Typhoid

Question 1

What causes typhoid?

Answer 1

Salmonella enterica serotype typhi and paratyphi A, B

Question 2

What does salmonella enterica look like?

Answer 2

Flagellated G-ve bacilli

Question 3

How is typhoid spread?

Answer 3

Faecal-oral

Asymptomatic carriers can excrete in stool and urine for years

Question 4

What is the pathophysiology of typhoid?

Answer 4

Penetrates gut, enters lymph then blood. Goes to liver, GB, spleen and BM.
Multiples in macrophages until its re-released into blood stream

Question 5

What are the symptoms of typhoid?

Answer 5

Fever with relative bradycardia
Abdo pain and headache
Constipation then diarrhoea
Hepatosplenomegaly 
Dry cough
Rose spots

Question 6

What are the complications of typhoid?

Answer 6

Perforation
Haemorrhage 
Haemodynamic shock
Abscess
Encephalopathy 
Pneumonia
Cholangiocarcinoma
From areas of inflammation

Question 7

How do you diagnose typhoid?

Answer 7

Large vol blood cultures
BM cultures
Stool/urine culture show if carrier

Question 8

How do you treat typhoid?

Answer 8

Very resistant
IV ceftriaxone
PO azithromycin if mild
Dexamethasone in severe disease?

Question 9

How do you prevent typhoid?

Answer 9

Boil water
WASH
Vaccination

Question 10

Who is recommended to have the typhoid vaccine?

Answer 10

Routine use in endemic countries
High risk groups
Travellers going to endemic countries

Question 11

What are the types of typhoid vaccine?

Answer 11

Live attenuated PO
Unconjugated Vi polysaccharide vaccine IM
Conjugated Vi polysaccharide vaccine IM