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Definition
Typhoid fever is an acute infectious disease of
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
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.
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:
Prevention
Control of source of infection:
isolation
Paratyphoid
Paratyphoid A & B are the same as typhoid