Typhoid fever – an acute intestinal infection characterized by cyclic course with a primary lesion of the lymphatic system of the intestine, accompanied by General intoxication and exanthema. Typhoid fever has an alimentary route of infection.
The incubation period lasts on average 2 weeks. Clinic characterizes typhoid intoxication syndrome, fever, rash of small red spots (rash), hepatosplenomegaly in severe cases, hallucinations, lethargy. Typhoid fever is diagnosed by the detection of the pathogen in blood, stool or urine. Serological tests have only auxiliary value.
Typhoid fever – an acute intestinal infection characterized by cyclic course with a primary lesion of the lymphatic system of the intestine, accompanied by General intoxication and exanthema.
Characterization of the pathogen
Typhoid fever is caused by the bacterium Salmonella typhi – gram-negative movable Bacillus with multiple flagella. Bruchnotifozna wand is able to remain viable in the environment up to several months, some foods are favorable environment for its reproduction (milk, cheese, meat, minced meat). Microorganisms can easily withstand freezing, boiling and chemical disinfectants act on them fatal.
Reservoir and source of typhoid fever is a sick person and the carrier of the infection. At the end of the incubation period, starts selection of the pathogen in the environment, which continues throughout the period of clinical manifestations and sometimes some time after recovery (acute carrier). In the case of the formation of a chronic carrier state a person can identify the pathogen throughout life, presenting the greatest epidemiological danger to others.
Abjection occurs in the urine and feces. Route of infection – water and food. Infection occurs by drinking water contaminated from faecal sources of food, not enough heat-treated. In disseminating typhoid participate flies carry on their feet microparticles of feces. The peak incidence is noted in summer-autumn period.
The symptoms of typhoid fever
The incubation period of typhoid fever is on average 10-14 days but can vary from 3-25 days. The onset is often gradual but can be acute. Gradually developing typhoid fever is manifested by a slow rise in body temperature, reaching high values to 4-6 day. Fever is accompanied by increasing intoxication (weakness, fatigue, headache and muscle pain, sleep disturbance, appetite).
The febrile period is 2-3 weeks, while there are significant fluctuations in body temperature in diurnal dynamics. One of the first symptoms developing in the early days, is the paleness and dryness of the skin. Rash appears, starting on the 8-9th day of illness, and are small red spots up to 3 mm in diameter, with pressure of short-term fading. Rashes persist for 3-5 days in case of severe acquire hemorrhagic in nature. During the entire fever period, and even in its absence it is possible the emergence of new elements of rash.
The physical examination is marked thickening of language, which clearly imprinted inner surface of the teeth. Language in the center and the root is covered with a white bloom. On palpation the abdomen marked abdominal distension due to intestinal paresis, rumbling in the right podstole. Patients report a tendency to difficulty bowel movement. From 5-7 day of the disease there may be enlarged liver and spleen (hepatosplenomegaly).
Onset of the disease may be accompanied by cough, auscultation of the lungs marked dry (sometimes moist) rales. At the peak of the disease there is a relative bradycardia if severe fever – mismatch heart rate body temperature. Can be fixed two-wave pulse (dicrotism). Notes muffled heart tones, hypotension.
The height of the disease is characterized by an intense increase in symptoms, severe intoxication, CNS toxicity (confusion, delirium, hallucinations). When the decrease in body temperature, patients notice overall improvement. In some cases, soon after the regression of clinical symptoms occurs fever and intoxication, appears rosealina rash. This so-called aggravation of typhoid fever.
A relapse of the infection differs in that it develops after a few days, sometimes weeks, after subsiding of symptoms and normalization of temperature. For relapses are usually more light, the temperature ranges from low-grade values. Sometimes clinic relapse of typhoid fever is limited to aneozinofiliya in the General analysis of blood and moderate enlargement of the spleen. The relapse is usually preceded by violation of the daily routine, diet, psychological stress, untimely lifting of the antibiotics.
The abortive form of typhoid fever is characterized by typical onset of the disease, intermittent fever, and rapid regression of symptoms. Clinical symptoms were obliterated weakly expressed, slight intoxication, for short.
Complications of typhoid fever
Typhoid fever may be complicated by intestinal bleeding (manifested in the form of progressive symptoms of acute hemorrhagic anemia, the stool becomes tarry character (melena)). Threatening complication typhoid fever may be perforation of the intestinal wall and subsequent peritonitis.
In addition, typhoid fever may contribute to the development of pneumonia, thrombophlebitis, cholecystitis, cystitis, myocarditis, and mumps, and otitis media. Prolonged bed rest can cause pressure sores.
Diagnosis of typhoid fever
Typhoid fever is diagnosed based on clinical manifestations and epidemiological history and confirm the diagnosis using bacteriological and serological studies. Already in the early stages of the disease possible release of the pathogen from the blood and inoculation of the culture medium. The result usually becomes available in 4-5 days.
Bacteriological research mandatory are exposed to feces and urine examined, and in the period of convalescence – the contents of the duodenum taken during duodenal intubation. Serological diagnosis is of auxiliary nature and is made using Phragmites. A positive reaction is observed since 405 days of the disease, diagnostically significant titer of 1:160 or more.
Treatment and prognosis of typhoid fever
All patients with typhoid fever are subject to mandatory hospitalization as a significant factor in a successful recovery is high-quality care. Bed rest prescribed for the entire febrile period and subsequent to the normalization of body temperature for 6-7 days. After this patients are permitted to sit only on 10-12-day normal temperature – rise. The diet in typhoid fever of high-calorie, easily digestible, mainly semi-liquid (meat broths, soups, steamed meatballs, yogurt, cottage cheese, liquid cereals except for millet, natural juices, etc.). Recommended drinking plenty of fluids (warm sweet tea).
Etiotropic therapy is the appointment of a course of antibiotics (chloramphenicol, ampicillin). In conjunction with antibiotic therapy to prevent the recurrence of the disease and the formation of bacteria often vaccinate. In severe intoxication detoxification of a mixture (colloid and crystalloid solutions) administered intravenously by infusion. Therapy if necessary, Supplement symptomatic drugs: cardiovascular, sedative drugs, vitamin complexes. Extract patients made after full clinical recovery and bacteriological negative samples, but not earlier than 23 days from the moment of normalization of body temperature.
At the present level of medical care the prognosis of typhoid prosperous, the disease ends in complete recovery. The poor prognosis observed in the development of life-threatening complications: perforation of the intestinal wall and massive bleeding.
Prevention of typhoid fever
General prevention of typhoid fever is in compliance with the sanitary standards in respect of water abstraction for household use and irrigation of farmland, control of sanitary regime of the food industry and public catering, over the conditions of transportation and storage of food products. Individual prevention involves personal hygiene and food hygiene, thorough washing of consumed raw fruits and vegetables, adequate heat treatment of meat products, pasteurization of milk.
Employees having contact with food in food processing industry, and other decreed groups are subject to regular testing for carriers and the allocation of the causative agent of typhoid fever, in the case of selection – are subject to suspension until a complete bacteriological cure. In relation to patients quarantine measures are applied: an extract not earlier than 23 days after subsiding of fever, after which patients are at the dispensary for three months, monthly coming full screening for carriage bruchnotifozna sticks. Food industry workers, had been ill with typhoid fever, are allowed to work not earlier than one month after discharge, provided the five-time negative test for selection of bacteria.
The contact person shall be observed for 21 days from the date of contact, or the identification of the patient. Prophylactic assigned bruchkomitsky bacteriophage. Not related to maternity groups to the contact persons made a single analysis of urine and feces on abjection. Vaccination of the population according to epidemiological indications with a single subcutaneous injection of liquid sorbirovannoe protivoprotosanoe vaccine.