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 2nd 3rd week 4th week

proliferation necrosis heal
edema ulceration 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