TYPHOID FEVER

TYPHOID FEVER
Typhoid fever is an acute anthroponosic infectious disease with fecal-oral mechanism of transmission.
It is characterized by cyclic course, prolonged fever, intoxication, typical rash, lesion of the lymphatic apparatus
of the small intestine with development clinical symptoms and syndromes.

ETIOLOGY
The causative agent is Salmonella typhi
Family – Enterobacteria
Genus – Salmonella
Serological group D
Antigenic Structure.
flagella (H) antigen – lipopolysaccharide components
somatic (O) antigen– protein components
Vi antigen – capsular or virulence antigen

EPIDEMIOLOGY
The source of infection is a sick man or bacteriocarrier.
The mechanism of the transmission is fecal-oral.
The routes of the transmission:
water
alimentary
contact
The factors of transmission:
water, milk and milk products, various food-stuff, unwashed fruits and vegetables
Flies play the supplementary rote
Susceptibility to agent is high
Seasonal spread – summer-autumn

PATHOGENESIS
The following phases are distinguished in the pathogenesis of typhoid fever:
Penetration of the causative agent into the organism.
Development of lymphadenitis and lymphangitis.
Bacteremia
Intoxication.
Parenchymatous diffusion.
Discharge of the agent from the organism (excretory phase).
Allergic reaction mainly of the lymphoid tissue of the small intestine
Formation of immunity.

ANATOMIC PATHOLOGY
Sequential changes in the typhoid fever tissue in the ileocecal area of the intestinal tract occur in typhoid fever, they have been classified into four phases:
hyperplasia (solitary follicules, Peyer’s patches);
necrosis and exfoliation;
ulceration;
healing.

CLINICAL MANIFESTATIONS
Typhoid fever is characterized by cyclic course:
incubation period (10-14 days)
initial period
period of climax
reconvalescence and outcomes
Initial period
fever
headache
malaise
anorexia
mialgia

CLINICAL MANIFESTATIONS
Period of climax
pale skin
rash
rose sports;
type of rash – roseolas that blanch on pressure;
localization – upper abdomen,
data of appearance – 8-10th day of the disease)
fever (temperature curve of Wunderlich, of Botkin)
cardiovascular symptoms
relative bradycardia;
muffed heart sounds;
systolic murmur at the heart apex;
respiratory symptoms
cough;
sore throat;
syndrome of hepatosplenomegaly
damage of gastrointestinal tract
diarrhea;
constipation;
on percussion short sound is marked in ileocaecal area due to enlarged mesenteric lymphatic nodes (symptom of Padalka)

COMPLICATIONS
1. Secondary to toxemia
myocarditis
hyperpyrexia
hepatic
bone marrow damage)
2. Secondary to local gastrointestinal lesions
haemorrhage
perforation
3. Secondary to prolonged severe illness
suppurative parotitis decubiti
pneumonia
4. Secondary to growth
5. Persistence of typhoid fever bacilli
relapse
localized infection - meningitis, endocarditis, osteomyelitis or arthritis
6. Secondary to therapy
bone marrow suppression
hypersensitive reactions
toxic shock).

DIAGNOSTICS
І. Blood count
leucopenia from the 3rd – 4th day
lymphocytosis
aneosinophilia
thrombocytopenia
ІІ. Specific diagnostics
Bacteriological methods
Serological methods (Vidal’s test, RIHA)
ІІI. Differential diagnostics

DIFFERENTIAL DIAGNOSIS
influenza and other acute viral diseases of the respiratory tract
brucellosis
rickettsioses
infectious mononucleosis
ornithoses
pneumonia
tuberculosis
blood diseases (lymphogranulematosis, leucosis)
sepsis
generalized form of other salmonelloses