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Infects roughly 21.6 million people each year * International Estimate Ramsden AE, Mota LJ, Münter S, Shorte SL, Holden DW. The SPI-2 type III secretion system restricts motility of Salmonella-containing vacuoles. Cell
Kills 200,000 people each year * International Estimate Ramsden AE, Mota LJ, Münter S, Shorte SL, Holden DW. The SPI-2 type III secretion system restricts motility of Salmonella-containing vacuoles. Cell
62% of these occurring in Asia and 35% in Africa * International Estimate * Taylor TE, Strickland GT. Malaria. In: Strickland GT, ed. Hunter’s Tropical Medicine and Emerging Infectious Diseases. 8th ed. Philadelphia: WB Saunders, 2000:614-43.
Highest in Pakistan & India in Asian countries (451.7 per 100,000) * WHO Estimate * Bull World Health Organ vol.86 no.4 Genebra Apr. 2008
Bilateral Salmonella typhi breast abscess unmarried 35-year-old female without any predisposing conditions Singh S, Pandya Y, Rathod J, Trivedi S. Bilateral breast abscess: A rare complication of enteric fever. Indian J Med Microbiol [serial online] 2009 [cited 2009 Oct 16];27:69-70. Available from: http://www.ijmm.org/text.asp?2009/27/1/69/45176
Ileum especially distal ileum , jejunum usually does not perforate in typhoid, usually happens in the third week
MECHANISM OF INTESTINAL PERFORATION Intestinal peyer’s patches
2 or 3 weeks hx of disease, with suddenly worsening of pain & general conditions , Tenderness starts in his right lower quadrant, spreads and eventually becomes generalized, Guarding , (seldom the board-like rigidity) Erect film, shows gas Under diaphragm (50% positive) lateral decubitus film, shows gas under his abdominal wall The bradycardia and leucopenia of typhoid may occasionally mask the tachycardia and leucocytosis of peritonitis PRESENTATIN PERFORATION
If peritonitis seems to be localized , signs confined to only part abdomen, general condition is good , patient not deteriorating , consider non-operative treatment . If signs of generalized peritonitis, do a laparotomy CONSERVATIVE SURGICAL VS
“ Suck and drip” Resuscitation, antibiotics, pass a NG-tube, Monitor abdominal tenderness, pulse, temperature, white blood count. If any of these rise, suspect that peritonitis is extending, so take an erect X-ray film of his abdomen CONSERVATIVE MANAGEMENT
MDR-area MDR+NAR-area MEDICATION TREATMENT WHO RECOMMENDATIONS
Do not forget to cover anaerobes and gram negative bacteria along with salmonella
Operate as early as possible , Do as much as necessory & as little as possible SURGICAL MANAGEMENT PREPARATION Adequately resuscitate, Maintain good urine output, pass nasogastric tube down, Start chemotherapy.
*Agbakwuru EA, Adesunkanmi AR, Fadiora SO, Olayinka OS, Aderonmu AO, Ogundoyin OO et al A review of typhoid perforation in a rural African hospital. West African Journal of Medicine 2003; 22(1):22-25. (13 kb) Abstract only Surgery Steps
Occurs in 1-2% of cases *According to Indian study 8% More common in children Antibiotic resistance & virulence of bacteria *M.L. Kulkarni, SJ. Rego, Department of Pediatrics, J.J.M. Medical College, Davangere 577 004. Acute Acalculous Cholecystitis TYPHOID
*Thickened gall bladder wall, sonographic Murphy's sign, pericholicystic collection in the absence of gall stones *Subha Rao SD, LewinS, Shetty B, et al. Acute acalculous cholecystitis in typhoid fever. Indian Pediatr 1992, 29: 1431-1435. Acute Acalculous Cholecystitis TYPHOID
Unlike other AACs, antibiotic therapy is the recommended treatment for Typhoid AAC Acute Acalculous Cholecystitis TYPHOID
Chronic Cholecystitis (Carriers) TYPHOID Excretes bacteria in stools for more > 1 year1-4% of non-treated infected patients become chronic carriers Patients with cholelithiasis, biliary anomalies, females, Salmonella can be cultured from stools, duodenal aspirate, gall stones
Mary Mallon (September 23, 1869 – November 11, 1938) Forcibly quarantined twice, she infected 47 people , three of whom died . She died in quarantine.
Good food handling & water sewage treatment can eliminate typhoid Prompt anntibiotic therapy can save many lives—take it a serious job Severe vomiting, diarrhoea & abdominal distension--- complicated, admit them & give IV antibiotics and support Prognosis of complications depends on the time-lapse b/w onset & treatment TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications take home message killer salmonella formidable