This document provides an overview of enteric (typhoid) fever. It discusses the epidemiology, etiology, pathogenesis, clinical features, diagnosis and management. Some key points:
- Enteric fever is most prevalent in impoverished areas with poor sanitation. South/Southeast Asia and Africa have high rates.
- Salmonella enterica serotypes Typhi and Paratyphi cause the disease. Risk factors include consumption of contaminated food/water and poor hand hygiene.
- The bacteria invade the small intestine and spread systematically, potentially causing complications like bowel perforation if untreated.
- Classic symptoms include prolonged fever, abdominal pain, and rose colored rash. Untreated cases
Typhoid fever is caused by the bacterium Salmonella enterica serotype Typhi and is transmitted through contaminated food or water. It has a variable incubation period of 1-2 weeks. Clinical presentation includes a stepwise fever pattern, gastrointestinal symptoms like abdominal pain, and occasionally a rose-colored rash. Without treatment, typhoid fever can last 3-4 weeks and be life threatening, but with antibiotics mortality is low. It remains common in areas with poor sanitation.
The document provides an overview of typhoid fever, including its various names, causative organism, signs and symptoms, transmission, diagnosis, prevention, management, and Ayurvedic perspective. It describes Salmonella typhi bacteria as the cause, with transmission via ingestion of contaminated food or water. Signs include fever, abdominal pain, and rose colored spots. Prevention relies on sanitation and hygiene while treatment involves antibiotics.
Typhoid fever, also known as enteric fever, is caused by the Salmonella Typhi bacteria which is typically spread through contaminated food or water. It causes a systemic infection and symptoms include a sustained fever along with abdominal pain. Without treatment, it can cause severe complications and even death. The disease is diagnosed through blood, stool, or urine cultures and treated with antibiotics like fluoroquinolones for at least two weeks. Prevention involves handwashing, drinking boiled water, and getting vaccinated which is especially important for those traveling to areas where typhoid is common.
This document provides an overview of enteric fever, which is caused by Salmonella Typhi and Paratyphoid bacteria. It discusses the history and epidemiology of the disease. Enteric fever is transmitted through the fecal-oral route and has an incubation period of 1-3 weeks. Clinical features include a rising fever pattern and abdominal symptoms. Complications can involve multiple organ systems. Diagnosis involves isolating the bacteria from blood or other cultures or detecting antibodies in serum. The document provides details on the pathogenesis, clinical course, complications and methods of diagnosing the disease.
Typhoid fever is caused by the bacterium Salmonella typhi and spreads through contaminated food or water. It causes sustained fever and toxic symptoms that worsen over 3-4 weeks if untreated. Diagnosis involves blood or stool cultures early in infection. Treatment aims to control symptoms, replace fluids, and use antibiotics like levofloxacin for 14 days. Complications can include intestinal bleeding or perforation if left untreated, but prognosis is good with timely antibiotic treatment. Prevention focuses on water sanitation and vaccination in endemic areas.
Typhoid fever is caused by the bacterium Salmonella enterica serotype Typhi and is transmitted through contaminated food or water. It has a variable incubation period of 1-2 weeks. Clinical presentation includes a stepwise fever pattern, gastrointestinal symptoms like abdominal pain, and occasionally a rose-colored rash. Without treatment, typhoid fever can last 3-4 weeks and be life threatening, but with antibiotics mortality is low. It remains common in areas with poor sanitation.
The document provides an overview of typhoid fever, including its various names, causative organism, signs and symptoms, transmission, diagnosis, prevention, management, and Ayurvedic perspective. It describes Salmonella typhi bacteria as the cause, with transmission via ingestion of contaminated food or water. Signs include fever, abdominal pain, and rose colored spots. Prevention relies on sanitation and hygiene while treatment involves antibiotics.
Typhoid fever, also known as enteric fever, is caused by the Salmonella Typhi bacteria which is typically spread through contaminated food or water. It causes a systemic infection and symptoms include a sustained fever along with abdominal pain. Without treatment, it can cause severe complications and even death. The disease is diagnosed through blood, stool, or urine cultures and treated with antibiotics like fluoroquinolones for at least two weeks. Prevention involves handwashing, drinking boiled water, and getting vaccinated which is especially important for those traveling to areas where typhoid is common.
This document provides an overview of enteric fever, which is caused by Salmonella Typhi and Paratyphoid bacteria. It discusses the history and epidemiology of the disease. Enteric fever is transmitted through the fecal-oral route and has an incubation period of 1-3 weeks. Clinical features include a rising fever pattern and abdominal symptoms. Complications can involve multiple organ systems. Diagnosis involves isolating the bacteria from blood or other cultures or detecting antibodies in serum. The document provides details on the pathogenesis, clinical course, complications and methods of diagnosing the disease.
Typhoid fever is caused by the bacterium Salmonella typhi and spreads through contaminated food or water. It causes sustained fever and toxic symptoms that worsen over 3-4 weeks if untreated. Diagnosis involves blood or stool cultures early in infection. Treatment aims to control symptoms, replace fluids, and use antibiotics like levofloxacin for 14 days. Complications can include intestinal bleeding or perforation if left untreated, but prognosis is good with timely antibiotic treatment. Prevention focuses on water sanitation and vaccination in endemic areas.
Typhoid fever is caused by Salmonella enterica serotype Typhi and presents with fever, abdominal pain and constipation or diarrhea. It is more common in areas with poor sanitation and affects children and young adults. The bacteria spreads through contaminated food or water and infects the intestines. Without treatment, it can develop complications like intestinal perforation. Diagnosis involves blood, stool or bone marrow cultures. Treatment is with antibiotics like fluoroquinolones or azithromycin. Vaccination is recommended for travel to affected areas.
This document provides information about enteric (typhoid) fever, including its definition, epidemiology, etiology and pathogenesis, clinical features, diagnosis, and prevention/control. It notes that enteric fever is caused by Salmonella typhi or paratyphi bacteria transmitted through contaminated food or water. Worldwide there are an estimated 22 million cases annually, more common in urban areas and among children/adolescents. Clinical features progress from non-specific symptoms in the first week to rose spots and spleen enlargement in the second week. Definitive diagnosis is through blood or stool culture. Prevention focuses on proper food handling and sanitation, as well as vaccination for travelers or close contacts of carriers.
Typhoid fever is caused by the Salmonella Typhi bacteria and spreads through contaminated food or water. It causes a sustained fever and can lead to serious complications without treatment. The bacteria infect the intestines and spreads through the lymphatic system. Symptoms progress over weeks from fever to abdominal pain and possible rash. Untreated it can lead to intestinal bleeding or perforation. Diagnosis involves blood or stool cultures and serologic tests. Treatment is with antibiotics like fluoroquinolones for 2 weeks. Hospitalization may be needed for serious cases or complications. With proper treatment, mortality is less than 1% but resistant strains are a global concern.
Typhoid fever, also known as enteric fever, is a potentially fatal multisystemic illness caused primarily by Salmonella enterica, subspecies enterica serovar typhi and, to a lesser extent, related serovars paratyphi A, B, and C.
The protean manifestations of typhoid fever make this disease a true diagnostic challenge. The classic presentation includes fever, malaise, diffuse abdominal pain, and constipation. Untreated, typhoid fever is a grueling illness that may progress to delirium, obtundation, intestinal hemorrhage, bowel perforation, and death within 1 month of onset. Survivors may be left with long-term or permanent neuropsychiatric complications.
TYHOID ILEAL PERFORATION, COMPLICATIONS AND MANAGEMENTSham Deen
Typhoid fever is caused by Salmonella typhi bacteria and spreads through contaminated food or water. It is characterized by sustained fever and bacteria invasion of organs like the liver and spleen. It remains an important cause of fever in developing countries with poor sanitation. The disease progresses from an initial bacteraemia phase with non-specific symptoms, to a septicemic phase with rose spots and hepatosplenomegaly. Treatment involves antibiotics and surgery if complications like intestinal perforation occur. Prevention relies on public health measures to ensure safe drinking water and proper sanitation.
Typhoid fever is caused by infection from the Salmonella typhi bacteria. It is spread through contaminated food or water. Symptoms include a sustained fever, abdominal pain, and headache. Without treatment, some patients may develop severe complications like intestinal bleeding or perforation. Diagnosis involves blood or stool cultures. Treatment is with antibiotics like fluoroquinolones for 2 weeks. A small percentage of patients become chronic carriers even after treatment.
This document provides an overview of enteric fever (typhoid fever). It defines the disease as an acute, life-threatening illness caused by Salmonella typhi or paratyphi bacteria. It predominantly affects developing countries with poor sanitation. The disease spreads through ingestion of contaminated food or water. It describes the pathogenesis as the bacteria invading the intestines through Peyer's patches before spreading to the liver, spleen and bone marrow. Clinical features include sustained high fever, abdominal pain, diarrhea or constipation. Management involves taking a thorough history, physical exam, diagnostic tests like blood cultures, and treating with antibiotics.
Typhoid fever is caused by Salmonella typhi bacteria. It is potentially fatal and affects multiple organ systems. Intestinal perforation and hemorrhage are major complications that can occur in the third week and require surgical intervention. Diagnosis involves epidemiological data, symptoms, and lab tests like blood cultures and serological tests. Treatment depends on antibiotic resistance of the infecting strain. Vaccines are available but have limitations. Paratyphoid fever is similar but generally milder and caused by other Salmonella species.
Management of Typhoid Intestinal Perforation which is a common and the most dreaded surgical complication of Typhoid fever.
This menace is still on the rise in low and medium income countries where we still battle with lack of potable water and open defecation.
This presentation is especially targeted at trainee surgeons in Nigeria and Medical Students also who may find it worthwhile.
Enteric fever, also known as typhoid fever, is caused by the bacteria Salmonella typhi. It is characterized by sustained fever and abdominal pain. The document discusses the definition, history, epidemiology, etiology, pathogenesis, clinical manifestations, diagnosis, treatment and prevention of enteric fever. Key points include that it is transmitted via the fecal-oral route, symptoms typically appear 10-14 days after exposure, and treatment involves supportive care and antibiotics such as chloramphenicol or ampicillin.
This document discusses communicable diseases that are common in toddlers, including viral and bacterial infections. It provides details on viral hepatitis A, including risk factors like contaminated food or water, modes of transmission through the fecal-oral or parenteral routes, incubation period of 15-45 days, clinical features such as jaundice and vomiting, and management including rest, diet, symptom relief, and prevention through hygiene and controlling transmission routes. Typhoid fever and poliomyelitis are also summarized, covering causes, transmission, symptoms, diagnosis, and treatment.
Typhoid fever is an acute illness caused by the bacteria Salmonella typhi, contracted through contaminated food or water. It is characterized by sustained fever, headache, abdominal pain, and rose-colored spots on the skin. If left untreated, it can lead to intestinal perforation or death. Diagnosis involves blood, stool, or bone marrow cultures. Treatment consists of antibiotics administered for 14 days. Prevention focuses on hand washing, drinking boiled water, and vaccination.
Typhoid fever is caused by the bacteria Salmonella typhi. It is transmitted through ingestion of food or water contaminated by the feces or urine of infected individuals. Symptoms include a sustained fever as high as 40°C, malaise, and involvement of lymphoid tissues and spleen. Diagnosis is confirmed through blood, stool, or bone marrow cultures. Treatment involves antibiotics like ciprofloxacin or azithromycin. Prevention relies on proper food handling and water treatment to avoid contamination.
This presentation on the topic of Mumps. What is the etilogy,how does it spread and what is the classification of mumps. We'll discuss the clinical manifestations along with treatment and prevention of this infectious disease of the children and adults.
1. The document discusses acute intestinal infections including dysentery, salmonellosis, and intestinal E. coli infection.
2. It describes the etiology, epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment and prophylaxis of dysentery caused by Shigella bacteria and salmonellosis caused by Salmonella bacteria.
3. Key symptoms of dysentery include abdominal pain and bloody diarrhea, while salmonellosis commonly presents with diarrhea, fever, and vomiting. Proper rehydration and use of antibiotics, when needed, are important for treatment.
Typhoid fever is a systemic infection caused by Salmonella typhi bacteria. It remains a significant public health problem globally, especially in developing countries in Asia and Africa. The disease is transmitted through ingestion of food or water contaminated by the feces or urine of infected humans. Laboratory diagnosis can be made through blood cultures early in the infection or the Widal test which detects antibodies in the blood. Treatment involves antibiotic therapy but multidrug resistant strains have emerged, complicating treatment.
Enterobacteriaceae are a family of Gram-negative, facultatively anaerobic bacteria that includes many pathogens. Escherichia coli is part of the normal gut flora but can cause urinary tract infections, meningitis, and diarrhea. Salmonella enterica serovar Typhi causes typhoid fever while S. enterica serovar Typhimurium causes gastroenteritis. Shigella species invade the intestinal tract and cause dysentery. Yersinia pestis, transmitted by fleas, causes bubonic or pneumonic plague. Klebsiella, Enterobacter, Proteus, and Serratia are opportunistic pathogens of hospitalsized patients, commonly causing urinary
Foodborne diseases, also called foodborne illness, is an illness caused by eating contaminated food. Infectious organisms including; bacteria, viruses and parasites or their toxins are the most common causes of food poisoning
Typhoid fever is caused by the bacterium Salmonella typhi. It spreads through contaminated food or water and causes symptoms like sustained fever, abdominal pain, and diarrhea. The disease is most common in developing nations with poor sanitation. Diagnosis involves blood or stool cultures. Treatment involves antibiotics like fluoroquinolones for 2 weeks. Vaccines provide some protection for travelers to endemic areas but immunity is not lifelong. Chronic carriers can harbor the bacteria and require long-term treatment.
This document provides an outline and overview of an approach to fever. It begins with an introduction that defines fever and classifies levels of fever. It then discusses signs and symptoms in adults and pediatrics, including elevated core temperature and associated symptoms like chills, sweating and fatigue. Differentials, clinical correlates, investigations, management and treatment are also outlined. Symptomatic treatment includes antipyretics like paracetamol and ibuprofen. The document concludes with potential complications if fever is left untreated, such as febrile seizures.
Typhoid fever is caused by Salmonella enterica serotype Typhi and presents with fever, abdominal pain and constipation or diarrhea. It is more common in areas with poor sanitation and affects children and young adults. The bacteria spreads through contaminated food or water and infects the intestines. Without treatment, it can develop complications like intestinal perforation. Diagnosis involves blood, stool or bone marrow cultures. Treatment is with antibiotics like fluoroquinolones or azithromycin. Vaccination is recommended for travel to affected areas.
This document provides information about enteric (typhoid) fever, including its definition, epidemiology, etiology and pathogenesis, clinical features, diagnosis, and prevention/control. It notes that enteric fever is caused by Salmonella typhi or paratyphi bacteria transmitted through contaminated food or water. Worldwide there are an estimated 22 million cases annually, more common in urban areas and among children/adolescents. Clinical features progress from non-specific symptoms in the first week to rose spots and spleen enlargement in the second week. Definitive diagnosis is through blood or stool culture. Prevention focuses on proper food handling and sanitation, as well as vaccination for travelers or close contacts of carriers.
Typhoid fever is caused by the Salmonella Typhi bacteria and spreads through contaminated food or water. It causes a sustained fever and can lead to serious complications without treatment. The bacteria infect the intestines and spreads through the lymphatic system. Symptoms progress over weeks from fever to abdominal pain and possible rash. Untreated it can lead to intestinal bleeding or perforation. Diagnosis involves blood or stool cultures and serologic tests. Treatment is with antibiotics like fluoroquinolones for 2 weeks. Hospitalization may be needed for serious cases or complications. With proper treatment, mortality is less than 1% but resistant strains are a global concern.
Typhoid fever, also known as enteric fever, is a potentially fatal multisystemic illness caused primarily by Salmonella enterica, subspecies enterica serovar typhi and, to a lesser extent, related serovars paratyphi A, B, and C.
The protean manifestations of typhoid fever make this disease a true diagnostic challenge. The classic presentation includes fever, malaise, diffuse abdominal pain, and constipation. Untreated, typhoid fever is a grueling illness that may progress to delirium, obtundation, intestinal hemorrhage, bowel perforation, and death within 1 month of onset. Survivors may be left with long-term or permanent neuropsychiatric complications.
TYHOID ILEAL PERFORATION, COMPLICATIONS AND MANAGEMENTSham Deen
Typhoid fever is caused by Salmonella typhi bacteria and spreads through contaminated food or water. It is characterized by sustained fever and bacteria invasion of organs like the liver and spleen. It remains an important cause of fever in developing countries with poor sanitation. The disease progresses from an initial bacteraemia phase with non-specific symptoms, to a septicemic phase with rose spots and hepatosplenomegaly. Treatment involves antibiotics and surgery if complications like intestinal perforation occur. Prevention relies on public health measures to ensure safe drinking water and proper sanitation.
Typhoid fever is caused by infection from the Salmonella typhi bacteria. It is spread through contaminated food or water. Symptoms include a sustained fever, abdominal pain, and headache. Without treatment, some patients may develop severe complications like intestinal bleeding or perforation. Diagnosis involves blood or stool cultures. Treatment is with antibiotics like fluoroquinolones for 2 weeks. A small percentage of patients become chronic carriers even after treatment.
This document provides an overview of enteric fever (typhoid fever). It defines the disease as an acute, life-threatening illness caused by Salmonella typhi or paratyphi bacteria. It predominantly affects developing countries with poor sanitation. The disease spreads through ingestion of contaminated food or water. It describes the pathogenesis as the bacteria invading the intestines through Peyer's patches before spreading to the liver, spleen and bone marrow. Clinical features include sustained high fever, abdominal pain, diarrhea or constipation. Management involves taking a thorough history, physical exam, diagnostic tests like blood cultures, and treating with antibiotics.
Typhoid fever is caused by Salmonella typhi bacteria. It is potentially fatal and affects multiple organ systems. Intestinal perforation and hemorrhage are major complications that can occur in the third week and require surgical intervention. Diagnosis involves epidemiological data, symptoms, and lab tests like blood cultures and serological tests. Treatment depends on antibiotic resistance of the infecting strain. Vaccines are available but have limitations. Paratyphoid fever is similar but generally milder and caused by other Salmonella species.
Management of Typhoid Intestinal Perforation which is a common and the most dreaded surgical complication of Typhoid fever.
This menace is still on the rise in low and medium income countries where we still battle with lack of potable water and open defecation.
This presentation is especially targeted at trainee surgeons in Nigeria and Medical Students also who may find it worthwhile.
Enteric fever, also known as typhoid fever, is caused by the bacteria Salmonella typhi. It is characterized by sustained fever and abdominal pain. The document discusses the definition, history, epidemiology, etiology, pathogenesis, clinical manifestations, diagnosis, treatment and prevention of enteric fever. Key points include that it is transmitted via the fecal-oral route, symptoms typically appear 10-14 days after exposure, and treatment involves supportive care and antibiotics such as chloramphenicol or ampicillin.
This document discusses communicable diseases that are common in toddlers, including viral and bacterial infections. It provides details on viral hepatitis A, including risk factors like contaminated food or water, modes of transmission through the fecal-oral or parenteral routes, incubation period of 15-45 days, clinical features such as jaundice and vomiting, and management including rest, diet, symptom relief, and prevention through hygiene and controlling transmission routes. Typhoid fever and poliomyelitis are also summarized, covering causes, transmission, symptoms, diagnosis, and treatment.
Typhoid fever is an acute illness caused by the bacteria Salmonella typhi, contracted through contaminated food or water. It is characterized by sustained fever, headache, abdominal pain, and rose-colored spots on the skin. If left untreated, it can lead to intestinal perforation or death. Diagnosis involves blood, stool, or bone marrow cultures. Treatment consists of antibiotics administered for 14 days. Prevention focuses on hand washing, drinking boiled water, and vaccination.
Typhoid fever is caused by the bacteria Salmonella typhi. It is transmitted through ingestion of food or water contaminated by the feces or urine of infected individuals. Symptoms include a sustained fever as high as 40°C, malaise, and involvement of lymphoid tissues and spleen. Diagnosis is confirmed through blood, stool, or bone marrow cultures. Treatment involves antibiotics like ciprofloxacin or azithromycin. Prevention relies on proper food handling and water treatment to avoid contamination.
This presentation on the topic of Mumps. What is the etilogy,how does it spread and what is the classification of mumps. We'll discuss the clinical manifestations along with treatment and prevention of this infectious disease of the children and adults.
1. The document discusses acute intestinal infections including dysentery, salmonellosis, and intestinal E. coli infection.
2. It describes the etiology, epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment and prophylaxis of dysentery caused by Shigella bacteria and salmonellosis caused by Salmonella bacteria.
3. Key symptoms of dysentery include abdominal pain and bloody diarrhea, while salmonellosis commonly presents with diarrhea, fever, and vomiting. Proper rehydration and use of antibiotics, when needed, are important for treatment.
Typhoid fever is a systemic infection caused by Salmonella typhi bacteria. It remains a significant public health problem globally, especially in developing countries in Asia and Africa. The disease is transmitted through ingestion of food or water contaminated by the feces or urine of infected humans. Laboratory diagnosis can be made through blood cultures early in the infection or the Widal test which detects antibodies in the blood. Treatment involves antibiotic therapy but multidrug resistant strains have emerged, complicating treatment.
Enterobacteriaceae are a family of Gram-negative, facultatively anaerobic bacteria that includes many pathogens. Escherichia coli is part of the normal gut flora but can cause urinary tract infections, meningitis, and diarrhea. Salmonella enterica serovar Typhi causes typhoid fever while S. enterica serovar Typhimurium causes gastroenteritis. Shigella species invade the intestinal tract and cause dysentery. Yersinia pestis, transmitted by fleas, causes bubonic or pneumonic plague. Klebsiella, Enterobacter, Proteus, and Serratia are opportunistic pathogens of hospitalsized patients, commonly causing urinary
Foodborne diseases, also called foodborne illness, is an illness caused by eating contaminated food. Infectious organisms including; bacteria, viruses and parasites or their toxins are the most common causes of food poisoning
Typhoid fever is caused by the bacterium Salmonella typhi. It spreads through contaminated food or water and causes symptoms like sustained fever, abdominal pain, and diarrhea. The disease is most common in developing nations with poor sanitation. Diagnosis involves blood or stool cultures. Treatment involves antibiotics like fluoroquinolones for 2 weeks. Vaccines provide some protection for travelers to endemic areas but immunity is not lifelong. Chronic carriers can harbor the bacteria and require long-term treatment.
This document provides an outline and overview of an approach to fever. It begins with an introduction that defines fever and classifies levels of fever. It then discusses signs and symptoms in adults and pediatrics, including elevated core temperature and associated symptoms like chills, sweating and fatigue. Differentials, clinical correlates, investigations, management and treatment are also outlined. Symptomatic treatment includes antipyretics like paracetamol and ibuprofen. The document concludes with potential complications if fever is left untreated, such as febrile seizures.
This document provides information about community-acquired pneumonia (CAP). It discusses the epidemiology, risk factors, etiology, pathogenesis, clinical features, diagnosis, and management of CAP. CAP results in over 1 million hospitalizations and 55,000 deaths annually in the United States. The most common causes are Streptococcus pneumoniae, Haemophilus influenzae, and respiratory viruses like influenza. Clinical features may include fever, cough, shortness of breath, and findings on physical exam like crackles and decreased breath sounds.
This slide presents some Gynecologic diseases and disorders in females and their proper management. It is a third-year course for those wishing to major PA or Nursing.
This PowerPoint presentation was compiled and prepared by Platon S. Plakar, Jr a student majoring in Physician Assistant at Cuttington University. This presentation provides a brief understanding of Syphilis, an infectious disease condition that affects people exposed to sexual contact.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Cell Therapy Expansion and Challenges in Autoimmune Disease
Enteric fever.pptx
1. E N T E R I C
F E V E ( T Y P H O I D
F E V E R
JAMES LUKE GARLO JR,
BSc(H O N S ), MD, MLCPS
(INTERNAL MEDICINE)
2. OUTLINE
• Introduction
• Epidemiology
• Magnitude of the problem in Africa
• Etiology
• Risk Factors
• Pathogenesis
• Clinical Features
• Diagnosis
• Management
3. INTRODUCTION
• Enteric fever severe systemic illness characterized by fever and abdominal pain.
• The term "enteric fever" is a collective term that refers to both typhoid and
paratyphoid fever, and "typhoid" and "enteric fever" are often used
interchangeably.
• The term typhoid derived from the ancient Greek word for cloud, was chosen to
emphasize the severity and long-lasting neuropsychiatric effects among the
untreated.
• Typhoid thrives in conditions of poor sanitation, crowding, and social chaos.
4. EPIDEMIOLOGY
• Worldwide, enteric fever is most prevalent in impoverished areas that are
overcrowded with poor access to sanitation.
• South-central Asia, Southeast Asia, and southern Africa are regions with high
incidence of S. Typhi infection (more than 100 cases per 100,000 person-years)
• Enteric fever is more common in children and young adults than in older patients.
• Humans are the only reservoir for S. Typhi and S. Paratyphi A, thus a history of
travel to settings in which sanitation is poor or contact with a known typhoid case
or carrier is useful for identifying people at risk of infection outside of endemic
areas, although a specific source or contact is identified in a minority of cases.
5. EPIDEMIOLOGY
• Typhoid fever infects roughly 21.6 million people (incidence of 3.6 per 1,000
population) and kills an estimated 200,000 people every year.
• With prompt and appropriate antibiotic therapy, typhoid fever is typically a short-term
febrile illness requiring a median of 6 days of hospitalization
• It has no racial predilection.
• Most documented typhoid fever cases involve school-aged children and young adults.
• There is often a seasonal pattern in endemic areas, with transmission starting at the end
of the dry season when water is sparse and sanitation may be poor, and continuing into
the rains, when infected water may be easily dispersed.
6. THE PROBLEM IN AFRICA
• Salmonella infections are among the commonest bacterial isolates from blood cultures
throughout Africa.
• Most cases are in Asia, but typhoid remains endemic in some areas of Africa, and
epidemics are also reported.
• Invasive non-typhoid salmonella (NTS) infections, a long-standing and common cause of
illness and death in African infants and children, have further increased among children
and significantly increased among adults as a result of the HIV epidemic.
• Whenever an African patient has few signs, yet is ill with a fever, invasive Salmonella
infection (either typhoid or non-typhoid) is high on the list of differential diagnoses.
7. ETIOLOGY: MICROBIOLOGY
• The organism classically responsible for the enteric fever syndrome
is S. enterica serotype Typhi (formerly S. typhi).
• S. enterica serotype Typhi causes disease only in humans; it has no
known animal reservoir.
– Infection therefore implies direct contact with an infected individual or
indirect contact via contaminated food or water.
• Salmonellae are Gram-negative, motile, facultatively anaerobic
bacilli, which produce acid on glucose fermentation, reduce nitrates
and do not ferment lactose.
8. ETIOLOGY: MICROBIOLOGY
• Others S. enterica serotypes also called typhoidal salmonella that
cause enteric fever include
– Salmonella paratyphi A, Salmonella paratyphi B, Salmonella Paratyphi C
• Infection due to S. Paratyphi species is less common than infection
due to S. enterica serotype Typhi.
– S. Paratyphi only causes disease in humans.
– S. Paratyphi species are generally thought to cause milder illnesses than S.
Typhi
9. RISK FACTORS
• Typhoidal salmonella have no nonhuman/animal vectors.
• Oral transmission via food or beverages handled by an often asymptomatic
individual—a carrier—who chronically sheds the bacteria through stool or, less
commonly, urine.
• Oral transmission via sewage-contaminated water or shellfish (especially in the
developing world)
• Paratyphi is more commonly transmitted in food from street vendors.
– It is believed that some such foods provide a friendly environment for the microbe.
• Hand-to-mouth transmission after using a contaminated toilet and neglecting
hand hygiene.
10. RISK FACTORS
• Typhoidal salmonella can survive a stomach pH as low as 1.5.
• Anything that decreases stomach acidity many facilitate S typhi
infection.
– Antacids
– histamine-2 receptor antagonists (H2 blockers)- Ranitidine, cimetidine
– proton pump inhibitors- Omeprazole
– gastrectomy
– Achlorhydria
• Genetic Polymorphisms: PARK2 and PACGR
• Evidence of prior Helicobacter pylori infection (an association probably
related to chronically reduced gastric acidity).
11. PATHOGENESIS
• Salmonellae must survive the acidic barrier in the stomach and then
colonize the small intestine (distal ileum).
• A relatively high inoculum (105) organisms or more is needed to
overcome the barrier imposed by low gastric pH (acidity).
• In general, the greater the infectious dose, the higher the attack rate
and the shorter the incubation period
• If gastric acid is reduced, for example, by achlorhydria or acid
suppressive medication (omeprazole), a lower infecting dose than 105
is required.
12. PATHOGENESIS
• The entry of S. Typhi into the epithelial cell of the small bowel appears to be
mediated by the cystic fibrosis transmembrane conductance regulator (CFTR)
protein.
– mutations in cystic fibrosis transmembrane conductance receptor (CFTR), which is
expressed on the gut membrane decreases susceptibility to enteric fever.
– 2% to 5% of white persons are heterozygous for the CFTR mutation
• After invading and crossing the gut epithelial cells, the bacteria are taken up by
phagocytic mononuclear cells which lie on the basal surface of the gut
epithelium and are transported to the Peyer’s patches and other local mucosa-
associated lymphoid tissue (MALT) of the small intestine/bowel.
13. PATHOGENESIS
• The infection disseminates from the small bowel, via the
lymphatics, to the reticuloendothelial system including the
bone marrow, spleen and liver, where a chronic infection is
established.
• This primary phase of small bowel infection is rapid and
causes no more than a mild transient enterocolitis in a few
cases.
14. PATHOGENESIS
• Salmonellae survive and replicate intracellularly in tissue
macrophages during an incubation period of approximately 5–
21 days after primary infection, then the infection becomes
bacteremia and typically presents with fever.
• Organisms may be seeded to other sites during bacteremia,
especially damaged or abnormal tissue in the renal tract,
endothelium, bone and joints, or biliary system, where
metastatic infections may arise.
15. PATHOGENESIS
• Organisms that reach the gallbladder may persist and re-enter the gut in
bile, setting up a later secondary small bowel infection.
• Unlike the mild primary infection, this secondary infection causes
severe Peyer’s patch inflammation, which is the basis of both the
abdominal symptoms and late complications that occur in some cases
of typhoid fever, and the basis of high-level shedding and person-to-
person transmission of typhoid fever.
16. CLASSIC TYPHOID FEVER SYNDROME
• The most prominent symptom is prolonged fever (38.8°–40.5°C; 101.8°– 104.9°F),
which can continue for up to 4 weeks if untreated.
– The fever rises progressively in a stepwise fashion.
• Over the course of the first week of illness, a wide variety gastrointestinal
symptoms of the disease develop:
– Abdominal Pain: Diffuse abdominal pain and, in some cases, fierce colicky right upper
quadrant pain.
– Constipation: Inflamed Peyer patches narrow the bowel lumen to the point of causing partial
obstruction that may persist for the duration of the illness.
• If untreated the individual may develop a dry cough, dull frontal headache,
delirium, and severe malaise associated with marked stupor.
17. CLASSIC TYPHOID FEVER SYNDROME
• Seven to ten days into the illness, the fever plateaus at 103-104°F (39-
40°C).
• The patient develop Rose Spots, salmon-colored, blanching, truncal,
maculopapular lesions that are 1-4 cm wide and fewer than 5 in
number.
– These generally resolve within 2-5 days.
– They are caused by bacterial emboli to the dermis.
• During the second week the signs and symptoms listed above progress.
– The abdomen becomes distended, and soft splenomegaly is common.
– Relative bradycardia and dicrotic pulse (double beat, the second beat weaker
than the first) may develop.
18. CLASSIC TYPHOID FEVER SYNDROME
• In the third week, the still febrile individual grows more toxic and anorexic
with significant weight loss.
• The conjunctivae are injected, and the patient is tachypneic with a thready
pulse and crackles over the lung bases.
• Abdominal distension is severe, and some patients experience foul, green-
yellow, liquid diarrhea (pea soup diarrhea).
• The individual may descend into the typhoid state, which is characterized by
apathy, confusion, and even psychosis.
• Necrotic Peyer patches may lead to bowel perforation and peritonitis. This
complication is often unheralded and may be masked by corticosteroids.
• At this point, overwhelming toxemia, myocarditis, or intestinal hemorrhage
may cause death.
19. CLASSIC TYPHOID FEVER SYNDROME
• If the individual survives to the fourth week, the fever, mental state,
and abdominal distension slowly improve over a few days.
• Intestinal and neurologic complications may still occur in surviving
untreated individuals.
• Weight loss and debilitating weakness last months.
• Some survivors become asymptomatic S typhi carriers and have the
potential to transmit the bacteria indefinitely.
20. TREATED TYPHOID FEVER SYNDROME
• If appropriate treatment is initiated within the first few days of full-
blown illness, the disease begins to remit after about 2 days, and the
patient's condition markedly improves within 4-5 days.
• Any delay in treatment increases the likelihood of complications and
recovery time.
21. CHRONIC CARRIERS
• Chronic Salmonella carriage is defined as excretion of the
organism in stool or urine >12 months after acute infection.
–Rates of chronic carriage after S. Typhi infection range from 1 to 6
percent
• Chronic carriers appear to reach an immunologic
equilibrium in which they are chronically colonized
(usually in the biliary tract) and may excrete large numbers
of organisms but do not develop clinical disease
22. CHRONIC CARRIERS
• Chronic carriage occurs more frequently in females and in
patients with cholelithiasis or other biliary tract
abnormalities
• Chronic carriage in the urine is rare and almost always
associated with an abnormality in the urinary tract (eg,
urolithiasis, prostatic hyperplasia) or concurrent bladder
infection with Schistosoma
23. DIAGNOSIS
• Enteric fever in Africa is frequently over-diagnosed, largely based
on the Widal test, which has significant limitations.
• The possibility of enteric fever should be considered in a febrile
patient living in, traveling from, or visiting from an endemic area.
• Duration of fever for more than three days or accompanying
gastrointestinal symptoms (abdominal pain, diarrhea, or
constipation) should heighten the suspicion.
24. DIAGNOSIS
• Culture: The criterion standard for diagnosis of typhoid fever has long been
culture isolation of the organism. Cultures are considered to be 100% specific.
• A high volume of blood sampled (eg, two to three 20 mL blood cultures in
adults) optimizes the yield of blood cultures.
• Other specimens can be cultured, including bone marrow, which yields the most
sensitive culture but is invasive and usually not warranted..
• Thus, when cultures are negative or not available, as in some resource-limited
settings, the diagnosis of enteric fever is often made presumptively based on a
protracted febrile illness without other explanation.
• Empiric therapy is often appropriate in the absence of an alternative diagnosis
because of the risk for severe sequelae with untreated enteric fever
25. DIAGNOSIS
• Specific serologic test:
• The Widal test, Tubex test, Typhidot test, ELISA test
• Assays that identify Salmonella antibodies or antigens support the
diagnosis of typhoid fever, but these results should be confirmed
with cultures or DNA evidence.
26. DIAGNOSIS
• The Widal test was the mainstay of typhoid fever diagnosis for decades.
– It is used to measure agglutinating antibodies against H and O antigens of S typhi.
– Neither sensitive nor specific, the Widal test is no longer an acceptable clinical
method.
– Limited used in endemic areas because positive results may represent previous
infection.
– The minimum titers defined as positive for the O (surface polysaccharide) antigens
and H (flagellar) antigens must be determined for individual geographic areas;
they are higher in developing regions than in the United States
27. DIAGNOSIS
• The Widal test:
– Positive after 7-10 days of infection. O and H antigens are found.
– After that, the titers starts to fall.
– O-antigen appears before H-antigen.
– Rising O-antigen is very important for the diagnosis.
– Positive Widal is seen after vaccination, in the case of a previous
infection, or typhoid fever.
28. DIAGNOSIS
• Tubex, which measures immunoglobulin (Ig)M antibodies to S. Typhi
lipopolysaccharide, had sensitivity and specificity of 78 and 87 percent,
respectively.
• Typhidot, which measures IgM or IgG responses to an outer membrane
protein, had overall average sensitivity and specificity of 84 and 79
percent, respectively.
• ELISA: Anti-Vi antibodies are not useful for the diagnosis of acute illness
30. MANAGEMENT
• Treatment of enteric fever has been complicated by the development
and rapid global spread of typhoidal organisms resistant to ampicillin,
TMP-SFX and chloramphenicol.
• Additionally, development of increasing resistance to
fluoroquinolones and cephalosporins is a growing challenge.
• Enteric fever is usually treated with a single antibacterial drug.
• Fluoroquinolone, Azithromycin, third generations cephalosporins, and
carbapenems.
• Older drugs no longer used unless there's a proven susceptibility are
chloramphenicol, ampicillin, or trimethoprim-sulfamethoxazole.
31. MANAGEMENT
• In many parts of South Asia, over 80% of S. Typhi isolates among clinical cases
are non-susceptible to fluroquinolones even though few years prior it was a
drug that was proven to be highly successful in treating S. Typhi.
• Fluroquinolone resistant isolates have been reported in Nigeria and rates are
rising in Africa.
• In some cases, these resistant isolates have been classified as a subclass of the
multidrug resistant (MDR) H58 typhoid strain that had widely disseminated
throughout Asia and some African countries
32. MANAGEMENT
• Multidrug resistant strains (MDR) strains (ie, those resistant
to ampicillin, trimethoprim-sulfamethoxazole,
and chloramphenicol) are prevalent worldwide, though they
have been in decline as other antibiotics have been more widely
used for treatment of enteric fever.
• Because of this, ampicillin, trimethoprim-sulfamethoxazole,
and chloramphenicol fell out of favor as first-line agents for
treatment of enteric fever
33. MANAGEMENT
• Extensively drug-resistant (XDR) strains (ie, those resistant to
five antibiotics: ampicillin, trimethoprim-
sulfamethoxazole, chloramphenicol, fluoroquinolones, and
third-generation cephalosporins) has been described.
– Susceptible to azithromycin, carbapenems and tigecycline
• Most S. Typhi and S. Paratyphi isolates remain susceptible
to azithromycin and ceftriaxone, although resistant isolates have been
reported.
• Ceftriaxone resistance is increasing
34. MANAGEMENT
• Antibiotic selection depends upon the severity of illness, local
resistance patterns, whether oral medications are feasible, the clinical
setting, and available resources.
• The main options are fluoroquinolones, third-generation
cephalosporins, and azithromycin and carbapenems.
• In some circumstances, older agents such
as chloramphenicol, ampicillin, or trimethoprim-
sulfamethoxazole may be appropriate, but these drugs are generally
not used widely because of the prevalence of resistance.
35. MANAGEMENT
• Severe disease: For patients who have severe disease (eg,
systemic toxicity, depressed consciousness, prolonged fever,
organ system dysfunction, or other feature that prompts
hospitalization), initial therapy with a parenteral agent is
appropriate.
• The geographic region where infection was likely acquired
helps inform the choice of parenteral agent because of the
risk of resistance in certain locations
36. MANAGEMENT
• Surgical care is indicated in cases of intestinal perforation or
extraintestinal complications (arteritis, organ abscesses).
• If antibiotic treatment fails to eradicate the hepatobiliary
carriage, gall bladder can be resected.
• Patient should stay home and rest until full recovery.
• Wash hands and avoid preparing food for others during
course of illness.
• Dispose of feces and urine safely and properly.
37. MANAGEMENT: OTHERS
• Adjunctive corticosteroids for severe infection — For
patients with suspected or known enteric fever and severe
systemic illness (delirium, obtundation, stupor, coma, or
shock), we suggest adjunctive dexamethasone (3 mg/kg
followed by 1 mg/kg every 6 hours for a total of 48 hours)
38. MANAGEMENT: OTHERS
• Patients with ileal perforation — For patients with ileal
perforation, prompt surgical intervention is usually
indicated, as is broader antimicrobial coverage to cover
peritonitis and potential secondary bacteremia with enteric
organisms.
• The extent of surgical intervention remains controversial;
the best surgical procedure appears to be segmental
resection of the involved intestine, when possible
39. MANAGEMENT: OTHERS
• Relapse — Relapse of enteric fever after clinical cure can occur
in immunocompetent individuals; in such cases, it typically
occurs two to three weeks after resolution of fever.
• The risk of relapse depends on the antibiotic used to treat the
initial infection.
• Relapse rates are highest with chloramphenicol, a bacteriostatic
agent, (10 to 25 percent)
• Relapsed infection should be treated with an additional course
of antibiotics, guided by susceptibility testing..
40. MANAGEMENT: OTHERS
• Chronic carriers: Fluoroquinolone therapy
(eg, ciprofloxacin 500 to 750 mg orally twice daily
or ofloxacin 400 mg orally twice daily) for four weeks is a
reasonable approach.
• If eradication is not achieved but thought necessary from a
public health perspective, an additional prolonged antibiotic
course and cholecystectomy may be warranted
41. REFERENCES
• Harrison Principles and Practice of Medicine
• Uptodate clinical resource
• Principles of Medicine in Africa
• Medscape
code for a protein aggregate that is essential for breaking down the bacterial signaling molecules that dampen the macrophage response.
They have specialized fimbriae that adhere to the epithelium over clusters of lymphoid tissue in the ileum (Peyer patches), the main relay point for macrophages traveling from the gut into the lymphatic system.
Heterozygous for a mutation in that CFTR means they are likely to have a mutation and thus protection against enteric fever.
Relative bradycardia is the term used to describe the mechanism where there is dissociation between pulse and temperature. Relative bradycardia is a poorly understood paradoxical phenomenon that refers to a clinical sign whereby the pulse rate is lower than expected for a given body temperature. Fever is usually accompanied by tachycardia (rapid pulse), an association known by the eponym "Liebermeister's rule".)
Each Celsius grade of body temperature increment corresponds to an 8 beats per minute increase in cardiac frequency, although the exact number of this rule varies significantly across different sources
The story of "Typhoid Mary," a cook in early 20th century New York who infected approximately 50 people (three fatally), highlights the role of asymptomatic carriers in maintaining the cycle of person-to-person spread, especially in areas of lower transmission. For this reason, eradication of carriage when identified should be attempted.
The story of "Typhoid Mary," a cook in early 20th century New York who infected approximately 50 people (three fatally), highlights the role of asymptomatic carriers in maintaining the cycle of person-to-person spread, especially in areas of lower transmission. For this reason, eradication of carriage when identified should be attempted.
sensitivity is a measure of how well a test can identify true positives and specificity is a measure of how well a test can identify true negatives.
Sensitivity refers to the test's ability to correctly detect ill patients who do have the condition.
Specificity of a test is the proportion of those who truly do not have the condition who test negative for the condition. Specificity relates to the test's ability to correctly reject healthy patients without a condition.
sensitivity is a measure of how well a test can identify true positives and specificity is a measure of how well a test can identify true negatives.When paired acute and convalescent samples are studied, a fourfold or greater increase is considered positive
sensitivity is a measure of how well a test can identify true positives and specificity is a measure of how well a test can identify true negatives.When paired acute and convalescent samples are studied, a fourfold or greater increase is considered positive
When paired acute and convalescent samples are studied, a fourfold or greater increase is considered positive
When paired acute and convalescent samples are studied, a fourfold or greater increase is considered positive
Talk about how the resistance is spreading from Asia to Liberia with migration of chinese nationals
Talk about how the resistance is spreading from Asia to Liberia with migration of chinese nationals
Talk about how the resistance is spreading from Asia to Liberia with migration of chinese nationals
For patients who have severe disease (eg, systemic toxicity, depressed consciousness, prolonged fever, organ system dysfunction, or other feature that prompts hospitalization), initial therapy with a parenteral agent is appropriate. The geographic region where infection was likely acquired helps inform the choice of parenteral agent because of the risk of resistance in certain locations:
For patients who have severe disease (eg, systemic toxicity, depressed consciousness, prolonged fever, organ system dysfunction, or other feature that prompts hospitalization), initial therapy with a parenteral agent is appropriate. The geographic region where infection was likely acquired helps inform the choice of parenteral agent because of the risk of resistance in certain locations:
For patients who have severe disease (eg, systemic toxicity, depressed consciousness, prolonged fever, organ system dysfunction, or other feature that prompts hospitalization), initial therapy with a parenteral agent is appropriate. The geographic region where infection was likely acquired helps inform the choice of parenteral agent because of the risk of resistance in certain locations: