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Typhoid Fever

Dept. Infectious Disease 2nd Affiliated Hospital CMU

Definition
Typhoid fever is an acute infectious disease of

digestive tract caused by typhoid bacillus.


Place of lesson lymphatics in the terminal ileum Pathological feature proliferation of large

mononuclear cells derived from MPS

Definition
Clinical feature

sustained fever relative slow pulse toxic symptoms a rose-color rash splenomegaly and hepatomegaly leukopenia Complication hemorrhage & perforation

Etiology
Causative organism: Typhoid bacillus

genus salmonella group D


Pathogenicity: endotoxin

Resistance: Stable in environment, sensitive to


heat, acid, common disinfectants

Etiology
Antigenicity: O antigen: lipopolysaccharide group-special H antigen: protein, strain-special Vi antigen: polysaccharide

Epidemiology
Source of infection Patient, Carrier, shed bacteria in feces Route of transmission Fecal-oral route: contaminated food or water contagious spread spread by insect Susceptibility Epidemic features sporadic cases high incidence in fall & summer

Pathogenesis
Bacillus Stomach killed by gastric acid incubation Small intestine penetrate mucosa period Regional lymphatics Blood stream - first bacteremia initial MPS in liver, spleen, bone marrow Blood stream -second bacteremia endotoxin liver spleen regional lymphotics Clinical symptoms absces inflammation

Pathology
Proliferation of large mononuclear cell 1st week proliferation edema 2nd 3rd week necrosis ulceration 4th week heal no scar

Clinical manifestation
Incubation period: 7-23 day(average 10 to 14 days) Typical typhoid fever: Initial period Fastigium Defervescence Convalescence

Clinical manifestation
Initial period
onset: insidious, gradual fever: T stepwise fashion rising

non-special symptoms:

Clinical manifestation
Fastigium
sustained fever toxic symptoms:
NS apathy, tinnitus, delirium,lethargy, coma DS anorexia, abdominal Pain, diarrhea Constipation CS relative slow pulse, bradycardia, myocarditis

Clinical manifestation
Fastigium
rose-colored rash: erythematous macules or papules occur on 6~13 days upper abdomen hepatomegaly and splenomegaly

Clinical manifestation
Devervescence Convalescence

Clinical manifestation
Clinical type: Mild type common type prolonged type, ambulatory type fulminate type

Clinical manifestation
Relapse:
It occur 1~3week after T has reached normal. The illness follows a similar pattern to the primary attach. Blood culture positive.

Recurrence: It occur 3~4 after the illness. T


begin to fall, then rise again. Blood culture positive.

Complications
Intestinal hemorrhage Intestinal perforation Toxic hepatitis and myocarditis

Pneumonia

Laboratory Findings
Blood picture: leukopenia Bacteria culture: blood bone morrow urine and stool

Laboratory Findings
Widal test: agglutination of serum reaction 5 Ag: O H, HABC titer:O>=1:80 H>=1:160 results analysis:

Diagnosis
Epidemiological data Clinical manifestation Laboratory findings Definitive diagnosis: bacteria culture positive

Differential Diagnosis
Typhus rickettsises malaria disseminated TB

Treatment
General therapy Etiologic therapy
guinolone:

first choice cephalosporins: 2nd and 3rd generation chloromycetin

Prevention
Control of source of infection:
isolation

Interruption of route of transmission

Protection of susceptible population :


Vaccinated with vaccine

Paratyphoid
Paratyphoid A & B are the same as typhoid

fever Paratyphoid C: septics or gastro-interitis