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Typhoid Fever
Dept. Infectious Disease
2nd Affiliated HospitalCMU
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DefinitionTyphoid 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
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DefinitionClinical feature
sustained fever
relative slow pulse
toxic symptoms
a rose-color rash
splenomegaly and hepatomegaly
leukopenia
Complication hemorrhage & perforation
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EtiologyCausative organism: Typhoid bacillus
genus salmonella group D
Pathogenicity: endotoxin
Resistance: Stable in environment, sensitive toheat, acid, common disinfectants
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EtiologyAntigenicity:O antigen: lipopolysaccharide
group-special
H antigen: protein, strain-special
Vi antigen: polysaccharide
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EpidemiologySource of infection
Patient, Carrier, shed bacteria in feces
Route of transmissionFecal-oral route:contaminated food or water
contagious spread
spread by insectSusceptibility
Epidemic features sporadic cases
high incidence in fall & summer
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PathogenesisBacillus 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 bacteremiaendotoxin liver spleen regional lymphotics
Clinical symptoms absces inflammation
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PathologyProliferation of large mononuclear cell
1stweek 2nd3rdweek 4thweek
proliferation necrosis heal
edema ulceration no scar
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Clinical manifestationIncubation period:7-23 day(average 10 to
14 days)
Typical typhoid fever:
Initial period
Fastigium Defervescence
Convalescence
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Clinical manifestationInitial period
onset: insidious, gradualfever: T stepwise fashion rising
non-special symptoms:
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Clinical manifestationFastigium
sustained fevertoxic symptoms:
NS apathy, tinnitus, delirium,lethargy, coma
DS anorexia, abdominal Pain, diarrhea ConstipationCS relative slow pulse, bradycardia, myocarditis
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Clinical manifestationFastigium
rose-colored rash:erythematous macules or papules
occur on 6~13 days
upper abdomen
hepatomegaly and splenomegaly
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Clinical manifestationDevervescence
Convalescence
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Clinical manifestationClinical type:
Mild type
common type
prolonged type,
ambulatory typefulminate type
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Clinical manifestationRelapse: It occur 1~3week after T has reachednormal. The illness follows a similar pattern to
the primary attach. Blood culture positive.
Recurrence: It occur 3~4 after the illness. Tbegin to fall, then rise again.
Blood culture positive.
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ComplicationsIntestinal hemorrhage
Intestinal perforation
Toxic hepatitis and myocarditis
Pneumonia
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Laboratory FindingsBlood picture: leukopenia
Bacteria culture: blood
bone morrow
urine and stool
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Laboratory FindingsWidal test:
agglutination of serum reaction
5 Ag: OH,HABC
titer:O>=1:80 H>=1:160
results analysis:
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Differential DiagnosisTyphus
rickettsises
malaria
disseminated TB
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TreatmentGeneral therapy
Etiologic therapy
guinolone: first choice
cephalosporins: 2ndand 3rdgeneration
chloromycetin
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PreventionControl of source of infection: isolation
Interruption of route of transmission
Protection of susceptible population :
Vaccinated with vaccine
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ParatyphoidParatyphoid A & B are the same as typhoid
fever
Paratyphoid C: septics or gastro-interitis