Typhoid & c holera zaim


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Typhoid & c holera zaim

  1. 1. Typhoid & CHolera Akmal Zaim B Mohd Noor 1010355 Dr Taufiq
  2. 2. TYPHOID Salmonella enterica serotype Typhi (SalmonellaTyphi) A gram-negative bacterium Others: S. Paratyphi A, S. Paratyphi B
  3. 3. Thyphoid  also known as typhoid fever  Typhoid fever occurs worldwide  About 21.7 million typhoid cases every year with high prevalence in Asian continence (Nelson textbook of paediatrics 18th edition)  transmitted by the ingestion of food or water contaminated with the feces of an infected person  which contain the bacterium Salmonella typhi, serotype Typhi.
  4. 4. epidemiology  World Health Organization identifies typhoid as a serious public health problem.  Its incidence is highest in children and young adults between 5 and 19 years old
  5. 5. SIGNS & SYMPTOMS  4 stages – each stages lasts for a week  1st week  Asymptomatic  Temperature rises slowly + fever fluctuations  Relative Bradycardia  Malaise + headache + cough  bloody nose (Epistaxis) is seen in a quarter of cases  Abdominal pain is also possible.  Leukopenia with eosinopenia and relative lymphocytosis  Adult – constipation, Child and HIV infected - diarrhoea
  6. 6. SIGNS & SYMPTOMS  2nd week –  High fever in plateau around 40 °C (104 °F) (Step ladder fever)  Rose spots appear on the lower chest and abdomen (in around a third of patients)  Bradycardia  Delirium is frequent, frequently calm, but sometimes agitated.  Rhonchi in lung bases.  abdomen is distended and painful in the right lower quadrant  Diarrhea : six to eight stools in a day, green with a characteristic smell, comparable to pea soup. Constipation is also frequent.  Hepatomegaly, Splenomegaly + tender ~ there is elevation of liver transaminases.  Widal test is strongly positive with antiO and antiH antibodies.
  7. 7. Rose Spots
  8. 8. SIGNS & SYMPTOMS  3rd week – complications 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.  Encephalitis  Neuropsychiatric symptoms, with picking at bedclothes or imaginary objects.  Metastatic abscesses, cholecystitis, endocarditis and osteitis  Lie motionless and exhausted with your eyes half-closed 4th week – fever subsides
  9. 9. Transmission  Hand-to-mouth transmission + Oral transmission  poor hygiene habits and public sanitation conditions  flying insects feeding on feces  asymptomatic carrier of typhoid fever, suffering no symptoms, but capable of infecting others
  10. 10. Mode of transmission Contaminated food and water Food handled by carrier Contaminated toilet
  11. 11. Diagnosis  Blood culture: Positive in 40-60%  Bone Marrow culture – gold standard and sensitive, specific  Stool and urine cultures:  Widal test - Antibody against antigen O & H of S.Typhi  Blood count Leucocytosis (20,000-25,000/ mm3),thrombocytopenia Blood or stool cultures and with the Widal test  (demonstration of salmonella antibodies against antigens O-somatic and H-flagellar)
  12. 12. Prevention  Sanitation and hygiene  Careful food preparation and washing of hands  Vaccines –  the live, oral Ty21a vaccine (sold as Vivotif Berna)  the injectable Typhoid polysaccharide vaccine (sold as Typhim Vi by Sanofi Pasteur and Typherix by GlaxoSmithKline)  recommended for travellers to areas where typhoid is endemic.  Boosters are recommended every five years for the oral vaccine and every two years for the injectable form
  13. 13. Treatment  oral rehydration therapy - prevent many of the deaths of diarrheal diseases  Chloramphenicol - bacteriostatic  Ciprofloxacin (fluoroquinolone) -Where resistance is uncommon, the treatment of choice is a  ceftriaxone or cefotaxime (third- generation cephalosporin) such as is the first choice
  14. 14. Surgical Treatment  In cases of intestinal perforation.  Most surgeons prefer simple closure of the perforation with drainage of the peritoneum.
  15. 15. CHOLERA
  16. 16. Cholera  affects an estimated 3-5 million people worldwide  causes 100,000-130,000 deaths a year as of 2010  infection of the small intestine that causes a large amount of watery diarrhea.  caused by the bacterium gram negative Vibrio cholerae.  The bacteria releases a toxin – causes increased release of water from cells in the intestines, which produces severe diarrhea.  most common causative agent is V. cholerae O1  Other - V. cholerae O139.
  17. 17. Sign & Symptoms  profuse, painless diarrhea and vomiting of clear fluid  start suddenly, one to five days after ingestion of the bacteria  Diarrhea - "rice water" in nature and may have a fishy odor  can result in life-threatening dehydration and electrolyte imbalances  typical symptoms of dehydration include low blood pressure, poor skin turgor (wrinkled hands), sunken eyes, and a rapid pulse
  18. 18. SIGNS & SYMPTOMS  Abdominal cramps  Dry mucus membranes or mouth  Dry skin  Excessive thirst  Glassy or sunken eyes  Lack of tears  Lethargy  Low urine output Nausea Rapid dehydration Rapid pulse (heart rate) Sunken "soft spots" (fontanelles) in infants  usual sleepiness or tiredness Vomiting Watery diarrhea that starts suddenly and has a "fishy" odor
  19. 19. Susceptibility  About 100 million bacteria must typically be ingested to cause cholera in a normal healthy adult.  less in those with lowered gastric acidity  type O blood being the most susceptible  lowered immunity
  20. 20. Transmission  contaminated food or water  untreated diarrheal discharge is allowed to get into waterways, groundwater or drinking water supplies  shellfish and plankton  In the developed world, seafood is the usual cause, while in the developing world it is more often water
  21. 21. Diagnosis  rapid dip-stick test - to determine the presence of V. cholerae  If positive, further testing should be done to determine antibiotic resistance  Stool samples  Blood & stool culture
  22. 22. Prevention  water treatment and sanitation practices  Proper disposal and treatment of infected fecal waste water  antibacterial treatment of general sewage  oral vaccines for cholera are available  Water purification  boiling, chlorination or antimicrobial filtration
  23. 23. Treatment  Continued eating speeds the recovery of normal intestinal function  Fluids  oral rehydration therapy  In severe cases with significant dehydration, intravenous rehydration may be necessary  Electrolytes  Antibiotics  Doxycycline is typically used first line, although some strains of V. cholerae have shown resistance  Other antibiotics proven to be effective include cotrimoxazole, erythromycin, tetracycline, chlorampheni col, and furazolidone
  24. 24. REFERENCES  Clinical Microbiology 2nd Edition  Medscape  Nelson Essential Paediatrics