Typhoid (enteric fever) presentation CHOs 2022.pptx

Enteric fever presentation

1. Typhoid Fever 2 nd Year CHO/CHA-2022 Dr. Brima Bobson Sesay (MBChB, MPH) DMO-Bonthe

2. Typhoid Definition Etiology Pathogenesis Epidemiology Clinical manifestations The laboratory and other examinations Complications Diagnosis and differential diagnosis Prognosis Treatment

3. 1.Definition of Typhoid fever Acute enteric infectious disease caused by Salmonella typhi ( S.Typhi ). prolonged fever, Relative bradycardia , apathetic facial expressions, roseola , splenomegaly, hepatomegaly, leukopenia. intestinal perforation, intestinal hemorrhage

4. 2. Etiology Salmonella typhi Gram-negative rod non-spore flagella Culture characteristics

5. Antigens: located in the cell capsule H ( flagellar antigen). O (Somatic or cell wall antigen). Vi (polysaccharide virulence) “ widel test”

6. A schematic diagram of a single Salmonella typhi cell showing the locations of the H (flagellar), 0 (somatic), and Vi (K envelope) antigens.

7. 3. Epidemiology continues to be a global health problem areas with a high incidence include Asia, Africa and Latin America affects about 6000000 people with more than 600000 deaths a year. 80% in Asia . sporadic occur usually, sometimes have epidemic outbreaks.

8. 4. Source of infection Cases and chronic carriers Cases discharge from incubation, more in 2~4 weeks after onset, a few (about 2~5%) last longer than 3 months chronic carrier Typhoid Mary

9. 5. Transmission fecal-oral route close contact with patients or carriers contaminated water and food flies and cockroaches.

10. 6. Pathogenesis gastrointestinal tract host-pathogen interactions The amount of bacilli infection (>10 5 baeteria).

11. ingested orally Stomach barrier (some Eliminated) enters the small intestine  Penetrate the mucus layer  enter mononuclear phagocytes of ileal peyer's patches and mesenteric lymph nodes  proliferate in mononuclear phagocytes spread to blood. initial bacteremia (Incubation period). Pathogenesis

12. Pathogenesis  enter spleen, liver and bone marrow (reticulo-endothelial system) further proliferation occurs  A lot of bacteria enter blood again. (second bacteremia).  Recovery

13. Pathology essential lesion: proliferation of RES ( reticulo -endothelial system ) specific changes in lymphoid tissues and mesenteric lymph nodes. "typhoid nodules“ Most characteristic lesion : ulceration of mucosa in the region of the Peyer’s patches of the small intestine

14. Major findings in lower ileum Hyperplasia stage(1st week): swelling of lymphoid tissue and proliferation of macrophages. Necrosis stage(2nd week): necrosis of swollen lymph nodes or solitary follicles.

15. Major findings in lower ileum Ulceration stage(3rd week): shedding of necrosis tissue and formation of ulcer ----- intestinal hemorrhage, perforation . Stage of healing (from 4th week): healing of ulcer, no cicatrices and no contraction

16. Clinical manifestations Incubation period: 3 ～ 60 days(7 ～ 14). The initial period (early stage) First week. Insidious onset. Fever up to 39~40 C in 5~7 days chills 、 ailment 、 tired 、 sore throat 、 cough ,abdominal discomfort and constipation et al.

17. The fastigium satge second and third weeks. Sustained high fever 、 partly remittent fever or irregular fever. Last 10 ～ 14 days. Gastro-intestinal symptoms: anorexia 、 abdominal distension or pain 、 diarrhea or constipation Neuropsychiatric manifestations: confusion 、 blunt respond even delirium and coma or meningism

18. Circulation system : relative bradycardia . splenomegaly 、 hepatomegaly toxic hepatitis. roseola :30%, maculopapular rash a faint pale color, slightly raised round or lenticular, fade on pressure 2-4 mm in diameter, less than 10 in number on the trunk, disappear in 2-3 days.

19. Fatal complications: Intestinal hemorrhage Intestinal perforation Severe toxemia

20. defervescence stage fever and most symptoms resolve by the forth week of infection. Fever come down, gradual improvement in all symptoms and signs, but still danger. convalescence stage the fifth week . disappearance of all symptoms, but can relapse

21. Special manifestations In children Often atypical sudden onset with high fever. Respiratory symptoms and diarrhea, dominant. Convulsion common in below 3. relative bradycardia rare. Splenomegaly, roseola and leucopenia less common.

22. In the aged temperature not high, weakness common. More complications.high mortality.

23. 7. Laboratory findings. Routine examinations: white blood cell count is normal or decreased. Leukocytopenia (specially eosinophilic leukocytopenia ). recovery with improvement of diseases decreased in relapse

24. II. Bacteriological examinations: Blood culture: the most common use 80~90% positive during the first 2 weeks of illness 50% in 3rd week not easy in 4th week re-positive when relapse and recrudesce attention to the use of antibiotics

25. 8. Complications Intestinal hemorrhage Intestinal perforation Toxic hepatitis Toxic myocarditis Bronchitis, bronchopneumonia

26. Other complications : toxic encephalopathy. Hemolytic uremic syndrome. acute cholecystitis 、 meningitis 、 nephritis et al.

27. 9.Differential diagnosis Viral infections Malaria Leptospirosis Tuberculosis Septicemia of Gram-negative bacilli

28. 10. Prognosis: Case fatality 0.5 ～ 1%. But high in old ages 、 infant 、 and serious complications Have immunity for ever after diseases About 3% of patients become fecal carriers .

29. 11. TREATMENT General treatment Isolation and rest good nursing care and supportive treatment close observation T,P,R,BP,abdominal condition and stool . suitable diet include easy digested food or half-liquid food.drink more water intravenous injection to maintain water and acid-base and electrolyte balance

30. Symptomatic treatment: for high fever: physical measures firstly antipyretic drugs such as aspirin should be administrated with caution delirium,coma or shock,2-4mg dexamethasone in addition to antibiotics reduces mortality.

31. Etiologic and special treatment 1.Quinolones: first choice it’s highly against S.typhi penetrate well into macrophages,and achieve high concentrations in the bowel and bile lumens Norfloxacin (0.1 ～ 0.2 tid ～ qid/10 ～ 14 days). Ofloxacin (0.2 tid 10 ～ 14days). ciprofloxacin (0.25 tid) caution: not in children and pregnant

32. 3.Cephalosporines: Only third generation effective Cefoperazone and Ceftazidime. 2 ～ 4g/day .10~14 days. 4.Treatment of complication. Intestinal bleeding: bed rest, stop diet,close observation T,P,R,BP. intravenous saline and blood transfusion,and attention to acid-base balances. sometimes,operative.

33. Perforation: early diagnosis. stop diet. decrease down the stomach pressure. intravenous injection to maintain electrolyte and acid-base balances. use of antibiotics. sometimes operative.

34. Toxic myocarditis: bed rest, cardiac muscle protection drugs, dexamethasone, digoxin. 5.Chronic carrier: Ofloxacin 0.2 bid or ciprofloxacin 0.5 bid, 4 ～ 6 weeks. Ampicillin 3 ～ 6g/day tid plus probenecid 1 ～ 1.5g/day. 4 ～ 6 weeks. TMP+SMZ 2 tabs. Bid. 1 ～ 3 months. Cholecystitis may require cholecystectomy.

35. Thank you!!!