Download Cholera Definition

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