Typhoid fever, caused by Salmonella typhi, belongs to the infectious intestinal diseases. When the infection spreads, it is mainly the lymphatic system of the small intestine that is affected. Symptoms are nonspecific and depend on the stage of development of the disease and the form of the course; treatment for typhoid fever is selected accordingly. In general, the disease responds well to treatment.
Typhoid fever is a serious infectious disease
The causative agent of typhus
Salmonella typhi is the source of typhoid fever. This is a bacterial microorganism of the Enterobacteriaceae family, the genus Salmonella. It has the shape of a stick, which is why it is popularly called E. coli.
The bacteria are gram-negative, that is, they do not stain on the Gram test. They differ in mobility. The causes of the disease are toxins and enzymes released by pathogenic microorganisms. For example, endotoxin (lipopolysaccharide), fibrinolysin, catalase.
There are many strains of typhoid fever, some of which are resistant to antibiotics. They are capable of causing epidemics.
Salmonella are highly resistant to external factors. They can be stored in water and soil for up to 5 months, in feces for up to a month, in linen for up to 14 days, and in food for up to several weeks. The most favorable food environment is dairy and meat products, vegetables in the form of salads. At 18 degrees in such an environment, the bacteria multiplies.
The disease is caused by a bacterium
The causative agent of typhoid fever is killed by boiling and treatment with chlorine, but can easily withstand freezing. In an organism with a strong immune system it takes the L form.
Routes of infection
The pathology is transmitted from person (patient or carrier) to person through the fecal-oral route. The incubation period of typhoid fever varies from 10 to 14 days, but can reach 25 days. Or, conversely, develop acutely in a matter of days. The onset of the disease is usually sluggish and gradual, which makes it difficult to accurately determine the first day.
Microbacteria begin to be released into the environment from the last days of incubation. This may continue even after recovery. On average, the illness lasts 7 weeks. The human carrier constantly excretes bacteria.
The peak capacity for infection occurs at 2-3 weeks of illness. At this point, bacteria are contained in all biological materials (urine, sweat, feces, milk, saliva).
Typhoid fever is transmitted through:
- contaminated water;
- contaminated food;
- household items.
If you drink dirty water, you can get typhus
The pathogenesis of typhoid fever begins with the entry of bacteria into the body (at least 10 million - 1 billion pathogens are needed for the development of the disease) and their penetration into the wall of the small intestine.
After which they penetrate the lymph and provoke inflammation of the lymph nodes (they multiply in them), and then into the blood. Due to the death of some microorganisms in the plasma and lymph, a toxin is released, which causes intoxication (first signs).
Through the bloodstream, the rods spread to all organs. At this stage, salmonella are actively released from the body. After the disease is eliminated, stable immunity is developed and the body’s self-regulation is restored.
It is noted that these stages may not follow each other, but in parallel or change the specified order. When the microorganism spreads throughout the organs, rapid suppression of all systems begins.
Due to the routes of infection for typhoid fever, human carriers associated with the food industry are classified as a separate epidemiological group.
Provoking factors
Typhoid fever as an infectious disease belongs to the category of epidemiologically dangerous. It is found in all regions, but more often in areas with a hot climate and poor hygiene. In epidemiological outbreaks, the main route of transmission is water.
Flies can help spread infection quickly
The transmission mechanism of typhoid fever makes dangerous factors such as dirty or technical reservoirs, untreated drinking water pipes, accidents and interruptions in water supply. Flies are active carriers of pathology (pieces of feces on their legs). It has been noted that infections occur more frequently in summer and autumn.
The status of an epidemiologically dangerous disease is confirmed by the fact that bacteria rapidly multiply in the body and are actively excreted. Every person is susceptible to the disease in question.
Symptoms of infection and stages
Symptoms of typhoid fever in adults are directly related to the stage of development of the disease. The description of each is reflected in the table.
Stages of typhoid fever Description| End of incubation – beginning of the disease | Smooth increase in temperature to high febrile levels. Cephalgia and weakness, sleep disorders are noted. There is a decrease in appetite, a coating in the center of the tongue and slight swelling are noticeable. Sometimes stool disturbances are possible, abdominal pain and dyspeptic disorders are noted. |
| Peak of the disease (7-14th day) | Fever begins, temperature readings fluctuate. Apathy, severe weakness and depression of consciousness occur. Pallor and dryness of the skin are noted. The clinical picture is complemented by typhoid roseola (typhoid fever rash) on the abdomen and lower border of the chest. They appear on average on the 8th day and last for three days. However, then new ones appear. |
| Recovery period (therapy) | First, the temperature normalizes, headaches and dizziness disappear. All symptoms and signs gradually disappear. |
Among the primary symptoms, a dry cough is sometimes noted. Rashes with advanced pathology can turn into hemorrhoids.
Often with this disease there is an increase in temperature
According to the form of the disease, it can be abortive and erased. The first is characterized by a short and fast course. The erased form may be asymptomatic or mild. For example, it can be manifested by hyperthermia no higher than 38 degrees and the absence of a rash. But the duration of the disease is also short.
Longer forms with relapses occur. A recurrent disease may occur within a few weeks or days due to premature cessation of therapy or exposure to negative factors (stress, poor nutrition).
It is important to know what typhoid fever is and its signs in order to promptly contact an infectious disease specialist with suspicions and undergo appropriate diagnosis and treatment.
Diagnosis of typhus
Diagnosis of the disease is based on medical history, bacteriological tests of urine and feces, and serological blood tests for typhoid fever. The result of the study will be ready in 4-5 days.
To confirm the diagnosis, a serological blood test is performed
For bacteriological analysis in the initial stages of the disease, urine and feces must be studied. At the recovery stage - biopsy material of the duodenum taken during probing.
Serological testing is the main method. As a rule, RNGA and RPGA are used when diagnosing blood for typhoid fever. These methods detect antibodies in blood serum.
A serological examination for typhoid fever is done on the 4-5th day of infection, biomaterial is collected, after which it is examined for O-, Vi- and H-antigens. 5-10 ml of material is introduced into Rapoport's bile medium (50-100 ml). Bacterial growth is assessed. With RPGA with cysteine, the increase in titer is studied. The diagnosis is made at a value of 1:160 or more.
The test for typhoid fever is taken before the 12th day. Do not eat for at least 5 hours before the test. Three days before the analysis, you need to exclude all medications (if you cannot refuse some permanent medications, then inform the doctor about this), give up alcohol and cigarettes, and avoid physical and mental overload. The day before the procedure, it is not recommended to eat fatty and fried foods and dairy products.
It is recommended to donate blood on an empty stomach
Complications of typhus
Complications can arise if the signs of typhoid fever in adults and the progression of the disease are ignored. Possible consequences include:
- inflammation of the peritoneum;
- inflammation of all body systems (pneumonia, cystitis, cholecystitis, otitis media, myocarditis);
- infectious psychosis;
- peripheral nerve atrophy;
- bedsores (consequences of carrying the disease in bed).
- Specific complications of typhoid fever include through breaks in the intestinal walls against the background of ulcers, bleeding from the anus, infectious-toxic shock (rapid heartbeat, hypothermia, hypotension, sweating, problems with urination).
- This video details the characteristics of typhoid fever and treatment methods:
Treatment options
After typhoid fever confirms the diagnosis, treatment is prescribed.
- Hospitalization and bed rest. You can sit down only on the 8th day, get up on the 11th day.
- Diet for typhoid fever. Food should be easy to digest, but nutritious. Preference should be given to liquid (semi-liquid) and pureed food, purees. It is necessary to maintain water balance (0.33 ml per kilogram of weight).
- Treatment of typhoid fever involves taking antibiotics (Ampicillin, Levomycetin). To eliminate intoxication, intravenous administration of colloidal solutions is prescribed. Treatment is supplemented with medications to eliminate existing disorders and symptoms, for example, cardiovascular ones.
The patient is discharged after at least 23 days (when the temperature returns to normal). Then they are observed for three months.
Prevention of typhus
Prevention of typhoid fever involves compliance with sanitary standards and the creation of appropriate conditions. It is important to monitor the purity of water, carefully handle food, and wash your hands. The wearer must maintain personal hygiene and clean the house regularly.
Vaccination against typhoid fever is recommended
To build immunity and prevent relapse, vaccination is indicated. The test result for typhoid fever is valid for a maximum of six months. One of the preventive measures is regular examination. People close to the patient are prescribed a three-week prophylaxis with a bacteriophage.
Source: https://kishechnik.guru/zabolevaniya/prochie-bolezni/vozbuditel-bryushnogo-tifa.html
Details about typhoid fever: symptoms, characteristics of the pathogen, analysis and treatment
The causative agent of typhoid fever is one of the salmonellas - Salmonella typhi. This is a bacterium that is quite resistant to environmental factors: it can survive at room temperature in food (meat and dairy), water, and on household items. It quickly dies under the influence of boiling, any disinfectant solutions, or ultraviolet radiation.
There are microbes that have much in common with Salmonella typhi - these are paratyphoid pathogens Salmonella paratyphi A, B, C. The clinical picture also has many similarities, therefore in domestic practice it is customary to combine them under the term “typhoid-paratyphoid disease” .
How is typhoid fever transmitted?
The predominant route of transmission of the causative agent of typhoid fever is food; contact and water are also possible.
- milk and everything made from it that does not undergo heat treatment before use (ryazhenka, kefir, cottage cheese, sour cream);
- meat, offal, minced meat, jellied meat and jelly;
- vegetables and fruits that have not been thoroughly washed.
The water route of transmission is relevant in regions with a low level of sanitary culture, where mixing of water for domestic purposes and sewage waste is possible. The possibility of the typhoid pathogen entering well water and bodies of standing water cannot be ruled out.
The contact route of transmission occurs through direct contact with a patient with typhoid fever or a carrier. This can occur in families through household contacts, as well as in public catering establishments where a person (the source of infection) may work.
The greatest danger to others is not the sick person (he is receiving treatment in a hospital), but the carrier. Such a person contains and releases Salmonella typhi into the environment, but does not show any signs of illness. The pathogen is released into the environment through feces and urine; carriage can last for several days or weeks.
After suffering from the disease, stable immunity is formed throughout life. Only patients with a weakened immune system may develop repeated episodes of the disease.
Symptoms
In the typhoid clinic, there are symptoms of a general nature and reflecting changes only in the digestive canal. Only a specialist can fully evaluate all clinical symptoms.
Typhoid fever begins gradually - 7-10 days, and sometimes even more, pass before specific clinical manifestations appear. This time is called the prodromal period or the period of initial clinical manifestations. At this time the patient notes:
- increasing weakness, which makes it difficult to live a normal life;
- headache, which is practically not relieved by conventional analgesics, has a bursting, aching character without clear localization;
- insomnia (difficulty falling asleep, waking up early);
- temperature rise often to low-grade levels (37-37.5°C).
After this, a period of clinical manifestations begins. Specific clinical signs force the patient to seek medical help, and the doctor is helped to correctly make a preliminary diagnosis.
- persistent fever, lethargy and constant drowsiness;
- pale skin and isolated roseate rashes on the skin of the abdomen;
- loose stools without pathological impurities (blood, mucus, pus), which is replaced by constipation;
- dyspeptic signs (deterioration of appetite up to its complete absence, nausea, vomiting, diffuse abdominal pain of moderate intensity);
- Some patients have a cough, pain in the heart and chest.
During an objective examination, some specific symptoms are noted, but they are understandable only to a specialist.
Signs of improvement in the condition of a typhoid patient are:
- decrease in temperature (gradual, over several days);
- disappearance of insomnia;
- improvement in general condition (decreased weakness, feeling of increased strength);
- normalization of appetite;
- normalization of stool (frequency of appearance and consistency).
Possible complications
Specific complications of typhoid fever are:
- intestinal bleeding;
- perforation of the intestinal wall;
- typhoid peritonitis;
- formation of secondary metastatic foci;
- Zenker muscle necrosis;
- bone marrow damage;
- damage to the heart sac (endocarditis, myocarditis).
Only a specialist can diagnose complications of typhoid fever. Intestinal bleeding and perforation of the intestinal wall are very serious processes that can lead to the death of the patient, especially if the diagnosis was made late.
The formation of secondary lesions - in the brain, lungs, kidneys - is not so dangerous for the patient’s health, but it delays the recovery process. The formation of a new focus of typhoid bacillus can provoke a new deterioration in the patient’s condition.
Zenker's necrosis is a rare but serious complication. The muscle tissue of the legs, less often the arms, undergoes decay without rotting. The limb permanently loses its functional abilities.
Damage to the bone marrow under the influence of typhoid toxin is manifested by a decrease in the number of white and red blood cells. A significant change in the cellular composition of the blood leads to serious disorders of all types of metabolism.
Diagnostics
The diagnosis and treatment of typhoid-paratyphoid diseases is carried out by an infectious disease specialist. It is usually recommended to carry out specific therapy in a hospital setting.
Nonspecific research methods (general and biochemical blood tests) help the doctor assess the patient’s condition and also suspect complications.
Specific methods make it possible to identify the pathogen in the human body and confirm the diagnosis of typhoid fever or paratyphoid fever.
The test for typhoid fever is taken for the first time before treatment begins, that is, before the patient begins to receive antibiotics. Blood, urine and feces are donated for testing. After completing a course of antibiotic therapy, the patient again donates the same biological fluids to monitor the effectiveness of therapy.
Mandatory tests for typhoid fever include:
- bacteriological blood test (hemoculture) – if Salmonella typhi is detected, then this is a 100% confirmation of the diagnosis;
- bacteriological examination of stool (coproculture) - can confirm the diagnosis of typhoid fever or carrier state;
- bacteriological examination of urine (urine culture) - can confirm the diagnosis of typhoid fever or carrier state;
- serological reactions (RPGA or Widal reaction, as well as reaction with virulence antigen).
Only a doctor can evaluate the results of laboratory tests.
Since patients with typhoid infection who work in catering establishments, schools and kindergartens pose a particular danger to others, this group of people must be examined.
For the study, human blood is taken, bacteriological culture is performed and a pure culture is isolated. After 4 days, a positive or negative result is obtained, which is entered in the health book.
General principles of treatment
Typhoid fever can be cured only if all medical prescriptions are followed. Trying to take medications on your own can only cause harm and cause complications. With uncomplicated typhoid fever, the prognosis is favorable.
Antibiotic ineffectiveness may be a problem, especially if the patient comes from Southeast Asian countries. If there is no result from using first-line drugs (chloramphenicol succinate), the patient should be prescribed reserve antibiotics.
It is better to reduce the temperature during typhoid fever not with medications, but with physical methods (rubbing with alcohol, applying cold to the main vessels).
Treatment of typhoid fever is long-term; complete recovery may take 1-2 months.
Monitoring of contact persons, that is, those who directly interacted with a typhoid patient, continues for at least 25 days. In addition, a bacteriological examination of the feces and blood of such people is carried out.
General principles of prevention
The vaccines developed for the prevention of typhoid fever do not provide 100% protection; immunity is short-lived and weak. The main way to protect yourself is to comply with sanitary and hygienic rules.
To prevent typhoid fever and paratyphoid fever, you should:
- wash your hands thoroughly;
- follow the rules for preparing and storing food;
- drink only boiled water;
- At the first sign of discomfort, contact a specialist.
Typhoid fever is a serious disease, but quite manageable if you seek medical help in a timely manner.
Source: https://ProKishechnik.info/zabolevaniya/bryushnoj-tif.html
Typhoid fever: symptoms, prevention and treatment
Of all the variety of bacterial diseases from the “intestinal infections” section, typhoid fever is considered a rather formidable disease, primarily due to possible complications, the elimination of which may require surgical intervention.
This disease can be defined as an acute strictly anthroponotic generalized intestinal infection, characterized by damage to the small intestinal lymphatic system, mesenteric lymph nodes and parenchymal organs.
Typhoid fever: pathogens and causes of infection
The causes leading to the development of such a dangerous intestinal infection as typhoid fever have long been a mystery to medicine. Until the discovery of the causative agent of this disease at the end of the 19th century, typhoid meant all conditions accompanied by fever.
Today, it is generally accepted throughout the world that typhoid fever is caused by a pathogen belonging to the Enterobacteriacea family, namely salmonella typhi (or, as it is also called, typhoid bacillus).
The causative agent was discovered by microscopy of splenic sections, Peyer's patches and mesenteric lymph nodes of deceased people. This was done in 1874 by the Polish researcher Bronich. Later (in 1876) N.I.
Sokolov also discovered a small number of bacteria in the above organs. And finally, in 1880, the German scientist K. Ebert made a detailed description of this bacterium.
A pure culture of typhoid bacillus was isolated in 1884 by Robert Koch’s student G. Gaffka.
- The peculiarity of this bacterium is that it is pathogenic only for humans, plus it is quite mobile due to its flagella, is not spore- and capsule-forming, and also does not stain according to Gram.
- “Salmonella typhi” has very good resistance: it can survive for several months in water, ice and soil, however, it immediately dies when boiled.
- It is known that the pathogen that causes typhoid fever is a microorganism that facultatively parasitizes inside cells and is tropic for lymphatic tissue.
- The antigenic composition of typhoid bacillus is formed by the thermostable O-antigen, Vi-antigen (somatic) and thermolabile H-antigen (flagellar).
Sources and routes of transmission of typhoid fever
The patient, the convalescent and the bacteria carrier are the main sources of typhoid fever. The pathogen is excreted in their feces, partly in urine. As a result, surrounding objects, food and water may become contaminated.
Based on this, we can quite simply describe the epidemic process that characterizes typhoid fever: infection occurs through the fecal-oral mechanism. In other words, the so-called “entry gate” of infection is the human oral cavity.
The transmission routes characteristic of an infection such as typhoid fever are as follows: salmonella can enter the human body through water, by eating food, as well as through contact and household methods.
This disease has a summer-autumn seasonality. However, sporadic typhoid fever is also quite possible: the reasons for this lie in bacterial excretion from bacteria carriers.
The population's susceptibility to typhoid bacillus is universal. Immunity after typhus is persistent and lasts until the end of life.
Pathogenesis of intestinal infection typhoid fever
At the incubation stage, the following occurs: after oral infection, most of the Salmonella die under the influence of acidic gastric contents, the surviving microorganisms enter the small intestine with its favorable alkaline environment. Next, the typhoid bacillus invades and multiplies in the intestinal lymph formations (solitary follicles, as well as Peyer's patches), which are the primary foci of infection in which the granulomatous process develops.
From the primary foci, the pathogen disseminates to regional lymph nodes, where granulomatous inflammation and death of Salmonella also occur.
In the initial period of the disease, the pathogenesis of typhoid fever is associated with incomplete phagocytosis of bacteria, as a result of which they enter the blood - bacterial and endotoxemia develops, as a result of which pathogens are introduced into the liver, bone marrow, spleen and lymph nodes with the formation of secondary foci of granulomatous inflammation in these organs .
The period of the height of the disease is associated with the entry of typhoid bacillus from secondary foci into the blood again. At this stage, the excretion of the pathogen begins (mainly in feces, but also in urine, saliva and breast milk).
During the convalescence stage, the intensity of specific humoral immunity increases. The pathogenesis of typhoid fever ends with an increase in the completeness of phagocytosis. However, it is possible to develop long-term persistence of L-forms of the pathogen in macrophages, which causes the development of bacterial carriage.
Symptoms and features of typhoid fever
The latent period (incubation) for typhoid fever lasts from a week to 25 days.
In the initial period, the symptoms accompanying typhoid fever are as follows: the patient is worried about weakness, sleep inversion (nighttime insomnia, daytime drowsiness), headache, fever increases, appetite decreases, pale skin, lethargy and adynamia are also observed.
The abdomen is moderately distended with dullness of percussion sound in the iliac region on the right (the so-called Padalka's symptom). In the same area, fine bubbling crepitus and/or rumbling with slight pain is noted.
By the end of the period, the liver and spleen enlarge, the temperature reaches its maximum.
Characteristic symptoms of typhoid fever at the height of the disease are high body temperature, lethargy, pallor, as well as the appearance of a scanty roseola rash in the chest and abdomen (which occurs on the 8-10th day of the disease). Quite rarely, typhus develops Duguay's angina (necrotic-ulcerative processes in the lymphopharyngeal ring).
Among the clinical manifestations, features of typhoid fever can be distinguished.
This is the so-called “typhoid tongue” (edematous, covered with a white coating, with the exception of the tip and edges, on which tooth marks are visible); this also includes the above-mentioned Padalka’s symptom; development of such a condition as “typhosus status” (the patient is disoriented, stupefied, hallucinations, acute infectious psychosis appear).
Diagnosis of the infectious disease typhoid fever
The main method in the diagnosis of typhoid fever is considered to be bacteriological research, which includes inoculating feces, blood, urine, and the contents of the duodenum on nutrient media containing bile. In this case, absolute confirmation of the diagnosis is the isolation of a blood culture of the pathogen.
Immunological diagnosis is possible from the first days of the disease. It consists in determining the antigens of the pathogen. The material for research in this case is also biological fluids. This method includes enzyme immunoassay and coagglutination reaction.
Serological diagnosis of typhoid fever is based on studying the dynamics of antibody titer. The diagnosis confirms its increase at least 4 times. The method is informative from 5-6 days from the onset of the infectious process and includes the Widal reaction (based on agglutination), as well as the indirect hemagglutination reaction.
In addition to these methods, it is also necessary to take into account epidemiological data and clinical manifestations.
Infectious diseases similar to typhoid fever should be excluded as part of the differential diagnosis at all stages of the disease.
Treatment of typhoid fever
- Etiotropic therapy includes the use of antibacterial drugs: aminoglycosides and/or fluoroquinolones.
- Pathogenetic treatment of typhoid fever is detoxification, which involves the administration of enterosorbents, glucose, hemodez, rheopolyglucin, as well as drinking plenty of fluids.
- Symptomatic therapy includes vitamin therapy, the prescription of sleeping pills, sedatives, and antipyretics.
In case of bleeding development, complex hemostatic therapy is carried out. In case of intestinal perforation, surgical treatment is performed.
A recovered person is discharged only when at least 3 weeks have passed since the restoration of normal body temperature. In this case, they also focus on urine and feces culture data (it is necessary to obtain 3 negative results), as well as on a bile tank test (a single negative result is sufficient).
First of all, early identification of sick people and their mandatory and prompt hospitalization are necessary.
The outbreak should undergo epidemiological examination and disinfection with mandatory clinical and laboratory tests of contact persons.
After discharge from the clinic of a person who has had typhoid fever, prevention boils down to the fact that the person who has recovered from the disease is placed under medical supervision with weekly thermometry for 60 days (over the next month, thermometry is carried out once every 14 days). In this case, stool and urine are examined monthly. And finally, at the 4th month, bile is tested and a serological blood test is performed. Only if the tests are negative, dispensary observation is stopped.
In regions with unfavorable epidemiological conditions, typhoid vaccines are used: chemical and alcohol, as well as typhoid bacteriophage, which is used for emergency prevention.
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Source: https://med-pomosh.com/?p=917
Typhoid fever consequences of the disease. Typhoid fever: symptoms, prevention and treatment
Typhoid fever is a common infection caused by a special pathogen - the typhoid bacillus Bacillus typhi abdominalis.
Anatomically, the disease consists of hyperplasia and ulceration of the intestinal lymphatic system, swelling of the mesenteric glands, hyperplasia of the spleen, parenchymal changes in other organs, has a unique clinical picture and symptoms - fever with a characteristic temperature curve, cyclicity along with intoxication of the whole body.
The causative agent of typhoid fever and etiology
The causative agent of typhoid fever is the typhoid bacillus (Salmonella typhi). The typhoid bacillus, first discovered by Ebert, was isolated in its pure form by Haffka in 1882. When examined under a microscope, the typhoid bacillus has the appearance of a short and thick rod with flagella and does not produce spores.
In its morphological properties and cultures, it is close to Escherichia coli (Bacterium coli) - a permanent inhabitant of the human intestine, but differs from it in its biological properties, which is used in the laboratory to distinguish typhoid bacilli from enteric.
The typhoid bacillus does not ferment grape sugar, does not curdle milk, and does not form indole in meat broth.
The causative agent of typhoid fever easily tolerates low temperatures. However, boiling and chemical disinfection will leave no chance for the survival of the typhoid bacillus.
The development of the disease is caused by the entry of typhoid bacilli into the food tract through water, milk and other food products in the presence of suitable conditions - general weakening of the body, etc.
From the gastrointestinal canal, and sometimes possibly from the pharynx, the bacilli enter the blood and lymph, where they are found in very large quantities at the onset of the disease. Then they settle in all lymphatic formations of the body, especially in the intestinal follicles, in the corresponding lymph glands and in the spleen. When bacilli are released through the intestines, they cause typical ulcers in the intestinal wall.
Thus, along with the general phenomena characteristic of any infection, secondary and local changes occur in the intestine.
During the recovery period and often for a long time after illness, the typhoid bacillus is excreted from the intestines with feces, in this form the bacillus ends up in rivers, lakes, etc.
, and is often a source of infection for entire villages and areas that use water from a contaminated source.
A person who has recovered from typhoid fever is a carrier of the infection; on the other hand, there are people who, when infected with bacilli, do not themselves become ill with typhoid fever, but, being carriers of typhoid bacilli, serve as spreaders of the infection. This sometimes applies to persons caring for a typhoid patient: they may not get sick due to innate immunity, innate immunity, but they can infect other people.
The incubation period of typhoid fever is from 8-11 days to 3 weeks after infection.
The disease usually begins gradually with general malaise, chills, headache, pain in the sacrum and legs (prodromal phenomena); the tongue becomes coated, then the temperature begins to rise, which rises over several days and by the end of the 1st week it is set at high levels - 39.5-40°.
Fever with typhoid fever has a certain typical pattern - a gradual step-like increase with small remissions between morning and evening temperatures within 1 ° during the 1st week - this is the stage of increase (stadium increment); in the 2-3rd week, the temperature usually settles at high levels without sharp fluctuations - fever of a constant type (febrie continue) - this is the so-called acme stage. At the 3-4th week, the temperature begins to drop and give remission between morning and evening temperatures within a range of often more than 1° - amphibolic stage.
Often the temperature curve has such a characteristic appearance that just from the temperature curve alone, without seeing the patient, one can suspect typhoid fever.
In the middle or end of the 1st week, the patient no longer gets out of bed. And if a doctor sees such a patient for the first time, the following features often attract attention: first of all, the patient’s appearance - slight redness on the face, which is bilateral. Mild cyanosis is often mixed in from bronchitis that soon develops, or more often from peripheral circulatory disorders.
In very severe cases, often along with cyanosis, a striking pallor of the face is striking. In terms of the general painful appearance, a typhoid patient gives the impression of an “abdominal” patient, i.e., suffering from a disease of the abdominal organs, and sometimes resembles a patient with peritonitis, but with typhoid there is no increased heart rate, but on the contrary, a slow pulse is observed (a very important symptom).
The tongue of patients with typhoid is coated, but often the edges and tip of the tongue are free from plaque. The labial form of herpes is usually absent.
These signs (temperature, general appearance, phenomena from the nervous system) create a special condition of the patient - the so-called status typhosus - typhoid state.
At the end of the 1st week, the spleen can be felt (soft but painful). Stools are often delayed at the beginning of the disease; soreness and swelling in the ileocecal region are noted. On the 8-9-10th day, roseola appears - rashes that usually do not rise above the skin and disappear with pressure; They are localized on the stomach, chest, and last 5-7 days.
In addition to these symptoms, it is necessary to point out three characteristic signs characteristic of typhoid fever:
- slowing of the pulse - it lags behind the temperature;
- leukopenia;
- diazoreaction.
Usually, any increase in temperature by 1° is accompanied by an increase in pulse rate by 6-8 beats, and with typhoid fever at 40°, the pulse instead of 110 gives 90-100 beats. In addition, the pulse in typhoid fever is dicrotic, that is, with an additional wave after each beat.
Almost all infectious diseases are accompanied by leukocytosis. Typhoid fever gives figures of 2-4 thousand leukocytes with relative lymphocytosis: lymphocytosis is sometimes pronounced - up to 50%. In patients who were vaccinated during the incubation period, leukocytosis of 15 thousand is often found.
In many infectious diseases (for example, miliary tuberculosis, typhus, measles), a positive diazoreaction is obtained. It acquires significance and confirms typhoid fever only in connection with a slow pulse and leukopenia.
However, the diazoreaction with typhus lasts up to 2 weeks and then weakens, whereas, for example, with miliary tuberculosis it lasts throughout the entire illness.
This triad of symptoms is characteristic of typhoid fever. Other symptoms include a characteristic temperature curve, a painful and soft spleen, tenderness in the ileocecal region, and roseola. Minor symptoms include pain in the calf muscles, bloating and rumbling in the abdomen, concomitant bronchitis, and headache.
Diagnosis of typhoid fever
At the very beginning, the diagnosis of “typhoid fever” can also be made with great accuracy on the basis of a bacteriological blood test. During the 1st and early 2nd weeks, in 80-90%, cultures of typhoid bacilli can be obtained by inoculating the patient's blood. It is easier to find bacilli in the blood than in feces, as well as in urine.
In terms of diagnosis, the above symptoms are important in typical cases, especially their main triad (slow pulse, leukopenia with relative lymphocytosis and diazoreaction), then - pain in the ileocecal region, an enlarged, soft spleen; all this makes it possible, at the end of the first week, to make a diagnosis of typhoid fever.
In doubtful cases, a bacteriological blood test (culture) can be of great help, which within the first week gives a positive result of 80-90%.
Examination of stool for typhoid bacilli is used mainly during the recovery of the patient, in order to find out whether he is a carrier of the bacilli.
Starting from the 9-10th day, the diagnosis of typhoid fever can be confirmed by an agglutination reaction.
Blood test for typhoid fever
In order for the results after a blood test for typhoid fever to correspond to reality, a number of measures must be observed:
- stop taking medications 72 hours before the procedure;
- limit alcohol consumption 48 hours before manipulation;
- 24 hours before the test, do not eat spicy, fried foods, dairy products, eggs;
- One hour before the procedure you should not smoke.
A blood test for typhoid fever to clarify and make a diagnosis can be carried out according to the following indicators:
- General blood analysis. The presence of the abdominal type may be indirectly indicated by an increase in ESR, leukopenia, and the absence of eosenophils.
- Enzyme immunoassay blood test for typhus.
- Serological blood test for typhus. This test can detect whether the body produces antibodies. This analysis is carried out on the fourth day of illness.
- Blood chemistry.
- Bacterial culture. It may take quite a long time to obtain data from this analysis, as it is necessary to wait for the bacteria to grow. You can wait up to 5 days for the results of such an analysis.
- Indirect hemolytic agglutination reaction (IRHA).
Course of the disease
Typhoid fever is a general disease in which the local process is localized in the lymphatic system of the large and small intestines; therefore, the greatest changes are observed precisely in the intestinal lymphatic system (enterotropic property of typhoid bacilli).
Usually, the painful process is most clearly expressed above the bauhinian valve, in the lowest part of the ileum.
In the first week,
anatomical changes are usually limited to hyperemia of the lymphatic formations of the intestine, which is then replaced by medullary infiltration.
Infiltrated plaques and follicles, white in cross-section, protrude above the level of the mucous membrane.
Clinically, at this time, an increase in temperature, bloating, intestinal flatulence, pain in the ileocecal region, and a tendency to constipation are usually observed.
In the second week,
the brain-like infiltration is replaced by a scab; sometimes the infiltration disappears by simple resorption. Clinically, at this time there is a high degree of persistent fever, general weakness, and roseola.
- In the third week,
the scabs that have formed usually fall off in small pieces, and sometimes entirely, so that ulcers form in place of the former scabs; in the small intestines, typhoid ulcers correspond to the outlines of Peyer's patches, have an oval shape and are located parallel to the longitudinal axis of the intestine, while in the large intestines the ulcer has a more round shape. - The third and fourth weeks
are usually characterized by clinically sharp fluctuations in temperature - the amphibolic stage, when the morning temperature can be normal, and the evening temperature rises to 38-39°. - The fourth and fifth weeks
are characterized by healing of the ulcers, and dark pigmented areas remain in place of the former ulcers. - In the fifth week,
the temperature begins to gradually decrease, very slowly - a stepwise lytic drop in temperature; the patient begins to feel better, the tongue gradually clears, appetite appears, sometimes increased; In contrast to the first 2-3 weeks, the pulse may increase (weakening of the heart muscle).
By the end of the 5th week,
the process subsides, but typhoid bacilli can still be excreted in the feces and urine for a long time. In other cases, typhoid fever progresses more quickly and the whole process is over in 4 weeks.
Complications
| Organs and systems of the body |
Possible complications |
| Respiratory system | A very common complication that occurs in almost all typhoid fever is bronchitis as a secondary process that affects the respiratory tract due to insufficient ventilation and stagnation in the small circle due to the horizontal position of the patient, as well as as a result of catarrh of the nose, larynx and trachea descending into the bronchi. Bronchitis can be dry (dry cough, dry wheezing when auscultating) and wet (with the presence of moist scattered wheezing throughout the chest); in the latter case, the cough is accompanied by a significant amount of viscous sputum. Often, due to the spread of the catarrhal process from the bronchi to the pulmonary parenchyma, real pneumonia develops, which usually proceeds as bronchopneumonia. Sometimes the picture of typhus, especially at the beginning of the disease, is generally dominated by phenomena from the respiratory tract; the painful process affects an entire lobe of the lungs, so that a picture of lobar pneumonia with scanty sputum production is obtained; Usually the process does not resolve for a long time - then they talk about pneumotyphoid fever. Due to insufficient breathing and blood circulation caused by prolonged lying in bed, congestive hypostatic phenomena sometimes form in the lower lobes of the lungs (especially in old people and children who do not cough up sputum) - hypostatic pneumonia. In persons who have suffered from tuberculosis, an exacerbation of the pulmonary process often begins after typhoid fever, and sometimes acute tuberculosis and general miliary tuberculosis develop. |
Source: https://papeleta.ru/diseases-of-the-nose/bryushnoi-tif-posledstviya-bolezni-bryushnoi-tif-simptomy-profilaktika-i-lechenie-profilaktika-i-privi/
Typhoid fever: etiology, signs, examination, methods of treatment and prevention - DoctorTut
Typhoid fever belongs to the group of typhoparatyphoid diseases that are highly contagious, have a fecal-oral transmission route and a similar clinical picture. This pathology is characterized by a severe course, the presence of fever, intoxication and damage to the intestinal lymphatic system.
Timely diagnosis and treatment of typhoid fever determines the prognosis for recovery and also reduces the possibility of spreading the infection.
Establishing diagnosis
A preliminary diagnosis will be made based on the characteristic clinical picture, life history and disease.
From the point of view of the effectiveness of the therapy and anti-epidemic measures, the diagnosis of “typhoid fever” should be established within the first 5-10 days. After all, it is during this period that antibacterial therapy is most effective, and the patient is minimally contagious.
A doctor may suspect typhoid fever based on clinical and epidemiological data. A combination of the following symptoms should alert him:
- increasing fever and intoxication without clear organ damage;
- relative bradycardia (pulse rate does not correspond to high body temperature);
- pale skin;
- roseola rash;
- characteristic changes in the tongue (swelling, grayish-yellow coating, teeth marks);
- hepatolienal syndrome (enlarged liver and spleen);
- flatulence and constipation;
- sleep disturbance;
- adynamia.
Among the epidemiological data, the following are of particular importance:
- presence of contact with a febrile patient;
- staying in an area unfavorable for typhoid fever;
- drinking water from open reservoirs;
- eating unwashed vegetables and fruits;
- use for food purposes of dairy products purchased from private individuals.
All persons with a fever for 5 days or more should be examined for typhoid infection.
Tests for typhoid fever
The diagnosis of typhoid fever must have laboratory confirmation. For this purpose, the following research methods are used:
- Isolation of a blood culture of the pathogen (blood sampling is carried out at the height of fever for 2-3 days daily; inoculation is performed on nutrient media containing bile).
- Immunofluorescence method (allows you to obtain a preliminary result 10-12 hours after inoculation).
- Bacteriological examination of feces, urine and duodenal contents (can be reliable from the 2nd week of illness; results are assessed after 4-5 days).
- Determination of antibody titer and its increase by studying paired blood sera in the reaction of indirect agglutination and complement fixation (a titer of 1:200 is considered diagnostic; it becomes positive from the 5-7th day of the disease).
- Enzyme immunoassay (a highly sensitive method based on the detection of complexes of microbial antigen and protective antibodies in the test material).
It should be noted that in addition to specific diagnostic methods, changes in the clinical blood test are informative:
- a decrease in the total number of leukocytes and neutrophils with a shift in the white blood count to the left;
- relative lymphocytosis;
- increase in ESR;
- decreased hemoglobin and platelet levels;
- absence of eosinophils.
Differential diagnosis
Considering that at the onset of the disease, the diagnosis of typhoid fever is difficult due to the paucity of clinical manifestations, it must be distinguished from many pathological conditions that occur with fever and intoxication:
Principles of treatment
All patients diagnosed with typhoid fever or suspected of having it are subject to mandatory hospitalization with isolation and anti-epidemic measures at the source of infection. Contact persons are monitored for the duration of a possible incubation period (21 days).
Treatment is carried out taking into account:
- severity of the disease;
- phases of the pathological process;
- the presence of complications and concomitant diseases.
Such patients are provided with:
- peace;
- bed rest in the acute period;
- gentle diet.
Food should not burden the digestive system and at the same time should be sufficiently high in calories. Pureed dishes and plenty of fluids (water, tea, fruit drinks) are recommended.
The basis of treatment is antibacterial drugs, taking into account the sensitivity of the pathogen. For this purpose, drugs from the group can be used:
- chloramphenicols;
- cephalosporins;
- fluoroquinolones;
- macrolides.
- The course of treatment continues until the 10th day of normal temperature.
- To restore impaired body functions and alleviate the patient’s condition, therapeutic measures include:
- detoxification and correction of water and electrolyte balance (infusion of glucose-salt and colloid solutions);
- fight against hypoxia (oxygen therapy);
- prescription of immunomodulators;
- use of cardiotropic and hypnotic drugs according to indications;
- vitamin therapy.
The tactics of managing patients with the development of complications has certain features.
- In case of intestinal bleeding, conservative therapy is carried out with the appointment of cold on the abdomen, fasting for 10-12 hours and hemostatic drugs. If the patient has significant blood loss, then he is indicated for the administration of plasma-substituting solutions or red blood cells.
- If intestinal perforation develops, urgent surgical intervention is performed.
After clinical recovery and normalization of laboratory parameters, but not earlier than 21 days after normalization of body temperature, such persons can be discharged home. They are subject to clinical observation throughout the year with periodic laboratory examinations. Relapses are treated according to the same principles as the primary disease.
Chronic bacteria carriers also require treatment. It includes long-term use of antibiotics and vaccine therapy. After the cessation of bacterial excretion, such persons remain registered, since after some time it may resume.
Prevention
In order to prevent the disease, people at risk are vaccinated.
To prevent the spread of infection and infection of healthy individuals, the following measures are taken:
- control over the operation of the water supply system and disinfection of drinking water;
- Cleaning of drains;
- compliance with the rules of preparation, storage and sale of food;
- periodic examination of workers in the food industry and child care institutions;
- timely detection and isolation of patients with typhoid fever, as well as bacteria carriers;
- anti-epidemic measures in the source of infection;
- dispensary observation of recovered and treated carriers of infection;
- preventive vaccination in risk groups for developing the disease (living in an area with a high incidence rate, having constant contact with patients or working in a laboratory with contaminated material).
Currently, thanks to modern methods of diagnosis and treatment, the prognosis for typhoid fever has improved. If previously the mortality rate reached 20%, then with the use of antibiotics it decreased to 0.1-0.3%. However, this does not exclude severe cases of the disease with the development of complications, which are much less common, but still possible.
Which doctor should I contact?
If typhoid fever is suspected, consultation with an infectious disease specialist is necessary. For differential diagnosis with other diseases, an examination by a dermatologist, gastroenterologist, neurologist, cardiologist, or pulmonologist may be required.
- About typhoid fever in the program “Live Healthy!” with Elena Malysheva:
Source: https://lekartut.ru/bryushnoj-tif-etiologiya-priznaki-obsledovanie-metody-lecheniya-i-profilaktiki.html
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