Typhoid Fever: ( Enterica )
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Typhoid Fever ( Enterica )
www.MansFans.com
Typhoid fevers are prevalent in many regions in the World
www.MansFans.com
Etiology of Typhoid fever
Typhoid fever is a bacterial disease, caused by Salmonella typhi.
It is transmitted through the ingestion of food or drink contaminated by the faeces or urine of infected people.
Paratyphoid fevers are produced by other species named Paratyphi A, B, C
It is similar in its symptoms to typhoid fever, but tends to be milder, with lower fatality rate. www.MansFans.com
Bacteriology –Typhoid fever
The Genus Salmonella belong to Enterobactericiae Facultative anaerobe Gram negative bacilli Distinguished from other bacteria by Biochemical and antigen structure www.MansFans.com
Antigenic structure of Salmonella Two sets of antigens Detection by serotyping
Somatic ( O ) Antigens. Flagellar ( H ) Antigens.
www.MansFans.com
How Typhoid fever spreads
S.Typhi lives only in humans.
Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. Small number of persons, called carriers , recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed S. Typhi in their feces (stool). www.MansFans.com
Clinical features Typhoid fever (enteric fever) is a septicemia, illness characterized by fever, bradycardia, splenomegaly, abdominal symptoms and 'rose spots' which are clusters of pink mauls on the skin. Complications such as intestinal hge or perforation can develop in untreated patients or when treatment is delayed. www.MansFans.com
Pathology and Pathogenesis of Enteric fever
Caused by S. typhi S.paratyphi A BC
The organisms penetrate ileal mucosa, reach mesentric lymph nodes via Lymphatics, Multiply. In 7 – 10 days invade blood stream via thoracic duct → Liver, GB,
spleen, Kidney, BM.
From GB, further invasion occurs in intestines Involvement of peyr’s patches, gut lymphoid tissue → inflammatory reaction, and infiltration with monocular cells → necrosis, Sloughing and formation of chacterstic typhoid ulcers
www.MansFans.com
Clinical presentation
Ingestion to onset of fever varies from 3 – 50 days (2 weeks). Insidious onset, early symptoms are vague
Dull continuous headache Abdominal tenderness discomfort may present with constipation. Step ladder pattern FEVER that fall by crisis in 3rd – 4th week
www.MansFans.com
Other manifestations
Relative bradycardia Hepatomegaly Splenomegaly
www.MansFans.com
Rashes in Typhoid
Rose spots, discrete pink maculae's found in front of chest Appear in crops of upto a dozen at a time Fade after 3 – 4 days
www.MansFans.com
Complication in Typhoid
Intestinal hge and perforation If not diagnosed can lead to fatal complications.
www.MansFans.com
Relapse
Apparent recovery can be followed by relapse in 5 – 10 % of untreated patients On few occasions relapses can be severe and may be fatal.
www.MansFans.com
Typhoid carriers
30% of typhoid survivors become carriers. In carriers the bacteria remain hidden inside cells and the GB, causing new infections as they are shed from an apparently healthy host.
www.MansFans.com
Diagnosis of Enteric Fever
www.MansFans.com
Blood Cultures in Typhoid Fevers
Bacteremia occurs early in the disease Blood Cultures are positive in
1st week in 90% 2nd week in 75% 3rd week in 60% 4th week and later in 25% www.MansFans.com
Other methods in Isolation of Enteric Pathogens
Feces Culture Urine Culture BM cultures ( Highly Sensitive )
www.MansFans.com
Diagnosis of Carriers
Useful in screening food handlers, cooks, to detect carrier state
Typhoid bacilli can be isolated from feces or from bile aspirates Detection of Vi agglutinins in the Blood can be determinant of carrier state.
Diagnosis of Enteric Fever Widal test
Serum agglutinins raise abruptly during the 2nd or 3rd week The widal test detects antibodies against O and H antigens Two serum specimens obtained at intervals of 7 – 10 days to read the raise of antibodies. Serial dilutions on unknown sera are tested against the antigens for respective Salmonella False positives and False negative limits the utility of the test Cross reactions limits the specificity www.MansFans.com
Significant Titers helps in Diagnosis
The following titers are significant when single sample is tested O > 1 in 160 H > 1 in 320 Testing a paired sample for raise of titers has greater significance
www.MansFans.com
Antimicrobial Therapy in Typhoid
Previously Choramphenicol was the drug of choice for the treatment of typhoid fever. But increasing resistance to it has prompted the use of other antibiotics . 3rd generation cephalosporins, like Ceftriaxone, and Flouroquinolones, like ciprofloxacin and levofloxacin are the drugs of choice for treatment of typhoid fever. www.MansFans.com
Vaccines for Typhoid Prevention
Two types of vaccines are available Oral and Injectable
Oral – live oral vaccine ( typhoral ) - One capsule given orally taken before food, with glass of water or milk, on 1, 3, 5 days ( three doses ). No antibiotics should be taken during the period of administration of vaccine The inject able vaccine, ( typhim –vi) - Given as single subcutaneous or intramuscular injection
Immunity lasts for 3 years. Need a booster www.MansFans.com
www.MansFans.com
Typhoid fevers are prevalent in many regions in the World
www.MansFans.com
Etiology of Typhoid fever
Typhoid fever is a bacterial disease, caused by Salmonella typhi.
It is transmitted through the ingestion of food or drink contaminated by the faeces or urine of infected people.
Paratyphoid fevers are produced by other species named Paratyphi A, B, C
It is similar in its symptoms to typhoid fever, but tends to be milder, with lower fatality rate. www.MansFans.com
Bacteriology –Typhoid fever
The Genus Salmonella belong to Enterobactericiae Facultative anaerobe Gram negative bacilli Distinguished from other bacteria by Biochemical and antigen structure www.MansFans.com
Antigenic structure of Salmonella Two sets of antigens Detection by serotyping
Somatic ( O ) Antigens. Flagellar ( H ) Antigens.
www.MansFans.com
How Typhoid fever spreads
S.Typhi lives only in humans.
Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. Small number of persons, called carriers , recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed S. Typhi in their feces (stool). www.MansFans.com
Clinical features Typhoid fever (enteric fever) is a septicemia, illness characterized by fever, bradycardia, splenomegaly, abdominal symptoms and 'rose spots' which are clusters of pink mauls on the skin. Complications such as intestinal hge or perforation can develop in untreated patients or when treatment is delayed. www.MansFans.com
Pathology and Pathogenesis of Enteric fever
Caused by S. typhi S.paratyphi A BC
The organisms penetrate ileal mucosa, reach mesentric lymph nodes via Lymphatics, Multiply. In 7 – 10 days invade blood stream via thoracic duct → Liver, GB,
spleen, Kidney, BM.
From GB, further invasion occurs in intestines Involvement of peyr’s patches, gut lymphoid tissue → inflammatory reaction, and infiltration with monocular cells → necrosis, Sloughing and formation of chacterstic typhoid ulcers
www.MansFans.com
Clinical presentation
Ingestion to onset of fever varies from 3 – 50 days (2 weeks). Insidious onset, early symptoms are vague
Dull continuous headache Abdominal tenderness discomfort may present with constipation. Step ladder pattern FEVER that fall by crisis in 3rd – 4th week
www.MansFans.com
Other manifestations
Relative bradycardia Hepatomegaly Splenomegaly
www.MansFans.com
Rashes in Typhoid
Rose spots, discrete pink maculae's found in front of chest Appear in crops of upto a dozen at a time Fade after 3 – 4 days
www.MansFans.com
Complication in Typhoid
Intestinal hge and perforation If not diagnosed can lead to fatal complications.
www.MansFans.com
Relapse
Apparent recovery can be followed by relapse in 5 – 10 % of untreated patients On few occasions relapses can be severe and may be fatal.
www.MansFans.com
Typhoid carriers
30% of typhoid survivors become carriers. In carriers the bacteria remain hidden inside cells and the GB, causing new infections as they are shed from an apparently healthy host.
www.MansFans.com
Diagnosis of Enteric Fever
www.MansFans.com
Blood Cultures in Typhoid Fevers
Bacteremia occurs early in the disease Blood Cultures are positive in
1st week in 90% 2nd week in 75% 3rd week in 60% 4th week and later in 25% www.MansFans.com
Other methods in Isolation of Enteric Pathogens
Feces Culture Urine Culture BM cultures ( Highly Sensitive )
www.MansFans.com
Diagnosis of Carriers
Useful in screening food handlers, cooks, to detect carrier state
Typhoid bacilli can be isolated from feces or from bile aspirates Detection of Vi agglutinins in the Blood can be determinant of carrier state.
Diagnosis of Enteric Fever Widal test
Serum agglutinins raise abruptly during the 2nd or 3rd week The widal test detects antibodies against O and H antigens Two serum specimens obtained at intervals of 7 – 10 days to read the raise of antibodies. Serial dilutions on unknown sera are tested against the antigens for respective Salmonella False positives and False negative limits the utility of the test Cross reactions limits the specificity www.MansFans.com
Significant Titers helps in Diagnosis
The following titers are significant when single sample is tested O > 1 in 160 H > 1 in 320 Testing a paired sample for raise of titers has greater significance
www.MansFans.com
Antimicrobial Therapy in Typhoid
Previously Choramphenicol was the drug of choice for the treatment of typhoid fever. But increasing resistance to it has prompted the use of other antibiotics . 3rd generation cephalosporins, like Ceftriaxone, and Flouroquinolones, like ciprofloxacin and levofloxacin are the drugs of choice for treatment of typhoid fever. www.MansFans.com
Vaccines for Typhoid Prevention
Two types of vaccines are available Oral and Injectable
Oral – live oral vaccine ( typhoral ) - One capsule given orally taken before food, with glass of water or milk, on 1, 3, 5 days ( three doses ). No antibiotics should be taken during the period of administration of vaccine The inject able vaccine, ( typhim –vi) - Given as single subcutaneous or intramuscular injection
Immunity lasts for 3 years. Need a booster www.MansFans.com
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