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Typhoid Fever

Dept. Infectious Disease

2nd Affiliated HospitalCMU

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DefinitionTyphoid 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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DefinitionClinical feature

sustained fever

relative slow pulse

toxic symptoms

a rose-color rash

splenomegaly and hepatomegaly

leukopenia

Complication hemorrhage & perforation

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EtiologyCausative organism: Typhoid bacillus

genus salmonella group D

Pathogenicity: endotoxin

Resistance: Stable in environment, sensitive toheat, acid, common disinfectants

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EtiologyAntigenicity:O antigen: lipopolysaccharide

group-special

H antigen: protein, strain-special

Vi antigen: polysaccharide

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EpidemiologySource of infection

Patient, Carrier, shed bacteria in feces

Route of transmissionFecal-oral route:contaminated food or water

contagious spread

spread by insectSusceptibility

Epidemic features sporadic cases

high incidence in fall & summer

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PathogenesisBacillus 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 bacteremiaendotoxin liver spleen regional lymphotics

Clinical symptoms absces inflammation

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PathologyProliferation of large mononuclear cell

1stweek 2nd3rdweek 4thweek

proliferation necrosis heal

edema ulceration no scar

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Clinical manifestationIncubation period:7-23 day(average 10 to

14 days)

Typical typhoid fever:

Initial period

Fastigium Defervescence

Convalescence

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Clinical manifestationInitial period

onset: insidious, gradualfever: T stepwise fashion rising

non-special symptoms:

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Clinical manifestationFastigium

sustained fevertoxic symptoms:

NS apathy, tinnitus, delirium,lethargy, coma

DS anorexia, abdominal Pain, diarrhea ConstipationCS relative slow pulse, bradycardia, myocarditis

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Clinical manifestationFastigium

rose-colored rash:erythematous macules or papules

occur on 6~13 days

upper abdomen

hepatomegaly and splenomegaly

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Clinical manifestationDevervescence

Convalescence

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Clinical manifestationClinical type:

Mild type

common type

prolonged type,

ambulatory typefulminate type

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Clinical manifestationRelapse: It occur 1~3week after T has reachednormal. The illness follows a similar pattern to

the primary attach. Blood culture positive.

Recurrence: It occur 3~4 after the illness. Tbegin to fall, then rise again.

Blood culture positive.

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ComplicationsIntestinal hemorrhage

Intestinal perforation

Toxic hepatitis and myocarditis

Pneumonia

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Laboratory FindingsBlood picture: leukopenia

Bacteria culture: blood

bone morrow

urine and stool

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Laboratory FindingsWidal test:

agglutination of serum reaction

5 Ag: OH,HABC

titer:O>=1:80 H>=1:160

results analysis:

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Differential DiagnosisTyphus

rickettsises

malaria

disseminated TB

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TreatmentGeneral therapy

Etiologic therapy

guinolone: first choice

cephalosporins: 2ndand 3rdgeneration

chloromycetin

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PreventionControl of source of infection: isolation

Interruption of route of transmission

Protection of susceptible population :

Vaccinated with vaccine

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ParatyphoidParatyphoid A & B are the same as typhoid

fever

Paratyphoid C: septics or gastro-interitis