Notes in typhoid fever

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Notes in Typhoid Fever : 

Notes in Typhoid Fever Dr. Hussam El MouziClinical PathologistAl Borg Laboratory

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Typhoid---ancient Greek Typhos, smoke or cloud that was believed to cause disease or madness

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S. typhi, a major human pathogen for thousands of years, thriving in conditions of poor sanitation, crowding, and social chaos

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the king of actors on the stage of disease, can present and progress in many diverse and varied ways .


BACTERIOLOGY the enteric bacilli have 3 common antigens: O antigen (body or somatic) H antigen on the flagellae, Vi antigen (virulence antigen)


RISK AREA Typhoid Fever is still common in the developing world. It affects about 21.5 million people worldwide every year.

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Source of infection : Source of infection Since there is No animal host , The source of infection are either : 1)Patient :suffering from the disease including mild& ambulatory cases, which excretes bacilli in the faeces & urine for about one month .infected vomit & pus from abscesses are also sources of infection.

Source of infection : Source of infection 2) Carriers : 3 types : a ) convalescent carrier : passes bacilli in the excreta for up to 6 months after an attack of typhoid. b ) chronic faecal carrier : continues to pass bacilli intermittently in the excreta at least one year after infection. The gall bladder is the seat of chronic infection. c) chronic urinary carrier : the renal pelvis infected &bacilli pass in urine

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A famous example is “Typhoid Carrier” Mary Mallon, who was a food handler responsible for infecting at least 78 people, killing 5. These highly infectious carriers pose a great risk to public health.

Symptoms : 

Symptoms No Symptoms - if only a mild exposure; some people become “Carriers" of typhoid. Rose spots Aches and pains Diarrhea and Abdominal colics

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Typhoid State When typhoid fever continues untreated for more than two or three weeks, the effected individual may be delirious or unable to stand and move, and the eyes may be partially open during this time. At this point fatal complications may emerge.

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After ingested, the bacteria temporarily enter the blood stream and travel to the small intestine. White blood cells carry the disease to the liver, spleen and bone marrow where it reproduces and reenters the blood stream. The bacteria then invades the gallbladder, biliary system, and the lymphatic tissue of the bowel. Typhoid Nodule in the liver How does the bacteria cause disease ?

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Laboratory findings Routine examinations: White blood cell count is normal or decreased. increased SGPT and alkaline phosphates and LDH can also be seen Low platelet count in some cases

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Bacteriological examinations: Blood culture the most common use80~90% positive during the first 2 weeks of illness 50% in 3rd week not easy in 4th weekre-positive when relapse and recrudesce attention to the use of antibiotics

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The bone marrow culture the most sensitive testspecially in patients pretreated with antibiotics. Urine and stool culturesincrease the diagnostic yieldpositive less frequentlystool culture better in 3~4 weeks The duodenal string test to culture bile useful for the diagnosis of carriers. Rose spots: Not use routinely

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Serological tests(Vidal test): five types of antigens:somatic antigen(O),flagella(H) antigen, and paratyphoid fever flagella(A,B,C) antigen. Antibody reaction appear during first week 70% positive in 3~4 weeks and can prolong to several months in some cases, antibodies appear slowly, or remain at a low level, some(10~30%) not appear at all.

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"O" agglutinin antibody titer ≥1:160 and "H" ≥1:160 or "O" 4 folds increase ( in two separate samples with 7-10 days apart) supports a diagnosis of typhoid fever "O" rises alone, not "H", early of the disease.Only "H" positive, but "O" negative, often nonspecifically elevated by immunization or previous infections. Antibody level maybe lower when have used antibiotics early.

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False positive in some infectious diseases. Some positive in blood culture ,but negative in widal test. 'Vi" often useful for carrier (1:40) molecular biological tests: DNA probe or polymerase chain reaction (PCR)

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Prevention And Treatment

Treatment : 

Treatment Typhoid is treated with an antibiotic that kills the Salmonella bacteria. With antibiotics, improvement can be seen in 1-2 days and recovery in 7-10 days. Intravenous fluids and electrolytes may also be given to patients. Vitamins specially water soluble (B&C) Typhoid Vaccine

Fatality : 

Fatality Before the antibiotic, the death rate was 20%. Antibiotics have reduced the fatality rate 1%-2%. Antibiotic to prevent Typhoid Fever

Prevention : 

Prevention Wash your hands hot soapy water ”before eating or preparing food and after using the toilet. “ carry hand-sanitizer to wash hands when water isn’t availableAvoid drinking untreated water drink only canned, bottled, or carbonated beverages, such as bottled water, wine, or bear try to drink mostly carbonated bottle water clean the outside of bottles and cans before you open. avoid drinking beverages with ice ”Use bottled water to brush your teeth” Avoid swallowing water while taking a shower

Prevention : 

Prevention Avoid raw fruits and vegetables (raw produce may have been washed with unclean water) “avoid fruits and vegetables that you can’t peel, especially lettuce_ Perhaps avoiding raw food entirely is safer Choose hot foods avoid food that stored at room temperature Try to stick to steaming hot foods avoid street vendor foods as those are more likely to be contaminated

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Best prevention Scrub of them off your hands

Simple hand hygiene and washing can reduce several cases of Typhoid : 

Simple hand hygiene and washing can reduce several cases of Typhoid

Vaccinations : 

Vaccinations First type of vaccine: Contains killed Salmonella typhi bacteria. Administered by a shot. Second type of vaccine: Contains a live but weakened strain of the Salmonella bacteria that causes typhoid fever. Taken by mouth.

Sources : 

Sources Dr. Adrian Popp, M.D. from the Long Island Infectious Disease Associates, P.C.

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Thank You

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