TYPHOID FEVER

TYPHOID FEVER

AL-ABBASI A.M.
PhD, FRCP, DCN, DTM&H
Professor of Infectious Diseases & Clinical Immunology

Salmonella groups

ENTEERIC GROUP
S.typhi, Sparatyphi, A, B & C

ENTERIC LIKE ILLNESS

S. enteritidis, S.cholerisuis, S.typhimurium

Salmonella food poisoning

Hundreds species

Typhoid fever

gastric fever, abdominal typhus, infantile remittent fever, slow fever, nervous fever and pythogenic fever.
Typhoid means "resembling typhus" and comes from the neuropsychiatric symptoms common to typhoid and typhus.

Typhoid: putrid malignant fever.

Typhus: slow nervous fever.

History

430–424 BC, a devastating plague killed one third of the population of Athens.

During the American Civil War, 81,360 Union soldiers died of typhoid or dysentery.

Mary Mallon, typhoid Mary in New York.
Several outbreaks in Scotland and Croyden in the UK.


An outbreak in the Democratic Republic of Congo in 2004–05 recorded more than 42,000 cases and 214 deaths.

Transmission

The bacterium spreads through poor hygiene habits and public sanitation conditions, flying insects feeding on feces.

According to statistics from the United States, (CDC), the chlorination of drinking water has led to dramatic decreases in the transmission of typhoid fever in the
U.S.A.
Carriers are the usual reservoirs of TF.

Cystic fibrosis has heterozygous advantage that it confers against typhoid fever.

Clinical picture
? 4 weeks course?
Fever characteristic.
Relative Bradycardia in first week.
leukopenia with eosinopenia
Delirium, typhoid status

Distended and painful abdomen in

the right lower quadrant, where
borborygmi can be heard.
Rose spots
Hepatosplenomegaly, painful;
Pneumotyphoid

Typhoid Fever (Rose Spots) on chest and upper abdomen

Traditional Medicine

Complications

In the third week of typhoid fever, complications can occur:
Intestinal hemorrhage due to bleeding in congested Peyer's patches; this can be very serious but is usually not fatal.

Intestinal perforation in the distal ileum: this is a very serious complication and is frequently fatal.

It may occur without alarming symptoms until septicaemia or diffuse peritonitis sets in.

Encephalopathy.

Neuropsychiatric symptoms "muttering delirium" or "coma vigil"), with picking at bedclothes or imaginary objects.
Metastatic

abscesses, cholecystitis, endocarditis and osteitis

The fever is still very high and oscillates very little over 24 hours.

Dehydration ensues, and the patient is delirious (typhoid state).

One third of affected individuals develop a macular rash on the trunk.


By the end of third week, the fever starts subsiding (defervescence).

Widal test

The Widal test is a presumptive serological test for enteric fever or undulant fever.
whereby bacteria causing typhoid fever are mixed with serum containing specific antibodies obtained from an infected individual.
Agglutination occurs.
BUT???

Treatment

oral rehydration therapy

ciprofloxacin

ceftriaxone or cefotaxime is the first choice

azithromycin is better at treating typhoid in resistant populations than both fluoroquinolone drugs and ceftriaxone.

Resistance to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, is now common, not used as first–line treatment for almost twenty years.


Salmonellosis
Nontyphoidal Salmonella, contracted from:

Poultry, pork, and beef, if the meat is prepared incorrectly or is infected with the bacteria after preparation

Infected eggs, egg products, and milk when not prepared, handled, or refrigerated properly.

Reptiles, such as turtles, lizards, and snakes, which may carry the bacteria in their intestines.
Tainted fruits and vegetables.

Symptoms

IP =12 to 72 hours after ingesting the bacterium.

Symptoms are usually gastrointestinal, nausea, vomiting, abdominal cramps, bloody diarrhea with mucus.

Headache, fatigue, and rose spots are also possible.

Symptoms can be severe, especially in young children and the elderly.
Osteomyelitis in sickle-cell anemia patients.
Reactive arthritis (Reiters syndrome).