Typhoid Fever Flashcards
Salmonella and Diseases
Gastroenteritis
Enteric Fever
Enteric Fever by s Typhii and s paratyphii
Typhoid
paratyphoid
Typhoid Epidemiology
Endemic, poor quality water,
Typhoid reservoirs
HUMANS ONLLY, school age and young adults
Typhoid transmission
Fecal oral
Innate resistance
Gastric acid
CFTR heterozygote
IgA
Normal Intestinal Flora
Acquired Resistance
circulating IgM or IgG
CD4 or CD 8 Sensitized
Sal Typhi Etiology
Gram negative bacilli
Motile
facultative anaerobe
regular medium
Sal Typhi Characteristics
H2S producer, non lactose fermenter
Hekoten–diff lactose vs non lactose
McConkey = clear colonies
Infect macrophages
Typhi Virulence Factors
Invasive w/ Type III O antigen H antigen-- flagella LPS SPI -1 and SPI-2 path islands Vi antigen Fimbriae- m cells
Typhoid Fever Pathogenes 9 steps
- microbes gain entrance
- survive acid and bile
3.attach to m cells - induce endocytosis
5, taken up by macrophages
6.travel lymphatics
7.initiate phagocytosis - released ito blood stream
- Repeat RES circuit
typhoid and peyers patches
Travel to ileum, find cftr gene of M cells
Induces BME or cell ruffling
Activates Type III sec inside phagolysosome
Where does Sal Typhi reside
Macrophages can cause rupture if high enough colony
Gall Bladder Enteric Fever
Predisposes, logn term carriage
Second INvasion of Peyers patches
Reseeding from bile
Hyperplastic
Necrotic
Clinical Manifestations week one
fever pattern, high in day gone by moring or
rise rapidly
• bacteremia
•bradycardia
Clinical Manifestations week Two
Abd Pain
Rose Spots
Constipation/Diarrhea
Clinical Manifestations week Three
Hepatosplenomegaly
Intestinal Bleeding
Perforation
Clinical Manifestations week 4
absence of complication
Some are chronic carriers
Chronic Carrier
occurs in women
patients with gall stones or bile
Urine w/ Schistosoma
Typhi Diagnosis
Culture Isolation
sensiivity nalidixic acid
Recovery Organisms
After 1 week, blood
bone marrow biopsy
• confirmatory
• isolate even after antibiotics
Serology Typhi
Widal- O and H antigen
Typhidot – IgM IgG
ELISA VI ANTIGEN
Typhi Treatment
Amp/ Tmp/SX Chloramphenicol
Treat Chronic Carriers
Cipro or norfloxacin
Typhi Prevention
2 vaccins
• live attneuated
• Injection=
Neither totally effective
Yersinia Pestis Epidemiology
Zoonotic rodents wild Xenopsylla cheopis oropsylla montana Feral mammals Native Americans increased risk Human to Human Transmission
Yersinia Etiology
PESSKY Strains Non Spore Pleomorphic Gram neg coccobacillus Path Island Temp Vairant NON MOTILE
How do you see Yersinia Microscopically?
Bipolar, SAFETY PIN
Wayson Stain
Giemsa Stain
What antigenic factor does Yersenia have?
F1 factor
Where does Yersenia Grow?
Fleas and Mammals
Facultative Intracellular
Virulence factors of Yersinia
3 plasmids and chromosome Biofilm synthesis Plasminogen-activating protease F1 protein Type III secretory system Endotoxin
What is the function of the F1 protein
Fimbrial capsule forming
V and W antigens
When does F1 do its job,
Has to be silent to form bubo,
Spreads during dissemination
Clinical Manifestations of Yersinia
- bubonic plaque
- systemic plague
- pneumonic plague
Bubonic Plague characteristics
Most common Sudden Onset Intese pain/swelling in Lns (bubo) Inguinal - Adult Axilla - children Erythema and edema
Septicemic Plague
w/out bubo, no localizing symptoms Febrile and ill hypotension DIC MODS
Pneumonic Plague
Primary or Seconday aerosol droplets Primary, direct inhalation---RARE Secondary=== progression from bubonic plague or septic RAPId Chest pain
Yersinia Disease Manifestations
Necrosis of small vessels, ecchymosis
Yersisnia Diagnosis
Aspirate fluid from lymph nodes, Sputum and Stains Immunofluorescence Culture 4x F1 ab titer chest radiograph
Yresinia Treatment
Streptomycin
IV/IM Gentamycin
Prophylactic Doxycycline or TMP/Sx
S Typhi vaccin
Recombinant
- F1
- Lcrv
