《传染病学教学课件》10、typhoid伤寒

1、Typhoid Fever,Dept. Infectious Disease 2nd Affiliated Hospital CMU,Definition,Typhoid fever is an acute infectious disease of digestive tract caused by typhoid bacillus. Lesion lymphatics in the terminal ileum Pathological feature proliferation of large mononuclear macrophage cells,Definition,Clinic

2、al feature continued fever relative slow pulse toxic symptoms rose rash splenomegaly and hepatomegaly leukopenia Complication hemorrhage & perforation,Etiology,Etiology,Etiology,Pathogen: Typhoid bacillus genus salmonella group D Pathogenicity: endotoxin Resistance: Stable in environment, sensitive

3、to heat, acid, common disinfectants,Etiology,Antigenicity: O antigen: lipopolysaccharide group-special H antigen: protein, strain-special Vi antigen: polysaccharide,Etiology,Epidemiology,Source of infection Patient, Carrier, shed bacteria in feces,1. The best known carrier was Typhoid Mary. Mary Mal

4、lon was a cook in Oyster Bay, New York in 1906 who is known to have infected 53 people, 5 of whom died. 2. Later returned with false name but detained and quarantined after another typhoid outbreak. 3. She died of pneumonia after 26 years in quarantine.,Epidemiology,Source of infection Patient, Carr

5、ier, shed bacteria in feces Route of transmission Fecal-oral route: contaminated food or water contagious spread spread by insect Susceptibility Epidemic features sporadic cases high incidence in fall & summer,Pathogenesis,Bacillus Stomach killed by gastric acid Small intestine penetrate mucosa Regi

6、onal lymphatics incubation period Blood stream - first bacteremia MPS in liver, spleen, bone marrow Blood stream -second bacteremia endotoxin liver spleen regional lymphotics clinical symptoms swelling inflammation,Pathology,Proliferation of large mononuclear cell 1st week 2nd 3rd week 4th week prol

7、iferation necrosis heal edema ulceration no scar,Pathology,Pathology,Pathology,Typhoid cell,Pathology,Clinical manifestation,Incubation period: 7-23 day(average 10 to 14 days) Typical typhoid fever: Initial period Fastigium Defervescence Convalescence,Clinical manifestation,Clinical manifestation,In

8、itial period onset: insidious, gradual fever: T stepwise fashion rising non-special symptoms:,Clinical manifestation,Fastigium sustained fever toxic symptoms: NS apathy, tinnitus, delirium,lethargy, coma DS anorexia, abdominal pain, diarrhea, constipation CS relative slow pulse, bradycardia, myocard

9、itis,Clinical manifestation,Clinical manifestation,Fastigium rose rash: erythematous macules or papules occur on 613 days upper abdomen hepatomegaly and splenomegaly,Clinical manifestation,Clinical manifestation,Devervescence Convalescence,Clinical manifestation,Clinical type: Mild type common type

10、prolonged type, ambulatory type fulminate 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 p

11、ositive.,Complications,Intestinal hemorrhage Intestinal perforation Toxic hepatitis and myocarditis Pneumonia,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:

12、O=1:80 H=1:160 results analysis:,Diagnosis,Epidemiological data Clinical manifestation Laboratory findings Definitive diagnosis: bacteria culture positive,Differential Diagnosis,Typhus rickettsises malaria disseminated TB,Treatment,General therapy Etiologic therapy quinolone: first choice cephalosporins: 2n