typhoid fever and paratyphoid fever guoli lin department of infectious diseases department of...
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TYPHOID FEVER TYPHOID FEVER AND AND
PARATYPHOID PARATYPHOID FEVERFEVERGuoli LinGuoli Lin
Department of Infectious DiseasesDepartment of Infectious Diseases The Third Affiliated Hospital of The Third Affiliated Hospital of SYSU SYSU
Typhoid and Paratyphoid Typhoid and Paratyphoid
DefinitionDefinition EtiologyEtiology PathogenesisPathogenesis EpidemiologyEpidemiology Clinical Clinical
manifestationsmanifestations The laboratory The laboratory
and other and other examinationsexaminations
ComplicationsComplications Diagnosis and Diagnosis and
differential differential diagnosisdiagnosis
PrognosisPrognosis TreatmentTreatment PreventionsPreventions Paratyphoid FeverParatyphoid Fever
Definition of Typhoid Definition of Typhoid feverfever
Acute enteric infectious diseaseAcute enteric infectious disease
caused by Salmonella typhi (S.Typhi).caused by Salmonella typhi (S.Typhi).
prolonged fever, Relative bradycardia, prolonged fever, Relative bradycardia,
apathetic facial expressions,apathetic facial expressions, roseola,roseola,
splenomegaly,splenomegaly, hepatomegaly,hepatomegaly, leukopenia.leukopenia.
intestinal perforation, intestinal intestinal perforation, intestinal
hemorrhagehemorrhage
EtiologyEtiology
Serotype: D group of SalmonellaSerotype: D group of Salmonella
Gram-negativeGram-negative
rodrod
non-sporenon-spore
flagellaflagella
Culture characteristicsCulture characteristics
Antigens: located in the cell Antigens: located in the cell
capsule capsule
H (flagellar antigen). H (flagellar antigen).
O (Somatic or cell wall antigen).O (Somatic or cell wall antigen).
Vi (polysaccharide virulence)Vi (polysaccharide virulence)
“ “widel test”widel test”
A schematic diagram of a single A schematic diagram of a single Salmonella typhi Salmonella typhi cell cell showing the locations of the H (flagellar), 0 (somatic), and showing the locations of the H (flagellar), 0 (somatic), and
Vi (K envelope) antigens.Vi (K envelope) antigens.
Endotoxin Endotoxin
A variety of plasmidsA variety of plasmids
Resistance: Live 2-3 weeks in Resistance: Live 2-3 weeks in
water. 1-2 months in stool. Die water. 1-2 months in stool. Die
out quickly in summerout quickly in summer
Resistance to drying and Resistance to drying and
coolingcooling
EpidemiologyEpidemiology
continues to be a global health continues to be a global health problemproblem
areas with a high incidence include areas with a high incidence include Asia, Africa and Latin AmericaAsia, Africa and Latin America
affects about 6000000 people with affects about 6000000 people with more than 600000 deaths a year. 80% more than 600000 deaths a year. 80% in Asia .in Asia .
sporadic occur usually, sometimes sporadic occur usually, sometimes have epidemic outbreaks.have epidemic outbreaks.
Source of infectionSource of infection
Cases and chronic carriersCases and chronic carriers
Cases discharge from incubation, Cases discharge from incubation,
more in 2~4 weeks after onset, a more in 2~4 weeks after onset, a
few (about 2~5%) last longer than few (about 2~5%) last longer than
3 months 3 months
chronic carrier chronic carrier Typhoid MaryTyphoid Mary
TransmissionTransmission
fecal-oral routefecal-oral route
close contact with patients or close contact with patients or
carrierscarriers
contaminated water and foodcontaminated water and food
flies and cockroaches.flies and cockroaches.
Susceptibility and immunitySusceptibility and immunity
all people equally susceptible to all people equally susceptible to infectioninfection
acquired immunity can keep acquired immunity can keep longer, reinfection are rarelonger, reinfection are rare
immunity is not associated with immunity is not associated with antibody level of “H”, “O”and antibody level of “H”, “O”and “VI”.“VI”.
No cross immunity between No cross immunity between typhoid and paratyphoid.typhoid and paratyphoid.
Susceptibility and immunitySusceptibility and immunity
All seasons, usually in summer All seasons, usually in summer and autumn.and autumn.
Most cases in school-age Most cases in school-age children and young adults.children and young adults.
both sexes equally susceptible.both sexes equally susceptible.
PathogenesisPathogenesis
gastrointestinal tract gastrointestinal tract host-pathogen host-pathogen interactionsinteractions
The amount of bacilli The amount of bacilli infection (>10infection (>1055baeteria). baeteria).
ingested orallyingested orally
Stomach barrier (some Eliminated) Stomach barrier (some Eliminated) enters the small intestineenters the small intestine
Penetrate the mucus layer Penetrate the mucus layer
enter mononuclear phagocytes of ileal enter mononuclear phagocytes of ileal
peyer's patches and mesenteric lymph peyer's patches and mesenteric lymph
nodesnodes
proliferate in mononuclear phagocytes proliferate in mononuclear phagocytes
spread to blood. initial bacteremia spread to blood. initial bacteremia
(Incubation period).(Incubation period).
Pathogenesis
Pathogenesis Pathogenesis
enter spleen, liver and bone marrow enter spleen, liver and bone marrow
(reticulo-endothelial system) (reticulo-endothelial system)
further proliferation occursfurther proliferation occurs
A lot of bacteria enter blood again.A lot of bacteria enter blood again.
(second bacteremia). (second bacteremia).
RecoveryRecovery
S.Typhi.
stomach
Lower ileum
peyer's patches &mesenteric lymph nodes
thoracic
duct
1st bacteremia(Incubation stage)
10-14d
(monomononuclenuclear ar phagophagocytescytes )
2nd bacteremia
liver 、 spleen 、 gall 、BM ,ect
early stage&acme stage(1-3W )
LN Proliferate,swell necrosis
defervescence stage
( 3-4w )
Bac. In gall
Bac. In feces
S.Typhi eliminatedconvalvescence stage
(4-5w)
Enterorrhagia,intestinal
perforation
PathologyPathology essential lesion:essential lesion:
proliferation of RES proliferation of RES (reticuloendothelial system )(reticuloendothelial system )
specific changes in lymphoid tissues specific changes in lymphoid tissues
and mesenteric lymph nodes.and mesenteric lymph nodes."typhoid nodules“"typhoid nodules“
Most characteristic lesionMost characteristic lesion: :
ulceration of mucous in the region ulceration of mucous in the region of the Peyer’s patches of the small of the Peyer’s patches of the small intestineintestine
回肠:集合淋巴结(PEYER’SPATCHES)增生
伤寒小结(TYPHOID NODULE)
Major findings in lower ileumMajor findings in lower ileum Hyperplasia stage(1st week):Hyperplasia stage(1st week):
swelling lymphoid tissue and swelling lymphoid tissue and proliferation of macrophages.proliferation of macrophages.
Necrosis stage(2nd week):Necrosis stage(2nd week):
necrosis of swelling lymph necrosis of swelling lymph nodes or solitary follicles.nodes or solitary follicles.
Major findings in lower Major findings in lower ileumileum
Ulceration stage(3rd week):Ulceration stage(3rd week):
shedding of necrosis tissue and shedding of necrosis tissue and formation of ulcer formation of ulcer ----- intestinal ----- intestinal hemorrhage, perforationhemorrhage, perforation . .
Stage of healing (from 4th Stage of healing (from 4th week):week):
healing of ulcer, no cicatrices healing of ulcer, no cicatrices and no contractionand no contraction
Clinical manifestationsClinical manifestations
Incubation period: 3Incubation period: 3 ~~ 60 days60 days(7(7 ~~ 14).14).
The initial period (early stage)The initial period (early stage) First week. First week. Insidious onset. Insidious onset. Fever up to 39~40Fever up to 39~4000C in 5~7 daysC in 5~7 days chillschills 、、 ailmentailment 、、 tiredtired 、、 sore sore
throatthroat 、、 cough ,abdominal cough ,abdominal discomfort and constipation et discomfort and constipation et al. al.
The fastigium satgeThe fastigium satge second and third weeks.second and third weeks. Sustained high feverSustained high fever 、、 partly partly
remittent fever or irregular fever. remittent fever or irregular fever. Last 10Last 10 ~~ 14 days. 14 days.
Gastro-intestinal symptoms: Gastro-intestinal symptoms: anorexiaanorexia 、、 abdominal distension abdominal distension or painor pain 、、 diarrhea or constipationdiarrhea or constipation
Neuropsychiatric manifestations: Neuropsychiatric manifestations: confusionconfusion 、、 blunt respond even blunt respond even delirium and coma or meningismdelirium and coma or meningism
Circulation systemCirculation system: :
relative bradycardia or dicrotic pulse.relative bradycardia or dicrotic pulse.
splenomegalysplenomegaly 、、 hepatomegalyhepatomegaly
toxic hepatitis.toxic hepatitis.
roseola roseola :30%, maculopapular rash :30%, maculopapular rash
a faint pale color, slightly raiseda faint pale color, slightly raised
round or lenticular, fade on pressureround or lenticular, fade on pressure
2-4 mm in diameter, less than 10 in 2-4 mm in diameter, less than 10 in
numbernumber
on the trunk, disappear in 2-3 days.on the trunk, disappear in 2-3 days.
fatal complications: fatal complications: intestinal hemorrhageintestinal hemorrhage
intestinal perforation intestinal perforation
severe toxemiasevere toxemia
defervescence stagedefervescence stage fever and most symptoms fever and most symptoms
resolve by the resolve by the forth weekforth week of of infection.infection.
Fever come down, gradual Fever come down, gradual improvement in all symptoms improvement in all symptoms and signs, but still danger.and signs, but still danger.
convalescence stageconvalescence stage the the fifth weekfifth week. disappearance of . disappearance of
all symptoms, but can relapseall symptoms, but can relapse
图 典型伤寒自然病程示意图
Clinical forms:Clinical forms: Mild infectionMild infection::
very common seen recentlyvery common seen recently
symptom and signs mildsymptom and signs mild
good general conditiongood general condition
temperature is 38temperature is 3800CC
short period of diseasesshort period of diseases
recovery expected in 1~3 weeksrecovery expected in 1~3 weeks
seen in early antibiotics usersseen in early antibiotics users
young children mild moreyoung children mild more
easy to misdiagnoseeasy to misdiagnose
Persistent infectionPersistent infection::
diseases continue than 5 diseases continue than 5 weeksweeks
Ambulatory infectionAmbulatory infection::
mild symptoms,early intestinal mild symptoms,early intestinal
bleeding or perforation.bleeding or perforation.
Fulminate infectionFulminate infection::
rapid onset, severe toxemia rapid onset, severe toxemia
and septicemia.and septicemia.
High fever,chill,circulation High fever,chill,circulation
failure, shock, delirium, coma, failure, shock, delirium, coma,
myocarditis, bleeding and myocarditis, bleeding and
other complications, DIC et all.other complications, DIC et all.
Special manifestationsSpecial manifestations
In childrenIn children
Often atypicalOften atypical
sudden onset with high fever.sudden onset with high fever.
Respiratory symptoms and diarrhea, dominant.Respiratory symptoms and diarrhea, dominant.
Convulsion common in below 3. Convulsion common in below 3.
relative bradycardia rare.relative bradycardia rare.
Splenomegaly, roseola and leucopenia less Splenomegaly, roseola and leucopenia less
common.common.
In the agedIn the aged
temperature not high, weakness temperature not high, weakness
common.common.
More complications.high More complications.high
mortality.mortality.
clinical manifestations reappear clinical manifestations reappear
less severe than initial episode less severe than initial episode
It’s temperature recrudesce when It’s temperature recrudesce when
temperature start to step down but temperature start to step down but
abnormal in the period of 2-3 weeks and abnormal in the period of 2-3 weeks and
persist 5~7 days then back to normal.persist 5~7 days then back to normal. seen in patients with short therapy of seen in patients with short therapy of
antibiotics.antibiotics.
RecrudescenceRecrudescence
relapserelapse
serum positive of S.typhi after 1serum positive of S.typhi after 1 ~~3 weeks of temperature down to 3 weeks of temperature down to
normal.normal.
Symptom and signs reappearSymptom and signs reappear
the bacilli have not been the bacilli have not been
completely removedcompletely removed
Some cases relapse more than onceSome cases relapse more than once
Laboratory findingsLaboratory findings
Routine examinations:Routine examinations:
white blood cell count is normal or white blood cell count is normal or
decreased.decreased.
Leukocytopenia(specially eosinophilic Leukocytopenia(specially eosinophilic
leukocytopenia).leukocytopenia).
recovery with improvement of diseasesrecovery with improvement of diseases
decreased in relapsedecreased in relapse
Bacteriological examinations:Bacteriological examinations:
Blood culture: Blood culture:
the most common usethe most common use
80~90% positive during the first 2 weeks of 80~90% positive during the first 2 weeks of
illnessillness
50% in 3rd week50% in 3rd week
not easy in 4th weeknot easy in 4th week
re-positive when relapse and recrudescere-positive when relapse and recrudesce
attention to the use of antibioticsattention to the use of antibiotics
The bone marrow culture The bone marrow culture
the most sensitive testthe most sensitive test
specially in patients pretreated with specially in patients pretreated with
antibiotics.antibiotics.
Urine and stool culturesUrine and stool cultures
increase the diagnostic yieldincrease the diagnostic yield
positive less frequentlypositive less frequently
stool culture better in 3~4 weeks stool culture better in 3~4 weeks
The duodenal string test to culture The duodenal string test to culture
bile useful for the diagnosis of bile useful for the diagnosis of
carriers.carriers.
Rose spots: Not use routinelyRose spots: Not use routinely
Serological tests(Vidal test):Serological tests(Vidal test):
five types of antigens:five types of antigens:somatic antigen(O),flagella(H) antigen, and paratyphoid somatic antigen(O),flagella(H) antigen, and paratyphoid
fever flagella(A,B,C) antigen.fever flagella(A,B,C) antigen.
Antibody reaction appear during first Antibody reaction appear during first
weekweek
70% positive in 3~4 weeks and can 70% positive in 3~4 weeks and can
prolong to several monthsprolong to several months
in some cases, antibodies appear slowly, in some cases, antibodies appear slowly,
or remain at a low level, or remain at a low level,
some(10~30%) not appear at all.some(10~30%) not appear at all.
"O" agglutinin antibody titer ≥1:80 and "H" "O" agglutinin antibody titer ≥1:80 and "H"
≥1:160 or "O" 4 times higher supports a ≥1:160 or "O" 4 times higher supports a
diagnosis of typhoid feverdiagnosis of typhoid fever
"O" rises alone, not "H", early of the "O" rises alone, not "H", early of the
disease.Only "H" positive, but "O" negative, disease.Only "H" positive, but "O" negative,
often nonspecifically elevated by often nonspecifically elevated by
immunization or previous infections or immunization or previous infections or
anamnestic reaction.anamnestic reaction.
Antibody level maybe lower when have used Antibody level maybe lower when have used
antibiotics early.antibiotics early.
Some cross reaction between group Some cross reaction between group
“D” and “A”.“D” and “A”. False positive in some infectious False positive in some infectious
diseases.diseases. Some positive in blood culture ,but Some positive in blood culture ,but
negative in vidal test.negative in vidal test. 'Vi" often useful for carrier (1:40) 'Vi" often useful for carrier (1:40)
molecular biological tests: molecular biological tests:
DNA probe or polymerase chain DNA probe or polymerase chain
reaction (PCR)reaction (PCR)
ComplicationsComplications
Intestinal hemorrhageIntestinal hemorrhageCommonly appear during the second-third Commonly appear during the second-third
week of illnessweek of illness
difference between mild and greater bleedingdifference between mild and greater bleeding
often caused by unsuitable food, diarrhea et al often caused by unsuitable food, diarrhea et al
serious bleeding in about 2~8%serious bleeding in about 2~8%
a sudden drop in temperaturea sudden drop in temperature 、 、 rise in pulserise in pulse 、、
and signs of shock followed by dark or fresh and signs of shock followed by dark or fresh
blood in the stool.blood in the stool.
IntestinalIntestinal perforation: perforation: The more serious .Incidence,1-4%The more serious .Incidence,1-4% Commonly appear during 2-3 weeks. Commonly appear during 2-3 weeks. Take place at the lower end of ileum.Take place at the lower end of ileum. Before perforation,abdominal pain orBefore perforation,abdominal pain or
diarrhea,intestinal bleeding . diarrhea,intestinal bleeding . When perforation, abdominal pain, sweating, When perforation, abdominal pain, sweating,
drop in temperature, and increase in pulse drop in temperature, and increase in pulse rate, then, rebound tenderness when press rate, then, rebound tenderness when press abdomen,abdomen,
abdomen muscle entasia, reduce or disappear abdomen muscle entasia, reduce or disappear in the sonant extent of liver, leukocytosis . in the sonant extent of liver, leukocytosis .
Temperature rise .peritonitis appear.Temperature rise .peritonitis appear. celiac free air under x-ray. celiac free air under x-ray.
Toxic hepatitisToxic hepatitis::
common,1-3 weeks common,1-3 weeks
hepatomegaly, ALT elevatedhepatomegaly, ALT elevated
get better with improvement of get better with improvement of
diseases in 2~3 weeksdiseases in 2~3 weeks
Toxic myocarditisToxic myocarditis. .
seen in 2-3 weeks, usually severe seen in 2-3 weeks, usually severe
toxemia. toxemia.
Bronchitis, bronchopneumonia.Bronchitis, bronchopneumonia.
seen in early stageseen in early stage
Other complicationsOther complications::
toxic encephalopathy. toxic encephalopathy.
Hemolytic uremic syndrome. Hemolytic uremic syndrome.
acute cholecystitisacute cholecystitis 、、
meningitismeningitis 、、
nephritis et al.nephritis et al.
图 典型伤寒自然病程示意图
DiagnosisDiagnosis
Epidemiology dataEpidemiology data
Typical symptoms and signsTypical symptoms and signs
Laboratory findings.Laboratory findings.
Differential diagnosisDifferential diagnosis
Viral infectionsViral infections:: such as upper respiratory tract infection. such as upper respiratory tract infection.
abrupt onset with fever, headache, abrupt onset with fever, headache,
leucopenia, sore throat, cough, coryza. leucopenia, sore throat, cough, coryza.
no rose spots, no enlargement of liver & no rose spots, no enlargement of liver &
spleen. The course of illness no more than spleen. The course of illness no more than
2 wks.2 wks.
differential diagnosis depends on typical differential diagnosis depends on typical
manifestations and blood culture.manifestations and blood culture.
MalariaMalariahistory of exposure to malaria.history of exposure to malaria.
Paroxysms(often periodic) of sequential Paroxysms(often periodic) of sequential
chill,high fever and sweating.chill,high fever and sweating.
Headache, anorexia, splenomegaly, Headache, anorexia, splenomegaly,
anemia, leukopeniaanemia, leukopenia
Characteristic parasites in Characteristic parasites in
erythrocytes,identified in thick or thin erythrocytes,identified in thick or thin
blood smears.blood smears.
LeptospirosisLeptospirosis
Endemic area,contacted with urine of mice.Endemic area,contacted with urine of mice.
Abrupt fever,chills,severe headache,and Abrupt fever,chills,severe headache,and
myalgias, especially of the calf muscles.myalgias, especially of the calf muscles.
Leptospires can be isolated from Leptospires can be isolated from
blood,cerebrospinal fluid.blood,cerebrospinal fluid.
Special agglutination titers develop after 7 Special agglutination titers develop after 7
days and may persist at high levels for days and may persist at high levels for
many years.many years.
Epidemic Louse-Borne typhusEpidemic Louse-Borne typhus
prodromal of malaise and headache prodromal of malaise and headache
followed by abrupt chills and fever.followed by abrupt chills and fever.
headaches,prostration,persisting high headaches,prostration,persisting high
fever.fever.
Maculopapular rash appears on the forth to Maculopapular rash appears on the forth to
seventh days on the trunk and in the seventh days on the trunk and in the
axillas, spreading to the rest of the body axillas, spreading to the rest of the body
but sparing the face,palms,and soles.but sparing the face,palms,and soles.
Laboratory confirmation by proteins OX19 Laboratory confirmation by proteins OX19
agglutination and specific serologic tests. agglutination and specific serologic tests.
TuberculosisTuberculosis continuous high or low continuous high or low
fever,fatigue,weight loss,night sweats.fever,fatigue,weight loss,night sweats.
Mild coughMild cough
pulmonary infiltration on chest pulmonary infiltration on chest
radiographradiograph
positive tuberculin skin test positive tuberculin skin test
reaction(most cases)reaction(most cases)
acid-fast bacilli on smear of sputumacid-fast bacilli on smear of sputum
sputum culture positive for sputum culture positive for
mycobacterium tuberculosismycobacterium tuberculosis..
Septicemia of Gram-negative bacilliSepticemia of Gram-negative bacilli
abrupt onset,high fever,symptom of abrupt onset,high fever,symptom of
toxemia.toxemia.
Chill,sweats.Chill,sweats.
Shock.Shock.
Positive of gram-negative bacilli Positive of gram-negative bacilli
from blood culture.from blood culture.
Prognosis:Prognosis:
Case fatality 0.5Case fatality 0.5 ~~ 1%. 1%.
but high in old agesbut high in old ages 、、 infantinfant 、、 and and
serious complicationsserious complications
Have immunity for ever after diseasesHave immunity for ever after diseases
About 3% of patients become fecal About 3% of patients become fecal
carrierscarriers . .
TREATMENTTREATMENT
General treatmentGeneral treatment
isolation and restisolation and rest good nursing care and supportive good nursing care and supportive
treatmenttreatment
close observation T,P,R,BP,abdominal close observation T,P,R,BP,abdominal
condition and stool .condition and stool .
suitable diet include easy digested food suitable diet include easy digested food
or half-liquid food.drink more wateror half-liquid food.drink more water
intravenous injection to maintain water intravenous injection to maintain water
and acid-base and electrolyte balanceand acid-base and electrolyte balance
Symptomatic treatment:Symptomatic treatment:
for high fever:for high fever: physical measures firstlyphysical measures firstly
antipyretic drugs such as aspirin antipyretic drugs such as aspirin
should be administrated with cautionshould be administrated with caution
delirium,coma or shock,2-4mg delirium,coma or shock,2-4mg
dexamethasone in addition to dexamethasone in addition to
antibiotics reduces mortality.antibiotics reduces mortality.
Etiologic and special treatmentEtiologic and special treatment
1.Quinolones: 1.Quinolones:
first choicefirst choice
it’s highly against S.typhiit’s highly against S.typhi
penetrate well into macrophages,and achieve penetrate well into macrophages,and achieve
high concentrations in the bowel and bile high concentrations in the bowel and bile
lumens lumens
Norfloxacin (0.1Norfloxacin (0.1 ~~ 0.2 tid0.2 tid ~~ qid/10qid/10 ~~ 14 days).14 days).
Ofloxacin (0.2 tid 10Ofloxacin (0.2 tid 10 ~~ 14days). 14days).
ciprofloxacin (0.25 tid)ciprofloxacin (0.25 tid)
caution: not in children and pregnantcaution: not in children and pregnant
2.Chloramphenicol: 2.Chloramphenicol:
For cases without multiresistant S.typhi. For cases without multiresistant S.typhi.
Children in dose of 50Children in dose of 50 ~~ 60mg/kg/per day. 60mg/kg/per day.
adult 1.5adult 1.5 ~~ 2g/day. tid. 2g/day. tid.
Unable to take oral medication, the same Unable to take oral medication, the same
dosage given introvenously dosage given introvenously
after defervescence reduced to a half. after defervescence reduced to a half.
complete a 10complete a 10 ~~ 14 day course.14 day course.
But ,drug resistance, a high relapse But ,drug resistance, a high relapse
rate,bone marrow toxicity.rate,bone marrow toxicity.
3.Cephalosporines: 3.Cephalosporines:
Only third generation effectiveOnly third generation effective
Cefoperazone and Ceftazidime. Cefoperazone and Ceftazidime.
22 ~~ 4g/day .10~14 days.4g/day .10~14 days.
4.Treatment of complication.4.Treatment of complication. Intestinal bleeding:Intestinal bleeding:
bed rest, stop diet,close observation bed rest, stop diet,close observation
T,P,R,BP.T,P,R,BP.
intravenous saline and blood intravenous saline and blood
transfusion,and attention to acid-base transfusion,and attention to acid-base
balances.balances.
sometimes,operative.sometimes,operative.
Perforation: Perforation:
early diagnosis.early diagnosis.
stop diet.stop diet.
decrease down the stomach decrease down the stomach
pressure.pressure.
intravenous injection to maintain intravenous injection to maintain
electrolyte and acid-base balances.electrolyte and acid-base balances.
use of antibiotics.use of antibiotics.
sometimes operative. sometimes operative.
Toxic myocarditis:Toxic myocarditis:
bed rest, cardiac muscle protection drugs,bed rest, cardiac muscle protection drugs,
dexamethasone, digoxin.dexamethasone, digoxin.
5.Chronic carrier:5.Chronic carrier: OfloxacinOfloxacin 0.2 bid or 0.2 bid or ciprofloxacinciprofloxacin 0.5 bid, 4 0.5 bid, 4 ~~ 6 6
weeks.weeks. Ampicillin 3Ampicillin 3 ~~ 6g/day tid plus probenecid 6g/day tid plus probenecid
11 ~~ 1.5g/day. 41.5g/day. 4 ~~ 6 weeks.6 weeks. TMP+SMZTMP+SMZ
2 tabs. Bid. 12 tabs. Bid. 1 ~~ 3 months.3 months. Cholecystitis may require Cholecystitis may require
cholecystectomy.cholecystectomy.
ProphylaxisProphylaxis
1.control source of infection1.control source of infection
Isolation and treatment of patientsIsolation and treatment of patients
stool culture one time per 5 days.stool culture one time per 5 days.
if negative continued two times ,without if negative continued two times ,without
isolation.isolation.
Control of carriers.Control of carriers.
observation of 25 days(15 days in observation of 25 days(15 days in
paratyphoid) when close contactparatyphoid) when close contact
2. Cut of course of transmission2. Cut of course of transmission
key way key way
avoid drinking untreated avoid drinking untreated
water and food. water and food.
3.Vaccination3.Vaccination
side-effect more, less useside-effect more, less use
Paratyphoid fever A,B,CParatyphoid fever A,B,C Caused by Salmonella paratyphoid Caused by Salmonella paratyphoid
A,B,C.respectively.A,B,C.respectively. in no way different from typhoid fever in in no way different from typhoid fever in
epidemiology, pathogenesis,epidemiology, pathogenesis,
pathology,clinical manifestations,pathology,clinical manifestations,
diagnosis, treatment anddiagnosis, treatment and
ProphylaxisProphylaxis
Paratyphoid A,B:Paratyphoid A,B: incubation period 2~15days, in incubation period 2~15days, in
genaral,8~10 days.genaral,8~10 days.
milder in severitymilder in severity
fewer in complications.fewer in complications.
Better in prognosis, Better in prognosis,
relapse more common in Paratyphoid A.relapse more common in Paratyphoid A.
Treatment same as in typhoid fever.Treatment same as in typhoid fever.
Paratyphoid C:Paratyphoid C: Always sudden onset.Always sudden onset. Rapid rise of temperature.Rapid rise of temperature. Presented in different forms-- Presented in different forms--
Septicemia, Septicemia,
Gastroenteritis and Enteric feverGastroenteritis and Enteric fever Complications--arthritis, abscess Complications--arthritis, abscess
formation, cholecystitis, pulmonary formation, cholecystitis, pulmonary
complications are commonly seen.complications are commonly seen. Intestinal hemorrhage and perforation Intestinal hemorrhage and perforation
not as common as in typhoid fever.not as common as in typhoid fever.
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