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Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
Typhoid fever
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Typhoid fever

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  • 1. TYPHOID FEVER
  • 2. Definition of Typhoid fever
    • Acute enteric infectious disease
    • caused by Salmonella typhi (S.Typhi).
    • prolonged fever, Relative bradycardia, apathetic facial expressions, roseola, splenomegaly, hepatomegaly, leukopenia.
    • intestinal perforation, intestinal hemorrhage
  • 3. Etiology
    • Serotype: D group of Salmonella
    • Gram-negative
    • rod
    • non-spore
    • flagella
    • Culture characteristics
  • 4.
    • Antigens: located in the cell capsule
    • H (flagellar antigen).
    • O (Somatic or cell wall antigen).
    • Vi (polysaccharide virulence)
    • “ widel test”
  • 5. A schematic diagram of a single Salmonella typhi cell showing the locations of the H (flagellar), 0 (somatic), and Vi (K envelope) antigens.
  • 6.
    • Endotoxin
    • A variety of plasmids
    • Resistance: Live 2-3 weeks in water. 1-2 months in stool. Die out quickly in summer
    • Resistance to drying and cooling
  • 7. Epidemiology
    • continues to be a global health problem
    • areas with a high incidence include Asia, Africa and Latin America
    • affects about 6000000 people with more than 600000 deaths a year. 80% in Asia .
    • sporadic occur usually, sometimes have epidemic outbreaks.
  • 8.  
  • 9. Transmission
    • fecal-oral route
    • close contact with patients or carriers
    • contaminated water and food
    • flies and cockroaches.
  • 10.  
  • 11. Susceptibility and immunity
    • all people equally susceptible to infection
    • acquired immunity can keep longer, reinfection are rare
    • immunity is not associated with antibody level of “H”, “O”and “VI”.
    • No cross immunity between typhoid and paratyphoid
  • 12.
    • All seasons, usually in summer and autumn.
    • Most cases in school-age children and young adults.
    • both sexes equally susceptible
  • 13. Major findings in lower ileum
    • Hyperplasia stage(1st week):
    • swelling lymphoid tissue and proliferation of macrophages.
    • Necrosis stage(2nd week):
    • necrosis of swelling lymph nodes or solitary follicles.
    • Ulceration stage(3rd week):
    • shedding of necrosis tissue and formation of ulcer ----- intestinal hemorrhage, perforation .
    • Stage of healing (from 4th week):
    • healing of ulcer, no cicatrices and
  • 14. Clinical manifestations
    • Incubation period: 3 ~ 60 days(7 ~ 14).
    • The initial period (early stage)
    • First week.
    • Insidious onset.
    • Fever up to 39~40 0 C in 5~7 days
    • chills 、 ailment 、 tired 、 sore throat 、 cough ,abdominal discomfort and constipation et al.
  • 15. The fastigium stage
    • second and third weeks.
    • Sustained high fever 、 partly remittent fever or irregular fever. Last 10 ~ 14 days.
    • Gastro-intestinal symptoms: anorexia 、 abdominal distension or pain 、 diarrhea or constipation
    • Neuropsychiatric manifestations: confusion 、 blunt respond even delirium and coma or meningism
  • 16.
    • Circulation system :
    • relative bradycardia or dicrotic pulse.
    • splenomegaly 、 hepatomegaly
    • toxic hepatitis.
    • roseola :30%, maculopapular rash
    • a faint pale color, slightly raised
    • round or lenticular, fade on pressure
    • 2-4 mm in diameter, less than 10 in number
    • on the trunk, disappear in 2-3 days.
  • 17.
    • fatal complications:
    • intestinal hemorrhage
    • intestinal perforation
    • severe toxemia
  • 18. Diagnosis
    • Epidemiology data
    • Typical symptoms and signs
    • Laboratory findings.
  • 19. TREATMENT
    • General treatment
    • isolation and rest
    • good nursing care and supportive treatment
    • close observation T,P,R,BP,abdominal condition and stool .
    • suitable diet include easy digested food or half-liquid food.drink more water
    • intravenous injection to maintain water and acid-base and electrolyte balance
  • 20.
    • Symptomatic treatment:
    • for high fever:
    • physical measures firstly
    • antipyretic drugs such as aspirin should be administrated with caution
    • delirium,coma or shock,2-4mg dexamethasone in addition to antibiotics reduces mortality.
  • 21.
    • Etiologic and special treatment
    • 1.Quinolones:
    • first choice
    • it’s highly against S.typhi
    • penetrate well into macrophages,and achieve high concentrations in the bowel and bile lumens
    • Norfloxacin (0.1 ~ 0.2 tid ~ qid/10 ~ 14 days).
    • Ofloxacin (0.2 tid 10 ~ 14days).
    • ciprofloxacin (0.25 tid)
    • caution: not in children and pregnant
  • 22.
    • 2.Chloramphenicol:
    • For cases without multiresistant S.typhi.
    • Children in dose of 50 ~ 60mg/kg/per day.
    • adult 1.5 ~ 2g/day. tid.
    • Unable to take oral medication, the same dosage given introvenously
    • after defervescence reduced to a half. complete a 10 ~ 14 day course.
    • But ,drug resistance, a high relapse rate,bone marrow toxicity.
  • 23.
    • 3.Cephalosporines:
    • Only third generation effective
    • Cefoperazone and Ceftazidime.
    • 2 ~ 4g/day .10~14 days.
    • 4.Treatment of complication.
    • Intestinal bleeding:
    • bed rest, stop diet,close observation T,P,R,BP.
    • intravenous saline and blood transfusion,and attention to acid-base balances.
    • sometimes,operative.
  • 24.
    • Perforation:
    • early diagnosis.
    • stop diet.
    • decrease down the stomach pressure.
    • intravenous injection to maintain electrolyte and acid-base balances.
    • use of antibiotics.
    • sometimes operative.
  • 25.
    • Toxic myocarditis:
    • bed rest, cardiac muscle protection drugs,
    • dexamethasone, digoxin.
    • 5.Chronic carrier:
    • Ofloxacin 0.2 bid or ciprofloxacin 0.5 bid, 4 ~ 6 weeks.
    • Ampicillin 3 ~ 6g/day tid plus probenecid 1 ~ 1.5g/day. 4 ~ 6 weeks.
    • TMP+SMZ 2 tabs. Bid. 1 ~ 3 months.
    • Cholecystitis may require cholecystectomy.

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