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Typhoid Fever

Typhoid Fever. Dept. Infectious Disease 2nd Affiliated Hospital CMU. Definition. Typhoid fever is an acute infectious disease of digestive tract caused by typhoid bacillus. Place of lesson lymphatics in the terminal ileum

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Typhoid Fever

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

  2. Definition • Typhoid fever is an acute infectious disease of digestive tract caused by typhoid bacillus. • Place of lessonlymphatics in the terminal ileum • Pathological feature proliferation of large mononuclear cells derived from MPS

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

  4. Etiology • Causative organism: Typhoid bacillus • genus salmonella group D • Pathogenicity: endotoxin • Resistance: Stable in environment, sensitive to heat, acid, common disinfectants

  5. Etiology • Antigenicity: • O antigen: lipopolysaccharide • group-special • H antigen: protein, strain-special • Vi antigen: polysaccharide

  6. 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

  7. 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

  8. Pathology • Proliferation of large mononuclear cell • 1st week 2nd 3rd week 4th week • proliferation necrosis heal • edema ulceration no scar

  9. Clinical manifestation Incubation period:7-23 day(average 10 to 14 days) Typical typhoid fever: • Initial period • Fastigium • Defervescence • Convalescence

  10. Clinical manifestation • Initial period • onset: insidious, gradual • fever: T stepwise fashion rising • non-special symptoms:

  11. 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

  12. Clinical manifestation • Fastigium • rose-colored rash: • erythematous macules or papules • occur on 6~13 days • upper abdomen • hepatomegaly and splenomegaly

  13. Clinical manifestation • Devervescence • Convalescence

  14. Clinical manifestation • Clinical type: • Mild type • common type • prolonged type, • ambulatory type • fulminate type

  15. 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.

  16. Complications • Intestinal hemorrhage • Intestinal perforation • Toxic hepatitis and myocarditis • Pneumonia

  17. Laboratory Findings • Blood picture: leukopenia • Bacteria culture: • blood • bone morrow • urine and stool

  18. Laboratory Findings • Widal test: • agglutination of serum reaction • 5 Ag: “O” “H”, “HABC” • titer:O>=1:80 H>=1:160 • results analysis:

  19. Diagnosis • Epidemiological data • Clinical manifestation • Laboratory findings • Definitive diagnosis: bacteria culture positive

  20. Differential Diagnosis • Typhus • rickettsises • malaria • disseminated TB

  21. Treatment • General therapy • Etiologic therapy • guinolone: first choice • cephalosporins: 2nd and 3rd generation • chloromycetin

  22. Prevention • Control of source of infection: • isolation • Interruption of route of transmission • Protection of susceptible population : Vaccinated with vaccine

  23. Paratyphoid • Paratyphoid A & B are the same as typhoid fever • Paratyphoid C: septics or gastro-interitis

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