Typhoid fever serology | Lecture 10

Causes

vCaused by the bacterium Salmonella Typhi.

vIngestion of contaminated food or water.
vClose contact with patients or carriers.
Water is contaminated.
v Eating food or drinking beverages that handled by a person carrying the bacteria.
v Senteriditis and Salmonella typhimurium are other salmonella bacteria, cause
food poisoning and diarrhoea.
 Etiology
*Gram-
Salmonella negative

*rod qAntigens: located in the cell capsule

H (flagellar antigen).
O (Somatic or cell wall antigen).
*non-spore
Vi (polysaccharide virulence)

*Flagella
qLive 2-3 weeks in water.
1-2 months in stool.

qResistance to drying and cooling

 Pathogenesis
• Ingestion of contaminated food or water (Salmonella bacteria)

• Invade small intestine (mononuclear phagocytes of peyer's patches) and

enter the bloodstream (initial bacteremia)

• Carried by white blood cells in the liver, spleen, and bone marrow

• Multiply and reenter the bloodstream (lot of bacteria enter blood again
(second bacteremia)

• Bacteria invade the gallbladder, biliary system, and the lymphatic tissue of
the bowel and multiply in high numbers

• Then pass into the intestinal tract and can be identified for diagnosis in
cultures from the stool tested in the laboratory
 S.Typhi.

stomach (mononuclear phagocytes )

Lower ileum

LN Proliferate,swell
necrosis
Enterorrhagia defervescence stage thoracic duct
,intestinal （3-4w）
perforation
Symptoms

• No symptoms - if only a mild exposure; some people become "carriers" of typhoid.

• Poor appetite,
• Headaches,
• Generalized pains,
• Fever, sleepiness
• Diarrhea,
• Have a sustained fever as high as 39 to 40 o C
• Chest congestion develops in many patients, and abdominal pain and discomfort are common,
• mild vomiting, slow heartbeat.
 Rose spots Aches and pains

Typhoid Meningitis

High fever
Diarrhea Chest congestion
Clinical manifestations

Occurs gradually over a few weeks after

exposure to the bacteria.

Sometimes children suddenly become

sick.

The condition may last for weeks or even

a month or longer without treatment.
 First-Stage Typhoid Fever
§ The beginning stage is characterized by high fever, fatigue, weakness, headache, sore
throat, diarrhea, stomach pain and a skin rash on the chest and abdominal area.

§ Adults are most likely to experience constipation, while children usually experience
diarrhea.

Second stage
§ Second-stage typhoid fever is characterized by weight loss, high fever, severe diarrhea
and severe constipation. Also, the abdominal region may appear severely distended
(swollen).

Typhoid State
§ When typhoid fever continues untreated for more than two or three weeks, the effected
individual may be unable to stand and move, and the eyes may be partially open during
this time. At this point fatal complications may emerge.
 • Intestinal hemorrhage
fatal complications: • Intestinal perforation
• Severe toxemia
Special manifestations
In children
• Sudden onset with high fever.
• Respiratory symptoms and diarrhea, dominant.
• Convulsion common in below 3.

In the aged
• Temperature not high, weakness common.
• More complications, high mortality.
• Clinical manifestations reappear
• Less severe than initial episode
Recrudescence
• It’s temperature recrudesce when temperature start to
• step down in the period of 2-3 weeks and persist 5~7
(relapse)
• days then back to abnormal.
• Seen in patients with short therapy of antibiotics.
• Serum positive of S.typhi after 1～3 weeks of
• temperature down to normal.
• The bacilli have not been completely removed
Two main typhoid fever prevention strategies:
1. Vaccination
v First type of vaccine:
§ Contains killed Salmonella typhi bacteria.
§ Administered by a shot.
v Second type of vaccine:
§ Contains a live but weakened strain of the Salmonella bacteria
that causes typhoid fever.
§ Taken by mouth.
2. Avoid risky food and drinks
v Buy bottled drinking water or bring it to boil for one minute Prevention
before drinking it.
v Ask for drinks without ice, unless the ice is made from bottled or
boiled water.
v Eat food that have been thoroughly cooked and that are still hot
and steaming.
v Avoid raw vegetables and food that cannot be peeled like
lettuce.
v When eat raw fruit and vegetables that can be peeled, Don’t eat
the peelings.
v Avoid foods and beverages from street vendors.
Treatment
Diet
§ Fluids and electrolytes should be monitored and replaced.
§ Oral nutrition with a soft digestible diet is preferable in the absence of
abdominal pain.
§ The patient should be encouraged to stay home from work until recovery

Medication
§ Antibiotics, such as ampicillin, chloramphenicol, fluoroquinolone
trimethoprim-sulfamethoxazole, Amoxicillin and ciprofloxacin etc used to
treat typhoid fever.
§ Treatment of the disease with antibiotics reduces the case-fatality