described the typhoid bacillus in spleen sections and mesenteric lymph nodes from a patient who died from typhoid and Gaffky isolated it in pure cultures.
Electron microscopy SALMONELLA
Contd.. • Source : Case of Typhoid or carriers in frequent. • Infective material : Contaminated food or water. • Route of infection : Ingestion of contaminated food or water.
Carrier state.. • CARRIERS are more important in the transmission of the disease. • Types of carriers: 1. Convalescent carriers 2. Temporary carriers 3. Chronic carriers • Convalescent carriers shed bacilli in feces for 3 WEEKS to 3 MONTHS after clinical cure. • Temporary carriersshed bacilli for more than 3 MONTHS but less than A YEAR. • Chronic carriers shed bacilli for over A YEAR.
Contd.. • 2-4 % of patients become Chronic carriers, esp. women over 40yrs. • Food handlers or cooks that become carriers are particularly dangerous. • The best known example was Mary Mallon, named for nick as TYPHOID MARY. • She caused at least 7 outbreaks in 15 yrs affecting over 200 people.
in a 1909 newspaper illustration Mary Mallon
Pathogenesis • Median Infective Dose (ID50) is about 1 000 to 1 000 000 bacilli in human volunteers. • The course of organism in the body is as follows.
Clinical Course.. • Incubation period is usually 7-14 days, but may range 3-56 days according to dose of infection. • Clinical course: From Mild Undifferentiated Pyrexia (AMBULANT TYPHOID) Rapidly fatal disease
Clinical features.. • Gradual Onset of head ache malaise anorexia • Typical features: Step ladder pyrexia Relative bradycardia Toxemia
Contd.. • A soft, palpable spleen is a constant finding • Hepatomegaly is also common • Rose spots that fade on pressure appear on skin during 2nd or 3rd week.
Bile is a good culture medium for the bacillus, it multiplies abundantly in GALL BLADDER INTESTINES involves the PAYERS PATCHES LYMPHOID FOLLICLES
Complications of the disease • Intestinal perforation • Hemorrhage • Circulatory collapse • Bronchitis or Bronchopneumonia is always found. • Psychoses • Meningitis • Cholecystitis • Arthritis • Abscesses
Contd.. • Periostitis • Nephritis • Hemolytic anemia • Venous thromboses • Peripheral neuritis • Osteomyelitis is rare sequel.
Convalescence & Relapse • Convalescence is slow • In 5-10% of cases relapse occurs during convalscence • Relapse rate is higher in patients treated early with Chloramphenicol.
Paratyphoid fever • Resembles typhoid fever but is generally milder • Caused by S. paratyphi A and B, rarely by S. paratyphi C which is often associated with frank septicemia in supporative complications.
Salmonella Gastroenteritis • Food poisoning. • Zoonotic disease. • Caused by any Salmonella except S. typhi. Pathogenic Species: 1. S typhimurium(most common) 2. S enteritidis
Pathogenesis • Source: Poultry, Meat, Milk and its products, esp., Eggs and its products (as the bacteria can enter through the shell if eggs are contaminated and grow inside), uncooked vegetables. • Route: Ingestion • Gastroenteritis may occur without food poisoning as in cross infection in hospitals.
Clinically.. • Short incubation period of 24hrs or less. • Featured by Diarrhea, Vomiting, Abdominal pain, Fever. • Diarrhea: May vary from one or more loose stools to an acute Cholera like • Usually subsides in 2-4 days resembles and dysentery.
Salmonella Septicemia • Caused by: S choleraesuis • Focal supporative lesions: Osteomyelitiss, Deep abscesses, Endocarditis, Pneumonia, Meningitis.