This document discusses typhoid fever, caused by the bacterium Salmonella enterica serotype typhi. It notes that over 21.7 million cases occur annually worldwide, with higher rates in developing countries and children under 10. Symptoms include prolonged fever and gastrointestinal disturbances. Complications can involve the central nervous system, gastrointestinal tract, or other organs. Diagnosis involves blood or bone marrow cultures. Treatment involves antibiotics like fluoroquinolones or third-generation cephalosporins. Vaccines can provide some protection. Prevention relies on safe drinking water, effective sewage disposal, and hygienic food preparation.
Measles is a highly contagious viral infection.
It is exanthematous disease with fewer, cough, coryza (rhinitis) and conjunctivitis.
Before the widespread use of measles vaccines, it was estimated that measles caused between 5 million and 8 million deaths worldwide each year.
Measles is a highly contagious viral infection.
It is exanthematous disease with fewer, cough, coryza (rhinitis) and conjunctivitis.
Before the widespread use of measles vaccines, it was estimated that measles caused between 5 million and 8 million deaths worldwide each year.
Pulmonary TB is a bacterial infection of the lungs that can cause a range of symptoms, including chest pain, breathlessness, and severe coughing. Pulmonary TB can be life-threatening if a person does not receive treatment. People with active TB can spread the bacteria through the air.
Pertussis : Highly contagious respiratory infection caused by Bordetella pertussis
Outbreaks first described in 16th century
Bordetella pertussis isolated in 1906
Estimated >300,000 deaths annually worldwide
Before the availability of pertussis vaccine in the 1940s, public health experts reported more than 200,000 cases of pertussis annually.
Since widespread use of the vaccine began, incidence has decreased more than 75% compared with the pre-vaccine era.
In 2012, the last peak year, CDC reported 48,277 cases of pertussis.
Extremely contagious-attack rate 100%
Immunity is never complete
Protection begins to wane in 3-5 yrs after vaccination
Intro to TB
epidemiology of TB
Structure of Mycobacterium TB
pathogenesis of TB
Immunosuppression by Mycobacterium TB
types of TB
Clinical manifestation
Diagnosis
Treatment
Pulmonary TB is a bacterial infection of the lungs that can cause a range of symptoms, including chest pain, breathlessness, and severe coughing. Pulmonary TB can be life-threatening if a person does not receive treatment. People with active TB can spread the bacteria through the air.
Pertussis : Highly contagious respiratory infection caused by Bordetella pertussis
Outbreaks first described in 16th century
Bordetella pertussis isolated in 1906
Estimated >300,000 deaths annually worldwide
Before the availability of pertussis vaccine in the 1940s, public health experts reported more than 200,000 cases of pertussis annually.
Since widespread use of the vaccine began, incidence has decreased more than 75% compared with the pre-vaccine era.
In 2012, the last peak year, CDC reported 48,277 cases of pertussis.
Extremely contagious-attack rate 100%
Immunity is never complete
Protection begins to wane in 3-5 yrs after vaccination
Intro to TB
epidemiology of TB
Structure of Mycobacterium TB
pathogenesis of TB
Immunosuppression by Mycobacterium TB
types of TB
Clinical manifestation
Diagnosis
Treatment
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
3. EPIDEMIOLOGY
Over 21.7 million cases/ annually
>2 lacs death
Additional >5.4 million cases – Paratyph.
Developed countries- <15/ lacs population
Developing countries- 100-1000/lacs.
4. In an Indian urban slum showed incidence as high as
2/ 1,000 /yr for children under five
5.1/ 1,000/ yr for children under ten
majority of cases occurred in children aged 5 to 12
years and 24.8% of cases were in children up to 5
years of age
S. Typhi (75.7%) was the predominant serovar
followed by S. Paratyphi A (23.8%)
maximum number of enteric fever cases occurred
during April to June (dry season) followed by July to
September (monsoon season
6. Contd..
Age – Children and young adults (5-25 years).
Recent Study from Delhi shows Typhoid fever also
common in < 5 years of age.
IP – 10-14 days (3-21 days).
MOT – Faeco-oral/Urine-oral route.
Through out the year esp. July-September
ROI – Man (Cases/Carriers)
7.
8. Organism
Salmonella typhi, a Gram-negative bacteria.
Similar but often less severe disease is caused by
Salmonella serotype paratyphi A.
The ratio of disease caused by S. typhi to that
caused by S. paratyphi is about 10 to 1.
Many genes are shared with E. coli and at least
90% with S. typhimurium,
Polysaccharide capsule Vi: present in about 90%
of all freshly isolated S. typhi and has a protective
effect against the bactericidal action of the serum
of infected patients.
9. Risk Factors
Impaired cell-mediated immunity
AIDS
Corticosteroid use
Malignancy
Impaired phagocytic function
Hemoglobinopathies
Chronic granulomatous disease
Malaria
Histoplasmosis
Schistosomiasis
10. Risk Factors
Extremes of age
Neonates
Elderly
Decreased gastric acidity
Antacids or suppression of acid secretion
Achlorhydria
Altered intestinal function
Inflammatory bowel disease
Prior antibiotic therapy
12. Contd..
Entry in GIT localization in Gut associated
lymphoid tissue Lymphatic channel thoracic
duct circulation primary silent bacteremia
localization in macrophages of RES in spleen, liver,
bone marrow (incubation period 8-14 days)
secondary bacteremia
14. Acute non-complicated disease
Characterized by
Prolonged fever, classic stepladder rise
uncommon.
Disturbances of bowel function Headache,
malaise and anorexia.
Bronchitic cough
Exanthem (rose spots appr 25%) on
the chest, abdomen and back.
15.
16. Complicated disease
10-15% of typhoid patients
CNS (3-35%): Encephalopathy, Typhoid meningitis,
encephalomyelitis, Guillain-Barré syndrome, cranial
or peripheral neuritis and psychotic symptoms, Coma
Vigil.
GIT: occult blood in 10-20% of patients, and intestinal
hemorrhage in upto 1%. Intestinal perforation has also
been reported in up to 1% of hospitalized cases.
Others: Hepatitis, myocarditis, pneumonia,
Empyema, disseminated intravascular, Osteomyelitis
17. Diagnosis
In endemic area, fever without evident cause more
than 7 days should be considered Typhoid until
proved otherwise.
Blood culture – standard diagnostic method . +ve in
40-60%
Failure to isolate the organism
(i) the limitations of laboratory media
(ii) the presence of antibiotics
(iii) the volume of the specimen cultured
18. Blood Cultures in Typhoid Fevers
Bacteremia occurs
early in the disease
Blood Cultures are
positive in
1st
week in 90%
2nd
week in 75%
3rd
week in 60%
4th
week and later in 25%
19. Antigenic structure of Salmonella
Two sets of antigens
Detection by serotyping
1 Somatic or 0 Antigens contain long chain
polysaccharides ( LPS ) comprises of heat stable
polysaccharide commonly.
2 Flagellar or H Antigens are strongly immunogenic and
induces antibody formation rapidly and in high titers
following infection or immunization.
20. Contd..
(iv) the time of collection, patients with a history of
fever for 7 to 10 days being more likely than others to
have a positive blood culture.
Bone marrow aspirate culture is the gold standard
for the diagnosis of typhoid fever
+ve 80-95%
Inspite on antibiotics.
Stool culture +ve in 30% with acute Typhoid
fever. Positivity rate increases with duration of
illness.
Cultures also been made from blood clots, rose
spots, intestinal secretion, urine.
21. Antigenic structure of Salmonella
Two sets of antigens
Detection by serotyping
1 Somatic or 0 Antigens contain long chain
polysaccharides ( LPS ) comprises of heat stable
polysaccharide commonly.
2 Flagellar or H Antigens are strongly immunogenic and
induces antibody formation rapidly and in high titers
following infection or immunization.
23. Widal Test
Measures antibody against O & H antigens of S.typhi.
Sensitivity-60%; specificity-80%.
O antibodies appear on days 6-8 and H antibodies on
days 10-12
Negative in up to 30% of culture-proven cases of typhoid
fever
S. typhi shares O and H antigens with other Salmonella
serotypes and has cross-reacting epitopes with other
Enterobacteriacae, and this can lead to false-positive
results. Such results may also occur in other clinical
conditions, e.g. malaria, typhus, bacteraemia caused by
other organisms, and cirrhosis
24. Contd..
This is acceptable so long as the results are
interpreted with care in accordance with appropriate
local cut-off values for the determination of positivity
A 4 fold rise Ab titre in paired sera highly suggestive
>1:160 titre against O & H highly suggestive with
relevent clinical findings.
25. New serological test
Specific antibodies usually only appear a week after
the onset of symptoms and signs. This should kept in
mind when a negative serological test result is being
interpreted.
New serological tests
Typhidot (better), high negative predictive value
Dipstick test,
DNA Probe
PCR
26. CONTD..
Typhidot –
Rapid serological test, detects IgM $ IgG antibody –
OMP of s.typhi.
Becomes +ve within 2-3 days of infection.
Sensitivity-90-98% ; specificity-75-90%.
Vi agglutinin reaction test- carrier.
CBC- WBC low in relation to fever, leucocytosis
common young children
Thrombocytopenia marker of severe illness/
accompany DIC.
27.
28.
29.
30. Oral drugs
Cotrimoxazole, Ampicillin, Chlorphenicol
Earlier used as 1st
line drugs, due to resistance
became 2nd line drugs.
In endemic area >90% typhoid cases treated at
home with proper antibiotics & good nursing care.
Patients with persistent vomiting, decreased oral
intake, severe diarrhea & abd. Distension require
parenteral antibiotic preferably in hospital.
31. Fluoroquinolones
Optimal for the treatment of typhoid fever
Not approved by drug controller general of India <18 yrs.
Age.
Relatively inexpensive, well tolerated and more rapidly
and reliably effective than the former first-line drugs, viz.
chloramphenicol, ampicillin, amoxicillin and
trimethoprim-sulfamethoxazole.
The majority of isolates are still sensitive.
32. Contd..
Attain excellent tissue penetration, kill S. typhi in
its intracellular stationary stage in
monocytes/macrophages and achieve higher
active drug levels in the gall bladder than other
drugs.
Dose- 15-20 mg/kg/day BD -7 days for NASST and
10-14 days for NARST.
Rapid therapeutic response, i.e. clearance of fever
and symptoms in three to five days, and very low
rates of post-treatment carriage.
33. Chloramphenicol
The disadvantages of using chloramphenicol include
a relatively high rate of relapse (57%), long treatment
courses (14-21 days) and the frequent development of
a carrierstate in adults.
The recommended dosage is 50 – 75 (100mg for iv/im)
mg per kg per day for 14 -21days divided into four
doses per day, or for at least five to seven days after
defervescence.
Oral administration gives slightly greater
bioavailability than intramuscular (i.m.) or
intravenous (i.v.) administration of the succinate salt.
34. Cephalosporins
Oral drugs:- Cefixime, Cefpodoxime.
Parenteral-Ceftriaxone, cefotaxime, cefoperazone.
Cefotaxime: 40-80mg per kg per day in two or three
doses
Ceftriaxone: 50-75 mg/kg/day OD/BD.
Most convenient & widely used.
Cefoperazone: 50-100 mg per kg per day
35. Contd..
In uncomplicated typhoid fever- cefixime DOC as
emperical therapy.
If by 5th
day No clinical improvement & culture
inconclusive—ADD second line drugs eg.
Azithromycin (drugs sensitivity pattern of the
area).
In complicated typhoid- DOC 3rd
gen. cephal.
Parenteral eg. Ceftriaxone.
In severe life threatening infection – FQs. May be
used. Aztreonam/ Imipenam may also be used.
36. hegazi8@hotmailcom 36
MEDICAL COMPLICATIONS
acute bronchitis and frank lobar pneumonia,
toxic myocarditis,
venous thrombosis,
hemolytic anaemia,
acute typhoid nephritis,
typhoid meningitis and
peripheral neuritis
37. hegazi8@hotmailcom 37
MEDICAL COMPLICATIONS
Myocarditis is extremely common, particularly in the
very toxic patient. The cardiac muscle is affected, even
in convalescence, and this is shown by a rapid
deterioration of the cardiovascular system in a relapse,
or after the administration of a general anaesthetic.
Febrile albuminuria is common, but true acute typhoid
nephritis is rare.
Peripheral neuritis and ‘tender toes’.
Mild hemolytic anaemia is fairly common in the very
toxic typhoid patient. A marked degree is rare, and the
mortality rate is high.
38. Dexamethasone for CNS
complication
Should be immediately be treated with high-dose
intravenous dexamethasone in addition to
antimicrobials
Initial dose of 3 mg/kg by slow i.v. infusion over 30
minutes
1 mg/kg 6 hourly for 2 days/ 8 doses.
Mortality can be reduced by some 80-90% in these
high-risk patients
39. hegazi8@hotmailcom 39
Typhoid Pneumonia
Acute bronchitis is so common that it should be
considered as a manifestation of the disease itself
rather than as a complication.
Typhoid lobar pneumonia presents with the
typical symptoms and signs of lobar pneumonia
except that ‘rusty’ sputum is uncommon, and the
white blood cell count is low.
It responds well to chloramphenicol. A patient
with typhoid pneumonia,.
40. GI complication
Patients with intestinal haemorrhage need intensive care,
monitoring and blood transfusion.
Surgical consultation for suspected intestinal perforation
is indicated. If perforation is confirmed, surgical repair
should not be delayed longer than six hours.
Metronidazole and gentamicin or ceftriazone should be
administered before and after surgery .
Early intervention is crucial, and mortality rates increase
as the delay between perforation and surgery lengthens.
Mortality rates vary between 10% and 32%.
41. hegazi8@hotmailcom 41
The major surgical complications of
typhoid fever may include:
parotitis,
intestinal perforation and haemorrhage,
acute cholecystlitis,
paralytic ileus,
orchitis,
pyelitis, cystitis, retention of urine,
empyema,
arthritis and osteomyelitis.
42.
43. Relapse
5-20% of typhoid fever cases that have apparently
been treated successfully.
A relapse is heralded by the return of fever soon
after the completion of antibiotic treatment. The
clinical manifestation is frequently milder than
the initial illness. Cultures should be obtained and
standard treatment should be administered.
Carrier- Temporary carrier(excreate bacilli upto
6-8 wks). eg.incubatory, convalescent state.3
Chronic carrier- excrete bacilli > 3 months after
infection.
44. Paratyphoid fever A,B,C
Caused by Salmonella paratyphoid
A,B,C.respectively.
in no way different from typhoid fever in ,
pathogenesis, pathology,clinical
manifestations,
diagnosis, treatment and
Prophylaxis
45. Paratyphoid A,B:
incubation period 2~15days, in genaral,8~10
days.
milder in severity
fewer in complications.
Better in prognosis,
relapse more common in Paratyphoid A.
Treatment same as in typhoid fever.
46. Paratyphoid C:
Always sudden onset.
Rapid rise of temperature.
Presented in different forms-- Septicemia,
Gastroenteritis and Enteric fever
Complications--arthritis, abscess
formation, cholecystitis, pulmonary
complications are commonly seen.
Intestinal hemorrhage and perforation not
as common as in typhoid fever.
48. Vaccination
Vi polysaccharide, is given in a single dose
Protection begins seven days after injection,
maximum protection being reached 28 days after
injection when the highest antibody
concentration is obtained.
Protective efficacy was 72% one and half years
after vaccination and was still 55% three years
after a single dose.
In Asian countries where Vi-negative strains have
been reported at the low average level of 3%.
49. Live oral vaccine Ty2la
three doses two days apart on an empty stomach.
Protection as from 10-14 days after the third dose.
> 5 years.
Protective efficacy of the enteric-coated capsule
formulation seven years after the last dose is still
62% in areas where the disease is endemic;
Antibiotics should be avoided for seven days
before or after the immunization
50. Contd..
Vi conjugated vaccine:
Induce T cell dependent response
Efficacy- >90%
Booster response
Doses: 3 mths.- 2 yrs.-2doses at 4-8 wks. Interval
followed by booster at 2-2.5 yrs age. Route-
intramuscular.
>2 yrs.- 2 doses at 4-8 wks. Interval.
51. MDR TYPHOID
Clinical failure
presence of persistent symptoms or, development of complications
.
Microbiological failure
positive blood / bone marrow culture at the end of treatment.
MDR Typhoid definition
Epidemiological- strains resistant =>2 antibiotics in vitro.
Clinical- => 2 1st
line drugs viz. Amp., Chlo., Cx.
Incidence - 49-83% of mdr typhoid in indian children.
Mediated by plasmid
Quinolone resistance is frequently mediated by single point
mutations in the quinolone-resistance–determining region of the
52. MDR
Nalidixic acid resistant: MIC of fluoroquinolones for these strains
was 10 times that for fully susceptible strains.
Incidence - 49-83% of mdr typhoid in indian children.
Mediated by plasmid
Quinolone resistance is frequently mediated by single point
mutations in the quinolone-resistance–determining region of the
gyrA gene
53. Diagnosis
High degree of suspicion viz. prolonged fever,
protracted course, unusual/ life threatening
complication, slow response to treatment.
Culture reports
Epidemiological reports.
54. The future of typhoid fever
Cheap,Rapid and reliable serological test
Fluoroquinolone and cephalosporin resistant case
Combination chemotherapy
New drugs
mass vaccination in endemic area
Typhoid vaccination programme for school
children or, with advent of new conjugate vi
vaccine, as part of EPI, should be considered.
56. Mary Mallon
(September 23, 1869 – November 11, 1938)
Also known as Typhoid Mary
was the first person in the United States to be identified as
a healthy carrier of typhoid fever.
She seemed a healthy woman when a health inspector
knocked on her door in 1907, yet she was the cause of
several typhoid outbreaks.
57. Mary Mallon
(September 23, 1869 – November 11, 1938)
Since Mary was the first "healthy carrier" of typhoid fever in the
United States, she did not understand how someone not sick
could spread disease -- so she tried to fight back.
She was forcibly quarantined twice by public health authorities
and died in quarantine.
Over the course of her career as a cook, she infected 47 people,
three of whom died from the disease.
It was also possible that she was born with the disease, as her
mother had typhoid fever during her pregnancy.
58. Mary Mallon
(September 23, 1869 – November 11, 1938)
MaryMallon died on November 11, 1938 at the age of
69
due to pneumonia (not typhoid), six years after a
stroke had left her paralyzed.
However, an autopsy found evidence of live typhoid
bacteria in her gallbladder.
Her body was cremated with burial in Saint Raymond's
Cemetery in the Bronx.
60. Serogroup Example (serotype)* Characteristic syndrome
A S. paratyphi A Enteric fever
B S. paratyphi B Enteric fever or gastroenteritis
B S. typhimurium Gastroenteritis
B S. heidelberg Gastroenteritis, bacteremia
C S. paratyphi C Enteric fever
C S. choleraesuis Bacteremia
C S. newport Gastroenteritis
D S. typhi Enteric fever
D S. enteritidis Gastroenteritis
D S. dublin Bacteremia