TYPHOID

Typhoid is also known as enteric fever. It is caused by Salmonella typhi and Salmonella paratyphi A and B. A range of clinical syndrome includes the diarrheal disease. These organisms are transmitted by the feco-oral route, usually by the carriers, often food handlers, through the contamination of food, milk and water.

Pathogenesis

The typhoid bacilli reach the small intestine, penetrate the mucosa and enter intestinal lymphatics via Peyer’s patches to be carried to the bloodstream. The bacilli are disseminated throughout the body and intracellular multiplication takes place. The organisms re-enter the bloodstream producing bacteremia when all organs are repeatedly exposed to typhoid bacilli.

Clinical Features

Symptoms of Typhoid

1st week
  • Step ladder fever
  • Malaise
  • Headache
  • Diarrhea
  • Vomiting
  • Constipation – rarely
  • Relative bradycardia

 2nd Week
  • Transient maculopapular rash (Rose Spot – present at lower trunk and upper abdomen)
  • Spleenomegaly
  • Abdominal distension
  • Diarrhea
  • Cough

 3rd Week
  • Delirium
  • Altered sensation
  • Complications are seen
  • Coma Death

 Complications

  • General – Toxaemia, dehydration, circulatory failure, DIC
  • Gastrointestinal – Perforation of intestine, intestinal hemorrhage
  • Neurological – Delirium, psychosis, meningitis, encephalopathy, coma
  • Miscellaneous – Myocarditis, endocarditis, pericarditis, pyelonephritis, pneumonia, arthritis, osteomyelitis

 Investigations

  • Complete Blood Count – Total and Differential Count, Hb
  • Blood Culture (B) – 1st week
  • Agglutination Test (A) (Widal test) – 2nd week
  • Stool Culture (S) – 3rd week
  • Urine Culture (U) – 4th week
  • Bone Marrow Culture
  • Bile Culture
  • PCR
  • ELISA
  • Scratch Test from rose spot
  • USG – hepatomegaly, splenomegaly
  • CPR

 Management

  • Bed rest
  • Isolation
  • Maintenance of nutrition and fluid intake
  • Antibiotics (2 weeks) – Ciprofloxacin (500mg BD is drug of choice) or Cotrimoxazole or Amoxicillin
  • If the disease is severe – IV antibiotic

 Prevention

  • Good hygiene
  • Proper sewage disposal
  • Proper water treatment
  • If endemic area – Typhoid vaccine


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