Typhoid fever symptoms, causes, diagnosis, complication and treatment

typhoid fever

It is also called as "enteric fever".

caused by salmonella typhi while similar but less severe illness paratyphoid caused by paratyphi A,B,C.

Typhoid fever

Etiology(causes):-

transmission -oro -fecal route, through contaminated food, milk, water etc.

the transmission of typhoid occur most commonly through the house flies.

pathology:-

bactraemia(presence of bacteria in blood while septicemia means presence and multiplication of bacteria) >>bacilli localize mainly in the lymphoid tissues of the small intestine>>the peyer's patches becomes inflamed at first, then ulcerated & ultimately heal, but during sequence they may perforate or bleed.

clinical features :-

week	symptoms
1st week	onset incidious with headache, bodyache, malaise, sore throat, anorexia GIT symptoms -coated tongue, often constipation in adult but diarrhea&vomiting common in children fever-step-ladder (low in morning but gradually increase and high in night),high grade fever, bronchitis, bradycardia
2nd week	temperature is high, spleen palpable at end of 1st week, abdomen tenderness at right iliac fossa. rash -rose spot rashes appear on upper abdomen.
3rd week	mild cases -gradual fall of temperature, toxaemia abates(decrease) severe cases -increased toxaemia, intestinal haemorrhage & perforation .patient may pass into coma and die.
convalescence	typical uncomplicated case fever subsides in four weeks.there is return of appetite, tonhue clear, pulse become faster. relapse may occur after 10 days of primary attack in inadequated treated .

complication :-

Haemorrhage

Perforation

Septisemic foci

other- urinary retention, enteric encephalopathy

investigation:-

wbc count

blood culture -1st week

bone marrow culture -1st week

stool culture -3rd week

typhoid test -the test identifies antibodies if IgM -recent infection

IgG -remote infection.

widal test(antibody detection) -2nd week

treatment-

ciprofloxacine -750 mg bid

ceftriaxone -1 gm iv bid

azithromycin 1 gm/day

ampicillin-6 gm/day or 100 mg /kg/day of child

amoxicillin 1 gm tid

chloramphenicol 25 mg/kg tid

duration of therapy 10-14 days

treat the carries with ciprofloxacin 750mg bid or ampicillin or cetrimoxazole for 4 weeks.

Milan Tomic

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