Report on Etiology, Epidemiology of typhoid fever & parathyphoid, Report prepared by 1. Dr. Sajid Mahmood, MD (EU), Accident & Emergency Department, NHS Royal infirmary Liverpool United Kingdom. 2. Dr. Adnan Akram, MD (EU), Department of Infectious Diseas
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Pg-1
Report on Etiology, Epidemiology, Clinic, D/D, Treatment, Profilaxis of typhoid fever & parathyphoid.
A) Etiology.
Salmonella is a G-, motile, bacteria of Enterobacteriacae family.
They are lactose non fermenters.
Produces acid...
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Pg-1
Report on Etiology, Epidemiology, Clinic, D/D, Treatment, Profilaxis of typhoid fever & parathyphoid.
A) Etiology.
Salmonella is a G-, motile, bacteria of Enterobacteriacae family.
They are lactose non fermenters.
Produces acid but not gas from glucose and produces H2S Evident by black colour colonies in Bi2S3 medium
(Shigella don’t produce colonies)
B) Main Types - Salmonella Typhi , Salmonella Paratyphi P, B, Salmonella Cholerasuis
- Salmonella Enteritidis, S typhimuriuns
C) Transmission by - Carriers ,Contaminated focal for water, Dairy products , Meat, Eggs, Shell Fish
D) Infective dose – 105
– 108
bacteria
E) Clinical Syndromes caused by Salmonella.
I- Enteric Fever (Typhi, Paratyphi, Thphimurium)
II- Enterocolitis
III- Bacteraemia (Sepsis)
IV- Extra Intestinal focal infections (Osteomyelitis)
V- Carrier State
Enteric Fever (Thyphoid Fever)
Ethiology: S.
Typhi, Paratyphi P, B, typhimurium.
Pathogenic dose: 105
– 108
bacteria
Pathogenisis: Bacteria enter through epithelium of jejunum reach submucosa phagocytosed by PMN,
Macrophages survive within the cells.
reach the mesenteric L.
N.
and multiply Enter blood stream
Transient bacteremia Reach gall bladder, liver, spleen, bone marrow, L.
N.
Further multiplication
Discharged by RES to intestine Enters peyers patches of distal ileum.
Causes inflammation; necrosis
ulcer formation intestinal bleeding Further ulceration Intestinal perforation.
Clinical features: Usually occurs during 4 weeks – IP: 10-14 days.
1st
Week : 1)Fever increasing in step ladder fashion to 40-41C (Remittent fever)
2) Anorexia, Malaise, Lethorgy
3) Headache – (Frontal)
4) Non productive cough ; sore throat
5) Epistasis
6) Constipation
7) Altered behaviour
* Physical examination during 1st
week reveals a toxic individual with relative bradycardia.
2nd
week : (Several signs can be elicited)
1) numerous erythematous maculopapular rash that blanches on P0
–“Rose
spot rash” appears mainly on the upper abdomen and thorax and lasts
for only 2-3 days.
These are not easily visible on dark skinned people.
2) Mild hepatosplenomegaly
3) Cervical Lymphoadenopathy
4) Right Illiac fossa tenderness
5) Diarrhoea is more common than constipation (Greenish in colour)
6) CNS Symptoms delinium, tremors etc.
3rd week : ”Week of complications” – Includes lobar pneumonia, haemolytic
anaemia, meningitis, cholecystitis, UTI, Intestinal (H), Osteomyelitis,
Intestinal perforation.
4th
week : “Week of convalascence” – Gradual return to health.
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