TYPHOID FEVER

Question 1

A potentially fatal multisystemic illness caused primarily by __________________ subspecies bacteria. .aka ___________

Mainly by S. ______

Answer 1

Salmonella enterica ; enteric fever

typhi

Question 2

S. paratyphi A, B, or C cause similar but often less severe disease – _____________

Answer 2

Paratyphoid fever

Question 3

Typhoid fever

A ______ term febrile illness with prompt and appropriate antibiotic therapy.
Untreated may become complicated and lead to death within ___________.

Answer 3

short

one month

Question 4

Typhoid fever

Occurs worldwide
● Rare in the _______ world.
● Most cases in developed world arise in ____________.
● Occurs primarily in developing countries where _______________ are poor.
● Associated with ______ socioeconomic status.
● No racial predilection

Answer 4

developed; international travelers

sanitary conditions ; low

Question 5

Transmission of typhoid fever

● __________ transmission
● Through ____________
● Through ________ with infected persons
● Eating _______ contaminated shell fish

Answer 5

Faeco – oral ; contaminated food and water; close contact

Sewage

Question 6

S. typhi passed in ________ and sometimes _______ of infected people.

Answer 6

faeces; urine

Question 7

Pathophysiology
● Stomach (has ______________)
● Small intestine - in the ________(_______)
● Co-opt _________ cellular machinery for ____________
● Carried through mesenteric L nodes to the TD and then lymphatics to RE tissues of liver, bone marrow, lymph nodes

Continues to multiply in RE tissues until a ________ is reached.
● Bacteria induced ____________ → release of S organism into __________→ invasion of the rest of the body.

● Gall bladder infection through either __________ or _________ →
● Organism re – enters GIT in bile → re-infection of Peyer patches and/or shed in stool → infection of another host .

Answer 7

high acid tolerance

distal ileum ( Peyers patches)

macrophages; their own reproduction

critical density; macrophage apoptosis

blood stream ; bacteremia or direct extension of infected bile

Question 8

Chronic carriers
● Defined as persons with excretion of S typhi in urine or stool for ≥ ________.
● Responsible for much of transmission ● (Symptomatic or Asymptomatic?)
● Shed bacteria in stool for decades
● Organism _________ themselves as either a _________ on __________ or _____________ or intracellular within the epithelium

Answer 8

1 year; Asymptomatic

sequester; biofilm on gallstones

gallbladder epithelium

Question 9

Typhoid fever begins ________ after the ingestion of the organism.

● Classically stepwise with peaks & troughs rising progressively over time(< 12%).
● GI & skin manifestation develops in the __________ of illness.
● 2nd week – above progresses + ______ features
● 3rd week – above progresses, more toxic/anorexic + ________ + ______ features

Answer 9

7-14 days

first week; CVS

respiratory; CNS

Question 10

Investigation
● Diagnosis primarily ________
● Sensitivities of various tests for S typhi vary greatly
● Culture isolation ______% specific.

Answer 10

clinical; 100

Question 11

● Worldwide gold standard of diagnosis - _______________________________________ from a patient’s ____________ and/or ___________.

Answer 11

isolation of Salmonella enterica serovar Typhi

bone marrow; blood culture

Question 12

Widal test is reliable for diagnosis

Answer 12

Widal test – not reliable for diagnosis

Question 13

Surgical intervention
● Closure of ____________
● _____________ for multiple perforations
●__________ of abscess
● _____________ to eradicate hepatobiliary carriage.

Answer 13

intestinal perforation

Small bowel resection

Drainge; Cholecystectomy

Question 14

Typhoid vaccine

Efficacy ≈ ______ %

Two recommended types:
Injectable ________ vaccine based on purified _________- _______ vaccine

Or

_______________ oral ______ vaccine in capsule formation

Answer 14

50

polysaccharide; Vi antigen ; Vi –PS

Live attenuated ; Ty21a