typhoid feverدكتور علاء خطار

Question 1

whats the typhoid fever ?

Answer 1

its acute systemic not localize febrile illness

Question 2

how transmitted ?

Answer 2

by feco-oral route

Question 3

which type of bacteria is responsible ?

Answer 3

Salmonella type and S paratyphi

Question 4

whats the important feature of the typhoid fever ?

Answer 4

its start as systemic infection then after bacteraemia its become localize in the lymphoid tissue of the small intestine which called peyers patches

these lymph nod sweet ulcerated then heal

Question 5

is there any chance that the pt become carrier after recovery ?

Answer 5

yes, but they are only 5% of them become chronic and continue to execrate the bacteria of 1 year
because the bacilli may live in the gallbladder for 1month or years and pass through the stool and less commonly in the urine

Question 6

whats the incubation period of typhoid fever ?

Answer 6

its 10- 14 days until the symptoms appear

Question 7

*what’re the symptoms that happen in the 1st week ?

Answer 7

1-headache , lassitude (lethargy) and fever character is step-ladder means that (temperature gradually increase to the higher level and the new spike is just higher than the pervious spike so its just like step of ladder )
2- constipation and myalgia

The temperature rises in a stepladder fashion for 4 or 5 days with malaise , relative bradycardia

Question 8

*what’re the signs and symptoms in the 2nd week ?

Answer 8

1- fever will be higher 
2-cough
3- rose spot in the trunk
4- spleenomegly 
5- abdominal distention and diarrhea

Question 9

what’re the signs and symptoms in the 3rd week ?

CMAD

Answer 9

1- intestianl complication as perforation and bleeding

2- myocarditis
3-anemia

4-delirium — coma and death

Question 10

*what’re the difference between the typhoid and paratyphoid fever ?

Answer 10

• paratyphoid fever is shorter course and mild symptoms
• the onset is more abrupt with acute enteritis
• Intestinal complication is less
• rash is more abundant (rose spot in the chest and upper abdomen )

Question 11

whats the differential diagnosis of the typhoid fever ?

Answer 11

1- influenza
2- brucellosis (fever + back pain + LN + spleenomegly )
3- infectious mononucleosis
4- malaria(fever + after 3 days of rash

Infectious mononucleosis (IM, mono), also known as glandular fever, is an infection usually caused by the Epstein–Barr virus (EBV). Most people are infected by the virus as children, when the disease produces few or no symptoms.
Causes: Epstein–Barr virus (EBV) usually spre…
Other names: Glandular fever, Pfeiffer’s disease, …
Symptoms: Fever, sore throat, enlarged lymph …
Specialty: Infectious disease

Question 12

how to investigate pt with typhoid fever ?

Answer 12

1- *blood culture is main diagnostic , bone marrow culture
2- WBCs is normal or low
3- widdle test 4 fold raising
4- + agglutination test (IgG)

Question 13

treatment of the enteric fever ?

Answer 13

1- ciprofloxacin (antibiotic that fights bacteria in the body second generation)
500mg X2 Day

• we could use an alternative of it in case of DM and infection with Clostridium difficile bacteria by using ceftriaxone and cefotaxime (3rd generation)

2- *chloramphenicol (is broad spectrum and stop bacterial growth ) * ampicillin (s a penicillin derived antibiotic used against bacteria. ... The main difference between ampicillin and amoxicillin is that amoxicillin is slightly more lipid soluble. As a result, amoxicillin may kill bacteria slightly quicker. Amoxicillin acts by inhibiting the synthesis of bacterial cell walls.)  750mg X4 day 
*co -trimoxazole known as ( is a combination of trimethoprim and sulfamethoxazole and is in a class of medications called sulfonamides. It works by stopping the growth of bacteria.)

+the drugs of choice Ciprofloxacin 500 mg twice daily

(ceftriaxone and cefotaxime) are useful alternatives

Chloramphenicol ,ampicillin (750 mg 4 times daily) and co-trimoxazole

treat chronic carier

Cholecystectomy may be necessary

Question 14

whats the treatment of chronic carrier ?

Answer 14

4 weeks of the ciprofloxacin

and cholecystectomy may be necessary

Question 15

what’re the prevention method of the enteric fever ?

Answer 15

because its endemic in our area
1- avoid risk food and drink
2-get vaccinated
3- improve sanitation and living condition

Question 16

what signs and symptoms of the typhoid fever in the 1st week and 2nd week ?

Answer 16

1st week
1-headache , lassitude (lethargy) and fever character is step-ladder means that (temperature gradually increase to the higher level and the new spike is just higher than the pervious spike so its just like step of ladder )
2- constipation and myalgia

2nd week
1- fever will be higher 
2-cough
3- rose spot in the trunk
4- spleenomegly 
5- abdominal distention and diarrhea

Question 17

what’re the intestinal and extra- intestinal complication of the typhoid fever ?

Answer 17

-intestinal complication :
perforation and bleeding

• septic foci as in
  1- bone and joint
  2- mangitis
  3-cholecyctis

-toxic phenomena
myocarditis and nephritis
- chronic carier
presistant gallbladder carriage

delirum and aneimia

Question 18

what’re the routs of the transmission of the typhoid fever ?

Answer 18

Transmission is usually person-to-person or animal-to-person via the faecal–oral route, through ingestion of the organisms via contaminated or improperly cooked foods. Foodborne transmission occurs particularly with: raw and undercooked eggs and egg products.