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Infectious disease > Enteric fever/typhoid and paratyphoid > Flashcards

Enteric fever/typhoid and paratyphoid Flashcards

1
Q

What is typhoid fever?

A

Systemic illness caused by salmonella typhy and paratyphi A,B and C causing septicaemia

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2
Q

When dose non typhoidal enteric fever occur

A

Immunocompromised or super imposed infection in chidlren with zoontoci salmonella

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3
Q

Endemic regions typhoid

A

India/south east asia
Sub saharan africa
Central/south america

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4
Q

WHo is typhoid most common in in endemic areas

A

Children and young adults

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5
Q

Causative organsims of salmonella

A

S.typhi
S.paratyphi A+B
Paratyphi C

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6
Q

How is typhoid spread

A

Faeco-oral - water and food
Or close contact with people or patients or carriers asypmtomatic
Insects and flies - contaminating foods

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7
Q

What strain of typhoid vomitting and diarrhoea before other symptoms and more predominant

A

Paratyphoid A+B - already multiplied in food

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8
Q

Which salmonella strain causes septicaemia and abscesses without gut involvement

A

Paratyphoid C

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9
Q

Antigens from salmonella general vs typhi

A

3 antigens
All salmonella - Smoatic - O antigen
Flagella - H antigen
Typhi and paratyphi also have Vi (coats O antigen)

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10
Q

What factor about contraction of typhoid effects severity of disease

A

Dose -related
Higher dose = more severe, shorter incubation period

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11
Q

Why do PPIs and H2 antagonists increase the risk of enteric infection

A

Lower stomach acidity - lower level of salmonella typhi needed to contract typhoid

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12
Q

What are the most important reservoirs for infection

A

Asymptomatic, convalescent or chronic human carriers eg food handlers

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13
Q

Pathology of enteric fever

A

Salmonella typhi -> Small intestine -> lymphatics -> mesenteric lymph nodes -> thoracic duct -> blood stream -> gall bladder, spleen, bone marrow, liver
Multiply inside macrophages at these sites
Re-enter blood stream -> symptoms

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14
Q

How is the bowel affected in enteric fever

A

Baceria collect in peyers patches and other intestinal lymph follicles
Strong inflam response -> hyperplasia, necrosis and ulceration after 7-10 days

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15
Q

Complications of gut inflammation in typhoid

A

Blood vessel involvement - bleeding
Perforation

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16
Q

Where do typhoid nodules occur

A

Initially liver, spleen, bone marrow and lymph
Diffuse -> Myocardium, kidney, lung
Abscess formation - bone, brain, liver, spleen

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17
Q

What are typhoid nodules

A

Aggregated infected macrophages with salmonella typhi

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18
Q

When does fever classically return to normal in typhoid

A

3 weeks

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19
Q

Fatal complications of eneteric fever

A

Perforation
Haemodynamic shock ass w intestinal haemorrhage or severe toxicaemia
Meningitis

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20
Q

Average incubation period of typhoid

A

14 dyas
Can be <7 days to 3 weeks

21
Q

Fever features in typhoid

A

Sustained through illness
Increases gradually in first week - evening rise
High or sustained fever of 39-40 degrees C progresses in 3rd and 4th week

22
Q

Symptoms of typhoid

A

Malaise, aches and pains, anorexia
Abdominal pain or discomfort, diarrhoea, headache, constipation, non productive cough

23
Q

Stage 1 and 2 typhoid symptoms

A

slowly rising - stepladder temp 4-5 days
Abdo pain and myalgia
Malasia
Headache
Constipation
Relative bradycardia
Stage 2 - progression of these in 2nd week

24
Q

End of 1st week signs of typhoid

A

Rose spots on upper abdomen and back
Cough
Splenomegaly
Abdo distension w tenderness
Diarrhoea

25
Q

Typhoid at end of 2nd week

A

Delirium, complications, coma and death if untreated
Severe dehydration

26
Q

Delirium ass w typhoid

A

Muttering delirium
Disconencted and flattened affect
May also have meningism

27
Q

Rash in typhoid

A

Rose spots

28
Q

Rose spots characteristics

A

Fair skin only
Day 7 onwards
Pink macules
sCANT, mainly on trunk
Disappear under glass

29
Q

What is a feature of typhoid with high fever that differentiates it

A

Relative bradycardia of <100BPM

30
Q

Illnesses displaying relative bradycardia with fever

A

TYPHOID
yellow fever - flavivirus
Tularemia
Brucellosis
Colorado tick fever
Leginoalla pneumonia
Mycoplasma pneumonia

31
Q

Complications of typhoid

A

Bowel - perforation, haemorrhage
Septicaemia foci - bone and joint infection, menningitis, cholecystisi
Toxic phenomena - myocarditis - chest pain, HF, nephritis (renal failure, acute nephrotic syndrome)
Chronic carraige - persistent gallbladder carriage

32
Q

How is typhoid carried chronically

A

Persistent gallbaldder carriage eg gallstones

33
Q

When do bowel perforation occur

A

3rd week

34
Q

Sing of peritonitis in toxic patients

A

Abdo distension
Increasing toxamia
Rising pulse

35
Q

Treatment for bowel perforation

A

Surgery - excision or segmental resection

36
Q

What should do with medications in typhoid at risk of bowel perforation

A

Widen antibiotic spectrum cover GI orgnaisms contaminate peritoneim

37
Q

INvestigations for typhoid

A

Blood culture in 1st/2nd week
Bone marrow culture
Aspirates - Rose spots, CSF, abscess
NOT stool!

38
Q

Why can bone marrow culture be preferable to blood culutre in typhoid

A

Higher positivity rate - 10 x concentration in bone marrow of bacteria
Blood - low conc of bacteria

39
Q

Widal test pros and cons

A

Cheap, widely availabel
Low sensitivity, specifiticty (general pop have low levels, many slamonella have these antigens, H antigen stays high long time after vaccination, titre rise before clinical onset, some culture + patients show no rise in tire)

39
Q

What test use for serology of typhoid

A

Widal test - measures anitbodies to somatic O and flagella H antigens

39
Q

Prev effective antibiotics for typhoid

A

Chloramphenicol
Amoxicillin
Cotrimoxazole

40
Q

Current treatment of typhoid antibiotic choice

A

Fluoroquinolones w ciprafloxacin or ofloxacin for 5-7 dyas - rapid reaction

3rd gen cephalosporins eg ceftriazone, ceflotazime

Azithromycin

41
Q

What use as marker for resisteance in fluoroquinolones

A

Nalidixic acid resistance - proxy marker
India, vietnam have resistant strains

42
Q

Benefits of 3rd gen cephalosporins and azithromycin for typhoid

A

Effective against MDR strains, severe disease but slower resposne

43
Q

What is teh chronic carrier state in typhoid

A

Several months post infection - biliary or urinary carriage of salmonella typhi
Variabel/erratic excretion

44
Q

Treatment for carriers of typhoids

A

ciprofloxacin 750mg for 28 dyas
Cholecystectomy if gallstones - difficult to clear

45
Q

Convalescent vs chronic carriers

A

Convalescent - spontaneouslty terminates after several months post infection
Chronic - persisting focus in gallbladder or urinary tract

46
Q

Feautres of chronic carriers of typhoid

A

Gallstones, chronic cholecystitis , chronic schistosoma in urinary tract

Infectious disease (37 decks)

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