1. 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 .

2. 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 .

3. -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.

4. 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.

5. 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 .

6. 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 .

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

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

9. 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 .

10. 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.

11. 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.

12. 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 .