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TYPHOID FEVER
Typhoid Fever
Enteric Fever Paratyphoid Fever Rose Spot Salmonella typhi Salmonella partyphi
Outbreaks are rare. The germ that causes typhoid is a unique human strain of Salmonella called Salmonella typhi.
Causes
It is caused by infection with Salmonella typhi a bacteria found in infected animals and transmitted to persons in contaminated food or fluids. It is most often found in countries with poor sanitary conditions or contaminated water supplies. Boiling water and thoroughly cooking food can kill the microorganism. The infection can also be spread asymptomatic carriers. These are people who have the bacteria in their gastrointestinal tract, but do not have symptoms.
Qurrataini I. Balocang MED IA 5
Pathophysiology
Systemic bacterial infection (Enteric Fever) 1.Salmonella typhi (Typhoid fever) Most common and more severe form 2. Salmonella paratyphi (Paratyphoid fever) Much more mild than Typhoid fever
Transmission
Ingestion of contaminated food Typhoid germs are passed in the feces and, to some extent, the urine of infected people. The germs are spread by eating or drinking water or foods contaminated by feces from the infected individual.
Epidemiology: Incidence
World: 17 million cases per year U.S.: 400 cases per year (70% in travelers) PHILIPPINES (Nov 2006) 478 in Agusan del Sur. (May 2004) 292 in Bacolod City
Risk factors
Travel to developing country or refugee camp Highly dense living conditions
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Symptoms:
Incubation (first 7-14 days after ingestion) Usually asymptomatic Diarrhea may occur Active infection Severe Headache Generalized Abdominal Pain Anorexia Constipation more common than Diarrhea Fever [usually higher in the evening]
Intermittent Fever initially Sustained Fever to high temperatures later
Qurrataini I. Balocang MED IA 12
Signs:
Pulse-Temperature Dissociation (uncommon) Rose Spots (Pathognomonic, present in 25% of cases)
Blanching pink macular spots 2-3 mm over trunk
For how long can an infected person carry the typhoid germ? The carrier stage varies from a number of days to years. Only about 3% of cases go on to become lifelong carriers of the germ and This tends to occur more often in adults than in children.
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Laboratory Exam
Blood Culture Best Test Sensitivity in first week Bone Marrow culture Higher sensitivity than Blood Culture Fecal culture Low sensitivity (~33%) Salmonella serology (Widal's Test) Poor Test Specificity Low Test Sensitivity (70%)
Qurrataini I. Balocang MED IA 15
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Management: Antibiotics
Specific antibiotics are often used to treat cases of typhoid. Antibiotic Resistance is increasing First-Line: Fluoroquinolones Alternative antibiotics (resistance is common) Chloramphenicol Amoxicillin Trimethoprim-Sulfamethoxazole (Septra)
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Prevention
Choose foods processed for safety Prepare food carefully Foods prepared by others (avoid if possible) Keep food contact surfaces clean (3 wash cycle) Eat cooked food as soon as possible Maintain clean hands Steam or boil shellfish at least 10 minutes All milk and dairy products should be pasteurized Control fly populations
Qurrataini I. Balocang MED IA 19
Mary Mallon
(September 23, 1869 November 11, 1938)
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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.
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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.
Qurrataini I. Balocang MED IA 22
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.
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