Typhoid is also known as enteric fever. It is caused
by Salmonella typhi and Salmonella paratyphi A and B. A range of clinical
syndrome includes the diarrheal disease. These organisms are transmitted by the
feco-oral route, usually by the carriers, often food handlers, through the contamination
of food, milk and water.
Pathogenesis
The typhoid bacilli reach the small intestine,
penetrate the mucosa and enter intestinal lymphatics via Peyer’s patches to be
carried to the bloodstream. The bacilli are disseminated throughout the body and
intracellular multiplication takes place. The organisms re-enter the
bloodstream producing bacteremia when all organs are repeatedly exposed to
typhoid bacilli.
Clinical Features
 |
| Symptoms of Typhoid |
1st week
- Step ladder fever
- Malaise
- Headache
- Diarrhea
- Vomiting
- Constipation – rarely
- Relative bradycardia
2nd Week
- Transient maculopapular rash (Rose Spot – present at lower trunk and upper abdomen)
- Spleenomegaly
- Abdominal distension
- Diarrhea
- Cough
3rd Week
- Delirium
- Altered sensation
- Complications are seen
- Coma Death
Complications
- General – Toxaemia, dehydration, circulatory failure, DIC
- Gastrointestinal – Perforation of intestine, intestinal hemorrhage
- Neurological – Delirium, psychosis, meningitis, encephalopathy, coma
- Miscellaneous – Myocarditis, endocarditis, pericarditis, pyelonephritis, pneumonia, arthritis, osteomyelitis
Investigations
- Complete Blood Count – Total and Differential Count, Hb
- Blood Culture (B) – 1st week
- Agglutination Test (A) (Widal test) – 2nd week
- Stool Culture (S) – 3rd week
- Urine Culture (U) – 4th week
- Bone Marrow Culture
- Bile Culture
- PCR
- ELISA
- Scratch Test from rose spot
- USG – hepatomegaly, splenomegaly
- CPR
Management
- Bed rest
- Isolation
- Maintenance of nutrition and fluid intake
- Antibiotics (2 weeks) – Ciprofloxacin (500mg BD is drug of choice) or Cotrimoxazole or Amoxicillin
- If the disease is severe – IV antibiotic
Prevention
- Good hygiene
- Proper sewage disposal
- Proper water treatment
- If endemic area – Typhoid vaccine
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