Typhoid fever

TYPHOID FEVER (ENTERIC FEVER)

    Definition: - Typhoid fever is an infectious disease by salmonela typhi &               salmonela paratyphi A,B 

ü  Which is gram negative, non-spore forming bacilli .The bacilli may live in gallbladder of carriers for month of year after clinical recovery & pass intermittently in the stool.

ü  Major cause morbidity and mortality.

ü  Food water borne disease.

ü  The bacteria are deposited in water or food by a human carrier and then spread to other people.

    CAUSE OF TYPHOID FEVER

          BACTERIA  - Salmonella Typhi.

                                               • Family-Enterobacteriacea.

                                                • Gram negative bacilii.

                                                • Best grows at 37 C

              

   TRANSMISSION OF TYPHOID

Fecal-oral route:-

•       Close contact with patients or carriers.

•       Contaminated water and food.

•       Flies and cockroaches.

 Does typhoid spread by kissing?

ü  The organisms can be transferred from person to person by both direct (via saliva, fecal/oral spread, kissing) and indirect contact (for example, using contaminated eating utensils)

ü  It occurs predominantly in association with poor sanitation and lack of clean drinking water

How to diagnosis of typhoid by clinical features & laboratory 

Clinical features:-

•       Onset may be insidious

•       Incubation period :- 10-14 day

1.      First weeks

•       High fever 103–104° F :- continuous , stepladder fashion

•       Headache

•       Myalgia

•       Relative bradycardiya

•        Constipation

•       Diarrhoea

•       Vomiting 

2.       End of first week:-

•       Ross spots on the trunk

•       Enlarge spleen

•       Cough

•       Stomach pain

•       Abdominal distended

3.       End of second week :-

•       Complication  , Delirium  , coma & death 

Complications of typhoid

•       Perforation, haemorrage

•       Septicemia

•       Bone & joint infection

•       Meningitis

•       Cholicystitis

•       Toxic phenomena-nephritis

•       Myocardidits 

Investigation of typhoid fever

•       Blood count – Leucopenia with relative pymphocytosis.

•       1st week – Blood culture positive

•       2nd week – Widal test positive

•       3rd week – Stool & urine culture positive

•       Blood count – Leucopenia with relative pymphocytosis.

•       1st week – Blood culture positive

•       2nd week – Widal test positive

•       3rd week – Stool & urine culture positive

•       NEW DIAGNOSTIC TESTS:-

•        IDL Tubex detects IgM09 antibodies within few minutes

•        Typhidot test that detects presence of IgM and IgG in one hour (sensitivity>95%, Specificity 75%)

•       Typhidot-M that detects IgM only (sensitivity 90% and specificity 93%) 

•       Typhidot rapid (sensitivity 85% and Specificity 99%) is a rapid 15 minute immunochromatographic test to detect IgM.

•       IgM dipstick test

Management of typhoid fever

General: - Supportive care includes

•       Maintenance of adequate hydration. Antipyretics. Appropriate nutrition.

•       Specific: Antimicrobial therapy is the mainstay treatment.

 Use antibiotics according to culture & sensitivity

Prevention of typhoid fever

CONTROL OF SANITATION

Protection & purification of drinking water supplies • Improvement of basic sanitation • Promotion of food hygiene

•       Best prevention Scrub of them off your hands Best prevention Scrub them off your hands

•       Simple hand hygiene and washing can reduce several cases of Typhoid

•       IMMUNIZATION :-Vaccination recommended 

Pathology of Typhoid infection 

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