typhoid

Enteric feverDeepak Kumar Gupta

Institute of Dental Education and Advance Studies, Gwalior (India)

Enteric fever• Typhoid – Salmonella typhi

• Paratyphoid – S. paratyphi A & B

• Fecal-oral route transmission.

• Incubation period – 10-14 days

• Few days of bacteremia –Bacilli localizes– Typical lesions in Peyer’s

patches & follicles

• Swells – ulcerate – usually heal– 5 % chronic carrier - gall

bladder – months to yearswww.facebook.com/notesdental

Clinical feature• 1st week

– Fever – temp rises in step ladder fashion with malaise

– Headache

– Myalgia (Pain in muscle)

– Relative bradychardia (Abnormally slow heartbeat)

– Constipation

– Diarrhoea & vomiting in child

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Clinical feature• 2nd Week

– Rose spots on trunk, specially seen in whites• Upper abdomen, back• Slightly raised• Fades on pressure

– Abdominal distension– Splenomegaly (7th -10th day)– Cough & epistaxis– Constipation is receded by

diarrhoea

• If untreated at the end of 2nd week - Delirium & bronchitis, coma & death.


Paratyphoid• Shorter and milder duration

• Onset – abrupt with acute enteritis (Inflammation of the intestine)

• Rash more abundant

• Intestinal complication less frequent.


Complications

• Bowel– Perforation (2nd-3rd week)

– Haemorrhage (Drop in temp to normal or subnormal – falsely reassuring)

• Septicaemic foci• Bone & joint infection

(common in children)

• Cholecystitis & meningitis

• Toxic phenomena• Myocarditis, nephritis


Investigation• Blood culture in the 1st week (Bone marrow

culture is better, but not commonly done)

– Leucopenia (increased WBC count)

• Antibody detection (Widal) in 2nd week

– shows a diagnostic titre for S. Typhi after 7-10 days of disease. It's positivity is maximum in third week

• Stool culture in the 3rd week

• Urine culture in the 4th week

BASU : Blood culture, Antibody, Stool, Urine


Management• Antibiotic therapy guided

by vitro sensitivity testing– Chloramphenicol

• 500 mg - 6 hrs

– Ampicillin• 750 mg, 6hrs

– Co-trimoxazole• 2tab

• or i.v. eq 12-hrs)

• Loosing their effect - drug resistance – India & sub continent


• Alternatives• Fluroquinolones

– 500mg - 12hrs

– commonly resistant

• Cephalosporin (ceftriaxone & cefotaxime)

• Azithromycin– 500mg O.D

– not for severe form

– In case of fluroquinolones failurer


Management

• Treatment for 14 days

– Pyrexia - after start of drug for 5 days

• Chronic carriers – 4 week therapy• Ciprofloxacillin

• Cholecystectomy may be necessary

• Prevention• Sanitation & living condition

• Vaccines– 2 inactivated injectable & 1 live oral attenuated



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typhoid

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