Enteric Disease Flashcards
What is enteric fever
Systemic illness with fever and abdominal pain
Main organism involved
Salmonella enterica
Main serotype of organism involved
Typhi
Main communities affected by enteric fever
Poor communities
Demography more at risk of enteric fever
Children
Immunocompromised
How is salmonella spread
Contaminated food
Water outside home
Sharing ustensiles
Patients with typhi around other patients
Lack of soap
Lack of toilet facilities
What cases of enteric fever are considered chronic
When there’s excretion of organism in urine or stool more than 12 months after acute infections
Percentage of cases that become chronic
1-5% of cases
Demography more at risks of chronic infection
Women
Cholelithiasis patient
Can antibiotic therapy or cholecystectomy get rid of chronic infection
No , still persistent
Which disease is linked with salmonella typhi infection in Africa
HIV
What are the characteristics of the salmonella enterica
Facultative anaerobe
Gram negative bacilli
Only reservoir of s typhi
Human
Is travel history important in s typhi
Yes , can give idea of sanitation status
Pathogenesis of s typhi
Ingested organism
Survives in acidic conditions of stomach
Get to small bowel
Goes to epithelium borough CFTR
Get to lymphoid tissue
Disseminate through lymphatic and hematogenous route
Can get to submucosal region of bowel by M cll or direct penetration where it proliferates and cause hypertrophy of payer patches
Abdominal pain and olio perforation possible which can lead to death
In bacteremia , what are the sites where you will find s typhi
In macrophages of
Bone marrow ( clinical sanctuary )
Liver
Spleen
Complications possible
Secondary bacteremia with other organisms
S typhi propagation and replication in réticuloendothélial system -> prostration -> generalized sepsis and hepatosplenomegaly
Multisystemic illnes
Severe intestinal hemorrhage
Intestinal perforation
Toxic myocarditis
Delirium
Obtundation
Death
Long term permanent neuropsychiatrist complications
Onset of symptoms
After 5 to 21 days
Symptoms in first week
Stepwise rising fever and bacteremia
Chill
Frank rigors
Relative bradycardia
Symptoms in second week
Abdominal pain
Rose soots
Symptoms in third week
Hepatosplenomegaly
Intestinal bleeding
Perforation due to payer patches
Secondary bacteremia
Peritonitis
Septic shock with altered consicousness
Resolution , acute complication or death
Other possible clinical manifestation
Abdominal pain
Constipation
Diarrhea
Intestinal perforation
Typhoid encephalopathy with altered condition , delirium , confusion
Upper motor neuron disease with hyperreflexia , spasticity and sustained clonus
Ataxia
Parkinsonism
Cough
Arthralgia
Myalgia
Focal extra intestinal manifestation with other systems
Possible lab investigations
FBC for anemia , leukopenia and leukocytosis (perforation )
LFT looking like acute viral hepatitis
CRP elevation
CSF with normal mild pleocytosis
Widal test
Type of culture possible
Stool culture
Bone marrow culture
Urine culture
Rose spots culture
Duodenal content culture
What is widal test
Blood test detecting antibodies against O and H antigens in 2n or 3rd week
Management
Antibiotic therapy with fluoroquinolone (ciprofloxacin , levofloxacin ) or 3rd generation cephalosporin (cftriaxone )
