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Dept. Infectious Disease 2nd Affiliated Hospital CMU
Typhoid Fever Dept. Infectious Disease 2nd Affiliated Hospital CMU
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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
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Definition Clinical feature sustained fever relative slow pulse
toxic symptoms a rose-color rash splenomegaly and hepatomegaly leukopenia Complication hemorrhage & perforation
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Etiology Causative organism: Typhoid bacillus Pathogenicity: endotoxin
genus salmonella group D Pathogenicity: endotoxin Resistance: Stable in environment, sensitive to heat, acid, common disinfectants
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Etiology Antigenicity: O antigen: lipopolysaccharide group-special
H antigen: protein, strain-special Vi antigen: polysaccharide
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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
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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
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Pathology Proliferation of large mononuclear cell
1st week nd 3rd week th week proliferation necrosis heal edema ulceration no scar
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Clinical manifestation
Incubation period: 7-23 day(average 10 to 14 days) Typical typhoid fever: Initial period Fastigium Defervescence Convalescence
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Clinical manifestation
Initial period onset: insidious, gradual fever: T stepwise fashion rising non-special symptoms:
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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
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Clinical manifestation
Fastigium rose-colored rash: erythematous macules or papules occur on 6~13 days upper abdomen hepatomegaly and splenomegaly
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Clinical manifestation
Devervescence Convalescence
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Clinical manifestation
Clinical type: Mild type common type prolonged type, ambulatory type fulminate type
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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.
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Complications Intestinal hemorrhage Intestinal perforation
Toxic hepatitis and myocarditis Pneumonia
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Laboratory Findings Blood picture: leukopenia Bacteria culture:
bone morrow urine and stool
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Laboratory Findings Widal test: agglutination of serum reaction
5 Ag: “O” “H”, “HABC” titer:O>=1:80 H>=1:160 results analysis:
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Diagnosis Epidemiological data Clinical manifestation
Laboratory findings Definitive diagnosis: bacteria culture positive
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Differential Diagnosis
Typhus rickettsises malaria disseminated TB
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Treatment General therapy Etiologic therapy guinolone: first choice
cephalosporins: 2nd and 3rd generation chloromycetin
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Prevention Control of source of infection:
isolation Interruption of route of transmission Protection of susceptible population : Vaccinated with vaccine
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Paratyphoid Paratyphoid A & B are the same as typhoid fever
Paratyphoid C: septics or gastro-interitis
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