Enteric fevers Typhoid fever : Identification : Enteric fever is a systemic disease caused by salmonella typhi , the route of infection is by ingestion. The organism depends on human to human transfer for its existence .

Typhoid fever is endemic in many parts of the world , including Iraq , where there is in adequate water supply & poor standard of hygiene …. In western countries the typhoid infection is uncommon .

-Salmonella typhi is a human pathogen , but some fruit –eating bats may harbor the organism. -Organisms survive for weeks in sewage ..while in fresh water 90% will die within< four weeks.

During acute illness , the organism present in stool, urine, and rarely reach blood before 2 weeks . -Chronic asymptomatic carriers are mostly responsible for persistence of the disease. -It may occur in epidemics or sporadic cases.

Pathogenesis : It is intracellular infection , after ingestion of microorganism , it will penetrate GIT , then in RES cells (multiply ) , go to the blood (septicemia ) , then go to different body systems …L.N ,intestinal wall , gallbladder ,….etc .

Diagnosis : 1st week urine & stool culture . -2nd week & more blood culture is the more precise investigation , but using serological tests like WIDAL TEST , is till now used in many parts of the world- I P :8days-1 month (8-14 days )…for paratyphoid 1-10 days .

CFR : was 10-20% , now <1% . Differential diagnosis : Malaria , Brucellosis , Occult abscess , Endocarditis .

Investigations : Neutropenia . -Stool & blood cultures Bone marrow sometimes needed. -Widal test

Complications : Most serious is GIT bleeding . -Perforation usually in the 3rd & 4th weeks . -Relapse occur in about 15% of cases . -Respiratory system ,cough, pneumonia ,laryngitis , & emphysema. -CVS ..thrombophlebitis ,myocarditis . -GUT..cystitis ,orchitis . -CNS..psychosis ,meningitis .

Prognosis : Before chloramphenicole , mortality with early diagnosis and treatment reduce , few patients may die if ignored . After initiating therapy , clinical improvement can be expected within 2-3 days , but the temperature takes 5 days to settle.

Prevention &Control : Prevention: 1.Health education . 2.Sanitary disposal of human feces . 3.protection ,purification &chlorination of public water . 4. Control flies . 5.clean food handling . 6.Personal hygiene . 7.Immunization for high risk groups.

Control: 1.Report to LHA. 2.Isolation . 3.Concurent disinfectant with terminal cleaning . 4.Specific treatment : a/patient should be isolated (enteric precautions) & if dehydrated give I V fluid . b/Antibiotics for 2 weeks at least …..chlora. Amoxicillin ,co-TMP. c/ Recently used in adults ,Ciprofloxacin &cefriatoxine .