Typhoid fever dr.saeid
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- 1. The enteric fevers are caused bySalmonella typhiS. paratyphi A and BThe bacilli may live in the gallbladder of carriers formonths or years after clinical recovery and passintermittently in the stool and less commonly in theurine.
- 2. Rout of transmissionfaecal-oral route
- 3. PathologyAfter a few days of bacteraemia, the bacillilocalise mainly in the lymphoid tissue of thesmall intestine. The typical lesion is in the Peyer's patchesand follicles. These swell at first, thenulcerate and ultimately heal, but during thissequence they may perforate or bleed.
- 4. The incubation period of typhoid fever isabout 10-14 daysThe onset may be insidious.
- 5. After clinical recovery, about 5% ofpatients become chronic carriers The bacilli may live in the gallbladder formonths or years and pass intermittently inthe stool and less commonly in the urine.Those patients developed chronic gallbladder diseases
- 6. The course tends to be shorter and milderthan that of typhoid fever .The onset is often more abrupt with acuteenteritis.The rash may be more abundant.The intestinal complications less frequent.
- 7. Haemorrhage from the ulcerated Peyer'spatches may occur at the end of the 2nd weekor during the 3rd week of the illness.Perforation of Peyer's patches lead to acuteperitonitisA drop in temperature to normal or subnormallevels may be falsely reassuring in patients withintestinal haemorrhage.Bone and joint infection is common in childrenwith sickle-cell disease.septicaemia
- 8. In the first week the diagnosis may be difficultbecause in this invasive stage with bacteraemiathe symptoms are those of a generalisedinfection without localising features.Complete blood count showleucopeniathrombocytopeniaanaemia
- 9. Blood culture is the most important diagnosticmethod.The faeces will contain the organism more frequentlyduring the 2nd and 3rd weeks.Bone marrow cultureThe Widal reaction detects antibodies to thecausative organisms.However, it is not a reliable diagnostic test andshould be interpreted with caution.
- 10. Chloramphenicol (500 mg 6-hourly),ampicillin (750 mg 6-hourly)amoxicillin (750 mg- 1gm 8 hr ) co-trimoxazole (2 tablets or i.v. equivalent 12-hourly)are important therapies but are losing theireffect due to resistance in many areas of theworld, especially India and South-east Asia
- 11. ManagementThe fluoroquinolones are the drugs of choice(e.g. ciprofloxacin (500 mg 12-hourly) if theorganism is susceptible, but resistance iscommon.Extended-spectrum cephalosporins (ceftriaxoneand cefotaxime) are useful alternatives but havea slightly increased treatment failure rate.ceftriaxone 1- 2 gm / day IV or IM for 7-10 days Azithromycin (500 mg once daily) is analternative where fluoroquinolone resistance ispresent but has not been validated in severedisease.
- 12. Treatment should be continued for 14 days. Pyrexia may persist for up to 5 days after thestart of specific therapy.Even with effective chemotherapy there is stilla danger of complications, and thedevelopment of a carrier state.Chronic carriers are treated for 4 weeks withciprofloxacin 500 mg twice dailycholecystectomy may be necessary.
- 13. Improved sanitation and living conditionsreduce the incidence of typhoid.Travellers to countries where entericinfections are endemic should be inoculatedwith one of the three available typhoidvaccinestwo inactivated injectable andone oral live attenuated
- 14. Listeriosis is a serious infection caused by eatingfoods contaminated with the bacterium ListeriaMonocytogenes.Listeria monocytogenes is an environmentalGram-positive bacillus which can contaminatefood.Outbreaks have been associated with rawvegetables, soft cheeses, undercooked chicken,fish and meat .This disease affects primarily pregnant women,newborn, and adults with weakened immunesystems.
- 15. Listeria monocytogenes is a rod-shaped aerobic andgram positive pathogenic bacterium that invades thecytoplasm of living cells. It develops a distinctiverocket tail structure to help push through thecytoplasm.
- 16. food-borne outbreaks of gastroenteritisIn pregnancy, listeriosis causeschorioamnionitis, fetal deaths, abortions andneonatal infection.Meningitis, similar to other bacterialmeningitis but with normal CSF glucose, CSFusually shows increased neutrophils.
- 17. FeverMuscle acheGI Sx: Nausea, diarrheaPregnant women: mildflu-like Sx, miscarriage,still birth, prematuredelivery, or infectednewborn.LethargyirritabilityIf infection spreads to thenervous system: headache,stiff neck, confusion, loss ofbalance, or convulsions.Listeria can causePneumonia, Meningitis,and Sepsis.
- 18. Eating food contaminatedwith Listeria.Babies can be born withListeriosis if the mothereats contaminated foodduring pregnancy.Listeriosis is generally notcontagious from person toperson.
- 19. There is no routine screening test for susceptibility.During pregnancy, a blood test is the most reliableway to find out if your Sx are due to Listeriosis.Diagnosis is made by blood and CSF culture.The organism grows readily in culture media.
- 20. Listeriosis is a serious disease rreeqquuiirriinngg hhoossppiittiilliizzaattiioonn..AA ccoommbbiinnaattiioonn ooff aannttiibbiioottiiccss iiss ggiivveenn iinnttrraavveennoouussllyyWWhheenn iinnffeeccttiioonn ooccccuurrss dduurriinngg pprreeggnnaannccyy,, aannttiibbiioottiiccss mmuussttbbee ggiivveenn pprroommppttllyy ttoo tthhee mmootthheerr ttoo pprreevveenntt iinnffeeccttiioonn ooff tthheeffeettuuss oorr nneewwbboorrnn..The most effective regimen consists of acombination of an intravenous (amoxicillin orampicillin) plus an aminoglycoside. Cephalosporins are of no use in this infection, as theorganism is inherently resistantTThhee dduurraattiioonn ooff aannttiibbiioottiicc ttrreeaattmmeenntt iiss aatt lleeaasstt 22 wweeeekkss..EEvveenn wwiitthh pprroommpptt ttrreeaattmmeenntt,, ssoommee iinnffeeccttiioonnss rreessuulltt iinnddeeaatthh..