Typhoid Fever Flashcards
What is responsible for 50% of the cases of typhoid in Asia?
Resistant to?
Salmonella typhi
Resistant to fluoroquinolones rising
Main cause typhoid fever in southern china?
Salmonella Paratyphi A
Phase 1 pathogenesis?
Phase 2 pathogenesis?
Phase 1: Bacteraemia and/or endotoxemia
Phase 2: Localisation and/or complications such as bowel perforation, GI bleeding, hepatitis and pneumonitis
What does typhoid initially present as?
High fever, malaise and headache
What happens between weeks 2-3 in typhoid fever?
30-60% of people go on to develop complications:
GI bleeding
Myocarditis
CNS involvement
15% of people died
How many people relapse?
5-10% within 8 weeks
What can happen in the following year after typhoid infection?
1-5% of people will be asymptomatic carriers
Whar are the clinical presentations of typhoid?
Fever common at night
Headahce
No sweating
Abdominal pain
Diarrhea common in children
Adults get constipation
Insomina in adults, hypersomnia in children
Other tell-tale signs of typhoid fever?
Dissociation between pulse and fever (eg pulse 80, temp 40C)
Rose spots (occur between 2nd and 5th week
Hepatomegaly
Most serious complication of TF?
Terminal ileus bowel perforation
How do you diagnose TF?
Blood cultures
Use BACTEC (can only do this without abx use!!), this is gold standard
Stool cultures more accurate in children (70-80% as kids get diarrhoea, much more easily isolated)
Bone marrow useful as independent of abx use
Can use bile culture with sting capsule
Tx of TF?
Ciprofloxacin PO or IV for 10 days
Drawbacks to chloramphenicol?
Doesn’t reduce transitory carrier or relapse rate and does not prevent chronic carriage
SEs of Chloraphenicol?
Haemtological: Anaemia, leucopenia and rarely bone marrow aplasia
ChlorampHEnicol
Other first line drugs against TF?
Amoxicillin
Trimethroprim-sulfamethoxazole
Ceftriaxone-cefoperazone
Why use ciprofloxacin for tx?
High cure rate
Better for community management
What do you use in MDR TF?
Azithromycin for 10 dyas
What is the most serious complication of TF?
Perforation
Usually in 2nd-3rd week
Pain in RIF
In ILEUM
Frequent complication of TF?
Enteric bleeding
Need ilectomy and right hemicolectomy if bleeding massive
What can you give in severe typhoid fever to improve mortality? When systemic illness
Dexamethasone for 2 days
What is chronic carriage of S Typhi or S paratyphi?
Salmonella Typhi excreted in bile and/or stools for 12 months
More common in adults, women and those with gallbladder disease
How do you treat chronic carrier?
Fluoroquinolones
Cipro 28 days BD
Where in the world are chronic carriers of S Typhi associated with schistosomiasis?
Egypt
What are chronic carriers at risk of?
cancer of biliary tract
Common cause of TF?
Caused by Salmonella Typhi
Spread by contaminated food and water
Vaccine for Typhoid Fever
Typhoid conjugate vaccine containing Vi polysaccharide conjugated to tetanus toxoid is a single-dose parental vaccine prequalified by WHO in 2017 and recommended for children as young as 6 months of age as well as for adults.
What is the difference between S Typhi and S Paratyphi and Non S Typhi?
Non S Typhi is gastroenteritis Not typhoid
Rarely causes mortality
Only dangerous in immunocompromised host, otherwise does not require tx
