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trop med > Typhoid/Paratyphoid > Flashcards

Typhoid/Paratyphoid Flashcards

1
Q

What is the incubation period for typhoid fever?

A

Water borne - 7-10 days
Food borne 3-10 days

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2
Q

Who do you perform microbiological tests in for patients with diarrhoea?

A

Recommended in travelers with severe or persistent symptoms

or In those who fail empiric therapy

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3
Q

What would you suspect if a patient has a high WCC and typhoid fever?

A

Bowel perforation (usually get leucopenia)
Perforation of terminal ileum

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4
Q

If you were to investigate diarrhoea, what tests would you perform?

A

Stool microscopy exam
Stool culture
Antigen tests
Multiplex PCR

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5
Q

Cause of travellers diarrhoea

A

Most common - bacterial: ETEC, shigella, campy, salmonella, aeromonas, EAEC

Parasites: giardia, cryptosporidium, entamoeba, cyclospora

Virus: rotavirus, norovirus (if OUTBREAK)- may be ETEC confection

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6
Q

How do you classify mild/mod/severe?

A

Mild - no interference with daily activity
Mod - some disturbance to daily activity
Severe - dysentery (blood/mucus) or significant disturbance to daily activity

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7
Q

When do you develop complications with typhoid fever?

A

Between weeks 2 and 3

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8
Q

What are the most common causes of travellers diarrhoea?

A

Norovirus and ETEC

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9
Q

Complications of Typhoid fever

A

gastrointestinal bleeding, myocarditis, or central nervous system
involvement, bowel perforation, hepatitis, Pneumonitis/Perforation

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10
Q

How to treat travellers diarrhoea?

A

Hydration, loperamide
Mild: No ABx
Mod: Consider ABx
Severe: ABx

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11
Q

Which antibiotic would you administer in campylobacter resistant to ciprofloxacin/from a country with high cipro resistance?

A

Azithromycin

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12
Q

Who do you investigate and treat?

A

Diarrhea lasting > 14 days
Diagnosis
◦ O + P (include coccidians), stool cultures
◦ C.diff toxin if history of antibiotics

If negative results
◦ Consider empirical antimicrobial therapy
◦ If no response administer antiprotozoal therapy

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13
Q

Explain the key pathogenesis of typhoid fever

A

Phase I: Bacteremia and/or endotoxemia: S. typhi penetrates primarily in terminal ileum -> liver, spleen, nodes

Phase II: Localization and/or complications

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14
Q

Classic presentation of travellers diarrhoea?

A

First week of travel, usually day 3
Diarrhoea plus abdo pain, fever, vomiting - may have blood in stools
Usually resolves by day 7

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15
Q

Why not give chloramphenicol in typhoid fever?

A

Risk of relapse high

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16
Q

How do you treat chronic carriage of typhoid?

A

Ciprofloxacin for 4 weeks

17
Q

Classic symptoms of typhoid fever

A

Malaise, headache, fever, abdo pain initially first 7 days. No sweating!
Abdo pain, diarrhoea after 7 days. May have constipation
Fagets sign - relative bradycardia
Rose spots - not petechial
HSM

Complications after 14 days

18
Q

Child with fever, HSM and rash. What is the diagnosis?

A

Typhoid fever - rose spots

19
Q

Gold standard investigation for typhoid

A

Blood cultures (BACTEC)

20
Q

How do you manage GI bleeding sec to typhoid?

A

Medical Rx for typhoid
Blood transfusion
Consider bowel resection

21
Q

First line drugs for typhoid fever

A

Ciprofloxacin - high cure rate
7-10 days

22
Q

What is the definition of travellers diarrhoea?

A

Classical: 3 or more bowel motions in 24 hrs plus an associated symptom (fever, malaise, nausea, abdo pain)

Moderate: 1 or 2 watery or loose stools over 24 hours plus some associated symptom or
more than 3 watery or loose stools without associated symptoms

Mild: 1 or 2 watery or loose stools over 24 hours without associated symptoms

23
Q

What are the classic lab findings for typhoid feature?

A

Leucopenia
Left shift
No eosinophils
Mildly deranged LFTs

24
Q

Treatment options for travellers diarrhoea?

A

Ciprofloxacin or Azithromycin

25
Q

Which antibiotic would you recommend for prophylaxis of travellers diarrhoea, and who would you give it to?

A

Rifaximin
High risk of complications (previous bowel resection/ileostomy) or high risk of infection (immunocompromised)

26
Q

What other tests for typhoid fever?

A

Stool culture (more positive in children)
Bone marrow (independent of antibiotics given - very sensitive)
Bile culture

27
Q

What Is persistent travellers diarrhoea?

A

Diarrhoea lasting >2 weeks

28
Q

Fever, diarrhoea, abdo pain with rose spots in patient in China. Likely organism?

A

Salmonella paratyphi - most likely in China (more than typhi)

29
Q

What is the Widal test?

A

indirect agglutination test for enteric fever - not very effective - <30%

30
Q

What organism is typhoid?

A

Gram negative

trop med (49 decks)

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