Transcript Typhoid Fever

TYPHOID FEVER
AL-ABBASI A.M.
PhD, FRCP, DCN, DTM&H
Professor of Infectious Diseases & Clinical
Immunology
Salmonella groups
ENTEERIC GROUP
S.typhi, Sparatyphi, A, B & C
ENTERIC LIKE ILLNESS
S. enteritidis, S.cholerisuis, S.typhimurium
Salmonella food poisoning
Hundreds species
Typhoid fever
gastric fever, abdominal typhus, infantile
remittent fever, slow fever, nervous fever and
pythogenic fever.
Typhoid means "resembling typhus" and comes
from the neuropsychiatric symptoms common to
typhoid and typhus.
Typhoid: putrid malignant fever.
Typhus: slow nervous fever.
H i s t o r y
430–424 BC, a devastating plague killed one third of the
population of Athens.
During the American Civil War, 81,360 Union soldiers
of typhoid or dysentery.
died
Mary Mallon, typhoid Mary in New York.
Several outbreaks in Scotland and Croyden in the UK.
An outbreak in the Democratic Republic of Congo in 2004–05
recorded more than 42,000 cases and 214 deaths.
T r a n s m i s s i o n
The bacterium spreads through poor hygiene habits and public
sanitation conditions, flying insects feeding on feces.
According to statistics from the United States, (CDC),
the chlorination of drinking water has led to dramatic
decreases in the transmission of typhoid fever in the
U.S.A.
Carriers are the usual reservoirs of TF.
Cystic fibrosis has heterozygous advantage that it confers
against typhoid fever.
C l
i n i c a l p i c t u r e
? 4 weeks course?
Fever characteristic.
Relative Bradycardia in first week.
leukopenia with eosinopenia
Delirium, typhoid status
Distended and painful abdomen in
the right lower quadrant, where
borborygmi can be heard.
Rose spots
Hepatosplenomegaly, painful;
Pneumotyphoid
Typhoid Fever (Rose
Spots) on chest and
upper abdomen
Traditional Medicine
C o m p l
i c a t
i o n s
In the third week of typhoid fever, complications can occur:
Intestinal hemorrhage due to bleeding in
congested Peyer's patches; this can be very
serious but is usually not fatal.
Intestinal perforation in the distal ileum: this is a
very serious complication and is frequently fatal.
It may occur without alarming symptoms
until septicaemia or diffuse peritonitis sets in.
Encephalopathy.
Neuropsychiatric symptoms "muttering delirium" or "coma
vigil"), with picking at bedclothes or imaginary objects.
Metastatic
abscesses, cholecystitis, endocarditis and osteitis
The fever is still very high and oscillates very little over 24
hours.
Dehydration ensues, and the patient is delirious (typhoid
state).
One third of affected individuals develop a macular rash on
the trunk.
By the end of third week, the fever starts subsiding
(defervescence).
Widal test
The Widal test is a
presumptive serological test
for enteric fever or undulant
fever.
whereby bacteria causing typhoid
fever are mixed with serum
containing specific antibodies
obtained from an infected
individual.
Agglutination occurs.
BUT???
T r e a t m e n t
oral rehydration therapy
ciprofloxacin
ceftriaxone or cefotaxime is the first choice
azithromycin is better at treating typhoid in resistant
populations than both fluoroquinolone drugs and
ceftriaxone.
Resistance to ampicillin, chloramphenicol, trimethoprimsulfamethoxazole, is now common, not used as first–line
treatment for almost twenty years.
Salmonellosis
Nontyphoidal Salmonella, contracted from:
Poultry, pork, and beef, if the meat is prepared incorrectly
or is infected with the bacteria after preparation
Infected eggs, egg products, and milk when not prepared,
handled, or refrigerated properly.
Reptiles, such as turtles, lizards, and snakes, which may
carry the bacteria in their intestines.
Tainted fruits and vegetables.
Symptoms
IP =12 to 72 hours after ingesting the bacterium.
Symptoms are usually gastrointestinal, nausea, vomiting,
abdominal cramps, bloody diarrhea with mucus.
Headache, fatigue, and rose spots are also possible.
Symptoms can be severe, especially in young children and
the elderly.
Osteomyelitis in sickle-cell anemia patients.
Reactive arthritis (Reiters syndrome).