TypoidFever伤寒

Typhoid Fever,Dept. Infectious Disease2nd Affiliated HospitalCMU,Definition,Typhoid fever is an acute infectious disease of digestive tract caused by typhoid bacillus.Place of lesson lymphatics in the terminal ileumPathological feature proliferation of large mononuclear cells derived from MPS,Definition,Clinical feature sustained fever relative slow pulse toxic symptoms a rose-color rash splenomegaly and hepatomegaly leukopenia Complication hemorrhage & perforation,Etiology,Causative organism: Typhoid bacillus genus salmonella group DPathogenicity: endotoxinResistance: Stable in environment, sensitive to heat, acid, common disinfectants,Etiology,Antigenicity:O antigen: lipopolysaccharide group-specialH antigen: protein, strain-specialVi antigen: polysaccharide,Epidemiology,Source of infection Patient, Carrier, shed bacteria in fecesRoute of transmission Fecal-oral route:contaminated food or watercontagious spread spread by insectSusceptibility Epidemic features sporadic cases high incidence in fall & summer,Pathogenesis,Bacillus Stomach killed by gastric acidincubation Small intestine penetrate mucosa period Regional lymphatics Blood stream - first bacteremia initial MPS in liver, spleen, bone marrow Blood stream -second bacteremia endotoxin liver spleen regional lymphoticsClinical symptoms absces inflammation,Pathology,Proliferation of large mononuclear cell 1st week 2nd 3rd week 4th weekproliferation necrosis heal edema ulceration no scar,Clinical manifestation,Incubation period: 7-23 day(average 10 to 14 days)Typical typhoid fever:Initial periodFastigiumDefervescenceConvalescence,Clinical manifestation,Initial periodonset: insidious, gradualfever: T stepwise fashion risingnon-special symptoms:,Clinical manifestation,Fastigiumsustained fevertoxic symptoms: NS apathy, tinnitus, delirium,lethargy, coma DS anorexia, abdominal Pain, diarrhea Constipation CS relative slow pulse, bradycardia, myocarditis,Clinical manifestation,Fastigiumrose-colored rash: erythematous macules or papules occur on 613 days upper abdomenhepatomegaly and splenomegaly,Clinical manifestation,DevervescenceConvalescence,Clinical manifestation,Clinical type:Mild typecommon typeprolonged type,ambulatory typefulminate type,Clinical manifestation,Relapse: It occur 13week after T has reached normal. The illness follows a similar pattern to the primary attach. Blood culture positive.Recurrence: It occur 34 after the illness. T begin to fall, then rise again. Blood culture positive.,Complications,Intestinal hemorrhageIntestinal perforationToxic hepatitis and myocarditisPneumonia,Laboratory Findings,Blood picture: leukopenia Bacteria culture: blood bone morrow urine and stool,Laboratory Findings,Widal test: agglutination of serum reaction 5 Ag: “O” “H”, “HABC” titer:O=1:80 H=1:160 results analysis:,Diagnosis,Epidemiological dataClinical manifestationLaboratory findingsDefinitive diagnosis: bacteria culture positive,Differential Diagnosis,Typhusrickettsisesmalariadisseminated TB,Treatment,General therapyEtiologic therapyguinolone: first choicecephalosporins: 2nd and 3rd generationchloromycetin,Prevention,Control of source of infection:isolationInterruption of route of transmiss