Typhoid-fever-教学讲解课件

TyphoidfeverTyphoidfever1

Catalog

1、Summary2、Etiology3、Epidemiology4、PathogenesisandPathology5、ClinicalManifestations6、Complication7、LaboratoryExaminations8、DiagnosisandDifferentialDiagnosis9、Treatment10、ProphylaxisCatalog2

Summarysalmonellatyphifecal-oralroutesummerandautumnPost-infectionimmunitycanlastdecadesSummarysalm3Keysignsandsymptoms:constantfever,relativebradycardia,mentalstatuschanges,diarrheaorconstipation,“rosespots”,hepatosplenomegaly,andleucopenia.Keysignsandsymptoms:4Etiology

Etiology5Salmonellatyphigermnegative,short-rod,aerobic,non-capsulated,non-spore-formingbelongtothesalmonellaspecies“D”group

Salmonellatyphi6Obodyorsomaticantigen,theHantigenontheflagellar,andtheViorvirulenceantigenNonfastidiousEnterobacteriaceaeendotoxin

Obodyorsomaticantigen,the7Typhoid-fever--教学讲解课件8Typhoid-fever--教学讲解课件9Electronmicroscope

22500Electronmicroscope2250010

Figure—TheTyphoidBacillus

11EpidemiologyEpidemiology12sourceofinfectionPatientsandpathogenycarriers

Chroniccarriers,whichhavetyphiorganismspersistinginstoolsorurinefor>3monthsChroniccarriersarepublichealththreats,becausetheymaysubstantiallycontaminatelocalwatersupplies,particularlyinareaslackingappropriatetreatmentfacilities.sourceofinfectionPatientsan13TyphoidMaryTyphoidMary14MaryMallon,betterknownasTyphoidMary,wasthefirstpersonintheUnitedStatesidentifiedasanasymptomaticcarrierofthepathogenassociatedwithtyphoidfever.MaryMallon,betterknownasT15Shewaspresumedtohaveinfected51people,threeofwhomdied,overthecourseofhercareerasacook.Shewastwiceforciblyisolatedbypublichealthauthoritiesanddiedafteratotalofnearlythreedecadesinisolation.Shewaspresumedtohaveinfec16RouteofTransmissionInfectionoccursthroughingestionoftheorganismsinfood(shellfish,fruit,vegetables)contaminatedatthesourceorduringhandling(handsorinstrumentssoiledbyfaeces/urineofinfectedperson).

RouteofTransmissionInfect17Fliesmayinfectthefoodinwhichtheorganismthenmultipliestoattainaninfectivedose.Eitherthecontaminatedwaterorfoodcanbringepidemics.Fliesmayinfectthefoodinw18SusceptiblePopulationAnyageandeithersexmaycontracttyphoidfever,butchildrenandyoungadultsaremostcommonlyaffected.SusceptiblePopulationAnyage19EpidemiologicFeature

Theseoftenoccuraspoint-sourceepidemics,fromhealthycarrierstofood.Outbreaksmayoccurthroughperson-to-personcontamination.Directfaecalcontaminationofuntreatedwatersuppliesmaycauseextensiveoutbreaks.

EpidemiologicFeature20

TheIndiansubcontinentandpartsofAfrica,Asia,andCentralandSouthAmericathatareeconomicallypoorcountriesareendemicfortyphoidfever.Indevelopedcountries,cleandrinkingwaterandadequatewastedisposalhavedramaticallydiminishedtheprevalenceoftyphoidfever,andmostcasesoftyphoidfeverareimportedfromendemicareas.TheIndiansubcontinen21PathogenesisandPathologyPathogenesisandPathology22Whenthebacteriumpassesdowntothebowel,itpenetratesthroughtheintestinalmucosatotheunderlyingtissue.TheorganismsarephagocytosedbymononuclearphagocytesWhenthebacteriumpassesdown23thebacteriumwillmultiplyand/oraredrainedbyterminallactealsandthoraciclymphducttothebloodstream,namedthefirstbacteremia.thebacteriumwillmultiplyan24Inthesecondphaseofthediseasethebacteriumreplicatedinmononuclearphagocytesystem,andtheoftenviolentsymptomssuchashyperphrexia,malaise,andmyalgiabegin.Inthesecondphaseofthedis25Iftheimmunesystemisunabletostoptheinfectionhere,thebacteriumpenetratesfurthertothebonemarrow,liverandbileducts,fromwhichbacteriaareexcretedintothebowelcontents,namedthesecondbacteremia.Iftheimmunesystemisunable26Atthesametime,organismsexcretedinthebileeitherreinvadetheintestinalwallorareexcretedinthefeces.Atthesametime,organismsex27

Salmonellatyphi(PH＞2;＞105)stomach（achlorhydria）intestinalmucosatotheunderlyingtissuethoraciclymphductbloodstream（thefirstbacteremia）bonemarrow,liverandbileducts

Salmonellatyphi(PH＞2;＞1028bloodstream（thesecondbacteremia）endotoxinsignsandsymptoms（constantfever,relativebradycardia,“rosespots”,hepatosplenomegaly,andleucopeniaorganismsexcretedinthebileeitherreinvadetheintestinalwallnecrosisandulcerationattheintestinaltract（EnterorrhagiaandIntestinalPerforation)bloodstream（thesecondbacter29PathologyPathology：monocytephagocytesystemproliferativereactionThefirstweek:LymphoidhyperplasiaswellingThesecondweek:NecrosisoflymphoidtissueThethirdweek:Thenecrotictissuesloughsoff,leavinganulcerThefouthweek:UlcerhealingPathologyPathology：monocytep30typhoidnodule

typhoidnodule

31Typhoid-fever--教学讲解课件32Typhoid-fever--教学讲解课件33ClinicalManifestations

incubation：10to14days

Theclinicalcauseofclassicaltyphoidfevermaybeseparatedintofourphases

Earlystage、Acmestage、Catabasisstage、Convalescencestage（1week）（2-3week）（3-4week）（5week）ClinicalManifestationsincuba34Earlystage：(1week)fever,chills,weakness,headache,malaise,andmyalgiaInitiallythefeverislowgrade,butitrisesprogressively,andbythesecondweekitisoftenhighandsustained(39~40℃)Earlystage：(1week)35Acmestage：(2～3week)1.Pyrexia(sustainedfever)2.Centralnervoussystem(lethargicface)3.Gastrointestinalsystem(diarrheaorconstipation)4.Cardiovascularsystem(relativebradycardia)5.Skin(Rosespot)6.hepatosplenomegalyAcmestage：(2～3week)36sustainedfeverTheclassicaltemperaturecharthasaplateauat39~40℃Typicalpatternispresentonlyintheuntreatedanduncomplicatedcase,andotherpatternsmayleadtodifficulty.sustainedfeverTheclassicalt37sustainedfeversustainedfever38Centralnervoussystem

dullexpressionlesslethargicfacecoatedtongueslightdeafnessamustyodourSeverelyagitated,delirious,completestupororcomaCentralnervoussystemdullex39dullexpressionlesslethargicfacedullexpressionlesslethargic40Gastrointestinalsystem

Vagueabdominaldiscomfort,VomitingConstipationoccursmorefrequentlythandiarrhoeaTheliverandspleenisenlargedandsoft,andthereisoftendiffusetenderness.GastrointestinalsystemVague41Cardiovascularsystem

relativebradycardia:Abetterdescriptionisthatthepulserateisrelativelyslowcomparedtothetemperatureduringthefirstweekofillness,anditseldomexceeds100perminute.

Cardiovascularsystemrelat42Typhoid-fever--教学讲解课件43rosespotsCharacteristicskinrash:nolargerthan1-2mmindiameterseldomnumbermorethan10to12inchest,upabdomen,andbackThespotsarerose-colored,slightlyraisedandfadeonpressure.rosespotsCharacteristicskin44Typhoid-fever--教学讲解课件45Typhoid-fever--教学讲解课件46Catabasisstage:Itisthethirdorfourthweekthatthefeverdropsandthegeneralconditionslowlyimproves.Butthereisadangerofcomplication.Intestinalperforationofprofusebleedingfromtheintestinalmucosamayoccuriftyphoidfeverisleftuntreated.ClinicalManifestationsCatabasisstage:ClinicalM47ClinicalManifestationsConvalescencestage:Thefifthweekofthediseasethathasthefeatureofnormaltemperature,goodappetite.ClinicalManifestationsConvale48Thetwoconceptsrelapse：Patientsinrecoverystage,stablecoolingtemperatureriseagainafteraperiodoftime,clinicalsymptomsappearagain.recrudescence：Thesignsandsymptomsofpatientsgraduallyreduced,thetemperaturedoesnotdroptonormalonceagainincreased,clinicalsymptomsappearagain.Thetwoconceptsrelapse：Patien49Typhoid-fever--教学讲解课件50complication1.Enterorrhagia2.IntestinalPerforation3.heartvalves(endocarditis)4.bones(osteomyelitis)5.Pneumonia6.kidneys(glomerulitis)complication1.Enterorrhagia51EnterorrhagiaAcommoncomplicationmaybeaveryseriouscomplicationoftyphoidfever;itusuallyoccurs14to21daysaftertheonsetoftheillnessandisoften‘silent’.Inthemajorityofcases,thebleedingisslightandresolveswithouttheneedforbloodtransfusion,butin2%ofcases,bleedingisclinicallysignificantandcanberapidlyfatalifalargevesselisinvolved.EnterorrhagiaAcommoncomplica52IntestinalPerforationItclassicallyoccursduringthethirdweekofillness.Inmanycasesthefirstindicationofperforationmaybethepresenceoffreefluidintheabdomen.Therewillalsobedeteriorationinthegeneralconditionofthepatient,severeabdominalpain,absentbowelsounds,andvomiting.IntestinalPerforationItclass53

LaboratoryExaminationsLaboratory54

RoutineDetection

whitebloodcellcount:AlowcountwitharelativelymphocytosisiscommonlyseenThecountofeosinophiliccellsmaybeloworzero.

RoutineDetecti55CultureoftheTyphoidBacillusBloodcultures:positivein60%~80%ofpatients

bonemarrowculture:positivein80%~95%ofpatients

Stoolandurineculture:positiveinthethirdorfourthweek,soClinicrarelyusedCultureoftheTyphoidBacillu56SerologicTesting

Theroleoftheagglutinationreactionoftheserum,ortheWidaltest,iscontroversial,becausethesensitivity,specificity,andpredictivevaluesofthiswidelyusedtestvaryconsiderablyamonggeographicareas.SerologicTestingTherole57

Thediagnostictitersare1:80forOantibody,1:160forHantibody,orthetitersofpostsampleisatleast2doubleoftheformer.

widaltestThediagnostictitersare158Hantigenagglutinationreaction

Hantigenagglutinationreacti59OantigenagglutinationreactionOantigenagglutinationreacti60widaltest

TheOantigenagglutinationbecomespositiveattheearlystageanddecreasessoon.ButthecaseofHantigenagglutinationisconverse.widaltestTheOantigenagg61widaltestInanun-immunisedpatientitdoesnotbecomepositiveuntilafter7to10daysofillness.Inanendemicarea,orinpatientswhohavehadpreviousTABvaccineinoculations,theHantibodylevelcanberaisedbymanynonspecificillnesses,andtherefore-yieldlittlespecificdata.widaltestInanun-immunisedp62widaltestAnOantigenagglutinationof1:200inapatientwitharisingtiterismuchmorevalue.

widaltestAnOantigenaggluti63

TOTHTATBTCmeaning

earlyinthedisease

Notlongagohadbeeninfectedtyphoid

typhoidfever

paratyphoidfeverA

paratyphoidfeverB

paratyphoidfeverC

TOTHTATBT64DiagnosisThediagnosismustbemademainlyonepidemiologyfinding,clinicalexaminationandlaboratoryinvestigations.SometestssuchasalowbloodcellcountandpositiveofWidalreactionmayindicatethediagnosis.DiagnosisThediagnosismustbe65Intheappropriateclinicalsetting,thedefinitivediagnosisoftyphoidfeverrequiresisolationandbiochemicalcharacterizationofetiologicagent.Intheappropriateclinicalse66Earlyinthecourseofdisease,bloodandbonemarrowculturesyieldthehighestrecoveryoforganisms,whilelaterinthecourseofdisease,stoolandsometimesurineculturesaremorelikelytobecomepositive.Earlyinthecourseofdisease67

DifferentialDiagnosisParatyphoidsA,BandC：Thelaboratoryisusuallyrequiredasthefinalauthority.Geographicdistributionsometimessimplifiesthematter;theparatyphoidsarerareinEastAfrica,butparatyphoidBisnotuncommoninBritain.DifferentialDiagnosisPa68DifferentialDiagnosisSalmonellaInfectionandGastroenteritisSalmonella,thedysenterygroup,andstaphylococcimayoccasionallycauseaninvasiveillnessresemblingtyphoidfeverwithbacteremia.Usually,however,thegastrointestinalsymptomsaremoreacutethanthegeneralmanifestationsandthepyrexiamuchlowerandofshorterduration.DifferentialDiagnosisSalmonel69DifferentialDiagnosisMalariaThismaybemistakenfortyphoidincountrieswherebothareendemic.Ahistoryofpreviousattacks,themorerapidonsetinmalaria,theshiveringandsweating,thehighearlypyrexia,therelativeinfrequencyofabdominalsymptomsandsigns,andapositivebloodslideallpointtoadiagnosisofmalaria.DifferentialDiagnosisMalaria70DifferentialDiagnosisInfluenzaInfluenzamayalsobeconfusedwithtyphoid,butisusuallyofmuchmorerapidonsetwithhightemperature,severesorethroat,cough,andtheabsenceofapalpablespleenandrosespots.DifferentialDiagnosisInfluenz71DifferentialDiagnosisBacillaryDysenteryTheonsetisusuallyacute,withsevereblooddiarrhoea.Diarrhoeawithbloodisrareinearlytyphoid.Thesignsandsymptomsindysenteryareusuallyabdominalandremainso,thementalstateandchestbeingclear.DifferentialDiagnosisBacillar72DifferentialDiagnosisPulmonaryTuberculosisandAtypicalAbdominalTuberculosisTheseareprobablythemostdifficultdiagnosestodifferentiatefromtyphoidineconomicallypoorcountries.Thepyrexiaandvaguesymptomsandsignsmaybeverysimilar.AchestX-ray,orlaboratoryconfirmationoftyphoid,maybetheonlysuremethodofdiagnosis.DifferentialDiagnosisPulmonar73

TreatmentTreatment74

GeneralManagementFeedingofthepatientmustincludeanadequatefluidandmineralintake,andalowroughagediet.Constipationshouldbeonlytreatedwithliquidparaffinandhypopiesiscoloclysterwithnormalsodium.Cathartic,suchasneostigmine,sennaleafisprohibited.GeneralManagement75Retentionofurinemaybe‘silent’inthetoxicpatientandwillrequirecatheterisation.HyperpyrexiawillrequiretepidspongingmentaldisturbancemayrequiresedationRetentionofurinemaybe‘sil76Thegeneralobservationofthepatientisimportant.Thisiswithparticularregardtopulse,bloodpressure,respiration,severetoxaemia,bloodinthestools,andanyevidenceofintestinalhaemorrhageorperforation.Thegeneralobservationofthe77AntimicrobialTherapyChloramphenicol,TMP/SMX,ampicillin,third-generationcephalosporins,andquinoloneshavebeenusedsuccessfullyforthetreatmentoftyphoidfever.

AntimicrobialTherapyChloramph78Unfortunately,antimicrobialresistancehasemergedtoeachoftheseagents.SomeSalmonellaisolatesaremultidrugresistant.Forthisreason,wheneverpossible,antimicrobialtherapyshouldbebasedonanindividualisolate’ssusceptibilityprofile,obtainedbystandardmethods.Unfortunately,antimicrobialr79Chloramphenicolwasthefirstdrugusedforthetreatmentoftyphoidfever.However,increasingresistance,highrelapserates,bonemarrowtoxicity,andthepromotionofachroniccarrierstatehavelimiteditsusefulness.advantagesincludeitshighefficacy,lowcost,andoraladministration.Chloramphenicolwasthefirst80AmpicillinandTMP/SMXwereusedtotreattyphoidfeverafterchloramphenicolresistanceemerged.Forsusceptibleisolates,thesedrugsareeffective,easilyadministered,anddonothavethehighrateofrelapseassociatedwithchloramphenicol.AmpicillinandTMP/SMXwereus81Thethird-generationcephalosporin,ceftriaxone,ishighlyeffectiveforthetreatmentofthetreatmentoftyphoidfeverinadultsandchildren.Third-generationcephalosporinsareespeciallyusefulasempirictherapyinareasinwhichmultiple-drugresistancehasbeenreported.Thethird-generationcephalosp82Currently,ciprofloxacinisthedrugofchoiceforadultsfromIndia,Asia,ortheMiddleEast.Chromosomallymediatedquinoloneresistancehasemerged.Currently,ciprofloxacinisth83Inadditiontherelapseratesappearedtobemuchhigherintheinadequatelytreatedpatients.Itisthereforerecommendedthattreatmentoftheinitialinfectionwithantibioticsshouldbecontinuedforatleast14days

Inadditiontherelapserates84ComplicationTherapy

Enterorrhagia:Forenterorrhagia,treatmentshouldbebyearlybloodtransfusion,nothingbymouthfor24hours,adequatedosagesofsuitableanalgesicsbyinjection,andverycarefulnursingandmedicalsupervision.ComplicationTherapyEnterorr85ComplicationTherapygastrointestinalperforation:Patientswithgastrointestinalperforationduringtyphoidrequireresuscitationwithfluids,blood,andoxygen,asappropriate,followedbysurgery.ComplicationTherapygastroint86ProphylaxisIntyphoidfeverpreventionismainlybyensuringpurewatersuppliesandsewagedisposal,rawfoodsuchasvegetablesandshellfish.Ontheotherhand,theaccentisonimprovementofpersonalhygiene.ProphylaxisIntyphoidfeverpr87Prophylacticmeasuresshouldbedirectedtowardpreventionandthetreatmentofeverysuspectedcarrier,aswellastheimprovementofhygienicstandardsoffoodhandlersandthepublicgenerally.

Prophylacticmeasuresshouldb88Ithasbeenshownthattyphoidinoculationoftyphoid,paratyphoida,andparatyphoidbvaccine(TAB),isoflimitedvalueinthepreventionoftyphoidfever.Itisalsoofpracticallynovalueinaffectingthecourseofthediseaseoncetyphoidhasbeencontracted.Afewvaccineshavehadmoresuccessandorshouldpresentlybereadyforlicensure.Ithasbeenshownthattyphoid89QuestionandAnswerQuestionandAnswer90ClinicalmanifestationsatacmestageofTyphoidfever1.Pyrexia(sustainedfever)2.Centralnervoussystem(lethargicface)3.Gastrointestinalsystem4.Cardiovascularsystem(relativebradycardia)5.Skin(Rosespot)6.hepatosplenomegalyClinicalmanifestationsatacm91ComplicationofTyphoidfever

1.Enterorrhagia2.IntestinalPerforation3.heartvalves(endocarditis)4.bones(osteomyelitis)5.Pneumonia6.kidneys(glomerulitis)ComplicationofTyphoidfever92AntimicrobialTherapyChloramphenicol,TMP/SMX,ampicillin,third-generationcephalosporins,andquinolonesAntimicrobialTherapyChloramph93Whatisthetransmissionwayoftyphoidfever?fecal-oralrouteWhatisthetransmissionwayo94ThanksThanks95TyphoidfeverTyphoidfever96

Catalog

1、Summary2、Etiology3、Epidemiology4、PathogenesisandPathology5、ClinicalManifestations6、Complication7、LaboratoryExaminations8、DiagnosisandDifferentialDiagnosis9、Treatment10、ProphylaxisCatalog97

Summarysalmonellatyphifecal-oralroutesummerandautumnPost-infectionimmunitycanlastdecadesSummarysalm98Keysignsandsymptoms:constantfever,relativebradycardia,mentalstatuschanges,diarrheaorconstipation,“rosespots”,hepatosplenomegaly,andleucopenia.Keysignsandsymptoms:99Etiology

Etiology100Salmonellatyphigermnegative,short-rod,aerobic,non-capsulated,non-spore-formingbelongtothesalmonellaspecies“D”group

Salmonellatyphi101Obodyorsomaticantigen,theHantigenontheflagellar,andtheViorvirulenceantigenNonfastidiousEnterobacteriaceaeendotoxin

Obodyorsomaticantigen,the102Typhoid-fever--教学讲解课件103Typhoid-fever--教学讲解课件104Electronmicroscope

22500Electronmicroscope22500105

Figure—TheTyphoidBacillus

106EpidemiologyEpidemiology107sourceofinfectionPatientsandpathogenycarriers

Chroniccarriers,whichhavetyphiorganismspersistinginstoolsorurinefor>3monthsChroniccarriersarepublichealththreats,becausetheymaysubstantiallycontaminatelocalwatersupplies,particularlyinareaslackingappropriatetreatmentfacilities.sourceofinfectionPatientsan108TyphoidMaryTyphoidMary109MaryMallon,betterknownasTyphoidMary,wasthefirstpersonintheUnitedStatesidentifiedasanasymptomaticcarrierofthepathogenassociatedwithtyphoidfever.MaryMallon,betterknownasT110Shewaspresumedtohaveinfected51people,threeofwhomdied,overthecourseofhercareerasacook.Shewastwiceforciblyisolatedbypublichealthauthoritiesanddiedafteratotalofnearlythreedecadesinisolation.Shewaspresumedtohaveinfec111RouteofTransmissionInfectionoccursthroughingestionoftheorganismsinfood(shellfish,fruit,vegetables)contaminatedatthesourceorduringhandling(handsorinstrumentssoiledbyfaeces/urineofinfectedperson).

RouteofTransmissionInfect112Fliesmayinfectthefoodinwhichtheorganismthenmultipliestoattainaninfectivedose.Eitherthecontaminatedwaterorfoodcanbringepidemics.Fliesmayinfectthefoodinw113SusceptiblePopulationAnyageandeithersexmaycontracttyphoidfever,butchildrenandyoungadultsaremostcommonlyaffected.SusceptiblePopulationAnyage114EpidemiologicFeature

Theseoftenoccuraspoint-sourceepidemics,fromhealthycarrierstofood.Outbreaksmayoccurthroughperson-to-personcontamination.Directfaecalcontaminationofuntreatedwatersuppliesmaycauseextensiveoutbreaks.

EpidemiologicFeature115

TheIndiansubcontinentandpartsofAfrica,Asia,andCentralandSouthAmericathatareeconomicallypoorcountriesareendemicfortyphoidfever.Indevelopedcountries,cleandrinkingwaterandadequatewastedisposalhavedramaticallydiminishedtheprevalenceoftyphoidfever,andmostcasesoftyphoidfeverareimportedfromendemicareas.TheIndiansubcontinen116PathogenesisandPathologyPathogenesisandPathology117Whenthebacteriumpassesdowntothebowel,itpenetratesthroughtheintestinalmucosatotheunderlyingtissue.TheorganismsarephagocytosedbymononuclearphagocytesWhenthebacteriumpassesdown118thebacteriumwillmultiplyand/oraredrainedbyterminallactealsandthoraciclymphducttothebloodstream,namedthefirstbacteremia.thebacteriumwillmultiplyan119Inthesecondphaseofthediseasethebacteriumreplicatedinmononuclearphagocytesystem,andtheoftenviolentsymptomssuchashyperphrexia,malaise,andmyalgiabegin.Inthesecondphaseofthedis120Iftheimmunesystemisunabletostoptheinfectionhere,thebacteriumpenetratesfurthertothebonemarrow,liverandbileducts,fromwhichbacteriaareexcretedintothebowelcontents,namedthesecondbacteremia.Iftheimmunesystemisunable121Atthesametime,organismsexcretedinthebileeitherreinvadetheintestinalwallorareexcretedinthefeces.Atthesametime,organismsex122

Salmonellatyphi(PH＞2;＞105)stomach（achlorhydria）intestinalmucosatotheunderlyingtissuethoraciclymphductbloodstream（thefirstbacteremia）bonemarrow,liverandbileducts

Salmonellatyphi(PH＞2;＞10123bloodstream（thesecondbacteremia）endotoxinsignsandsymptoms（constantfever,relativebradycardia,“rosespots”,hepatosplenomegaly,andleucopeniaorganismsexcretedinthebileeitherreinvadetheintestinalwallnecrosisandulcerationattheintestinaltract（EnterorrhagiaandIntestinalPerforation)bloodstream（thesecondbacter124PathologyPathology：monocytephagocytesystemproliferativereactionThefirstweek:LymphoidhyperplasiaswellingThesecondweek:NecrosisoflymphoidtissueThethirdweek:Thenecrotictissuesloughsoff,leavinganulcerThefouthweek:UlcerhealingPathologyPathology：monocytep125typhoidnodule

typhoidnodule

126Typhoid-fever--教学讲解课件127Typhoid-fever--教学讲解课件128ClinicalManifestations

incubation：10to14days

Theclinicalcauseofclassicaltyphoidfevermaybeseparatedintofourphases

Earlystage、Acmestage、Catabasisstage、Convalescencestage（1week）（2-3week）（3-4week）（5week）ClinicalManifestationsincuba129Earlystage：(1week)fever,chills,weakness,headache,malaise,andmyalgiaInitiallythefeverislowgrade,butitrisesprogressively,andbythesecondweekitisoftenhighandsustained(39~40℃)Earlystage：(1week)130Acmestage：(2～3week)1.Pyrexia(sustainedfever)2.Centralnervoussystem(lethargicface)3.Gastrointestinalsystem(diarrheaorconstipation)4.Cardiovascularsystem(relativebradycardia)5.Skin(Rosespot)6.hepatosplenomegalyAcmestage：(2～3week)131sustainedfeverTheclassicaltemperaturecharthasaplateauat39~40℃Typicalpatternispresentonlyintheuntreatedanduncomplicatedcase,andotherpatternsmayleadtodifficulty.sustainedfeverTheclassicalt132sustainedfeversustainedfever133Centralnervoussystem

dullexpressionlesslethargicfacecoatedtongueslightdeafnessamustyodourSeverelyagitated,delirious,completestupororcomaCentralnervoussystemdullex134dullexpressionlesslethargicfacedullexpressionlesslethargic135Gastrointestinalsystem

Vagueabdominaldiscomfort,VomitingConstipationoccursmorefrequentlythandiarrhoeaTheliverandspleenisenlargedandsoft,andthereisoftendiffusetenderness.GastrointestinalsystemVague