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● Greek word for cloud, to emphasize the severity and long lasting
neuropsychiatric effects among the untreated.
1. AGENT FACTORS
● Specialised fimbrae
● Quorum Sense
Antigenic structure
● S typhi and paratyphi enter the host from distal ileum. They have specialized fimbriae
that adhere to the epithelium over clusters of lymphoid tissue in the ileum (Peyer
patches), here macrophages are traveling from the gut into the lymphatic system.
Blood stream
Disseminated
● 1st Week : Malaise , headache , stepladder fever, dull frontal headache ,coated tongue, dry
cough, bloating , diffuse abdominal pain and tenderness and, colicky right upper quadrant
pain. Inflamed Peyer patches narrow the bowel lumen causing constipation .
● 3rd Week : Weight loss , “Typhoid state” - apathy, confusion and even psychosis, crackles
over the lung bases. Some experience foul, green-yellow, liquid diarrhea (pea soup
diarrhea). Necrotic Peyer’s patches may lead to bowel perforation and peritonitis .
ROSE SPOTS
COMPLICATIONS OF TYPHOID
● General- Toxaemia , DIC , Shock
● Miscellaneous-
Myocarditis,Cholecystitis,Endocarditis,Pericarditis,Glomerulonephritis, Osteomyelitis
,Pneumonia, Hepatitis
DIAGNOSIS
● The classic Widal serologic test for “febrile agglutinins” is simple and rapid but has limited
sensitivity and specificity, especially in endemic regions. Rapid point-of-care tests that detect
antibodies to outer-membrane proteins or to Vi or O:9 antigen are available for detection of S.
Typhi; they are moderately sensitive and specific, but their cost and accuracy have limited their
routine use in developing countries.
● Widal test – Detects antibodies to O, H and Vi antigens of S. paratyphi A, and B, other Salmonella
species.Antibodies against the O antigen are predominating IgM, rise early in the illness and disappear
early.
● In the absence of recent immunisation, a high titre of O antibodies (= 1:320) is useful, but not specific
for typhoid.
● The H antigen are flagellar antigens of Salmonella typhi, paratyphi A and B. Antibodies to H antigens
are both IgM and IgG, rise late in the illness and persist for longer time.
● Typhi dot- detects IgM and IgG antibodies ( against a outer membrane protein)
● DOC for drug-susceptible typhoid fever is fluoroquinolones but due to high prevalence of
ciprofloxacin resistance in Indian subcontinent , not used for empirical treatment .
● Over the years, it has developed increasing resistance to antibiotics. During 2016,
extensively drug-resistant typhoid (XDR) were documented in Pakistan. Only three
classes of antimicrobial agents, azithromycin, carbapenems, and tigecycline, remain
affective among these strains.
PREVENTION