Enteric Fever Overview
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Questions and Answers

What is another name for enteric fever?

Typhoid fever

Enteric fever is caused by which bacteria?

  • Salmonella enterica typhi
  • Salmonella paratyphi A, B, C
  • Both A and B (correct)
  • None of the above

What is the ratio of typhi infections to paratyphi infections?

10:1

Enteric fever is transmitted via the fecal-oral route.

<p>True (A)</p> Signup and view all the answers

Enteric fever is most prevalent during the winter season.

<p>False (B)</p> Signup and view all the answers

Enteric fever can affect individuals of all ages.

<p>True (A)</p> Signup and view all the answers

What is the first stage of pathogenesis for enteric fever?

<p>Oro-faecal route</p> Signup and view all the answers

What is the final stage of pathogenesis?

<p>Disseminated to different organs</p> Signup and view all the answers

Which of the following is a clinical feature of Enteric fever?

<p>All of the above (I)</p> Signup and view all the answers

Enteric fever is characterized by tachycardia.

<p>False (B)</p> Signup and view all the answers

What is the name of the specific skin lesions that are often observed during the first week of enteric fever?

<p>Rose spots</p> Signup and view all the answers

Inflammation of the heart muscle can be a complication of Enteric fever.

<p>True (A)</p> Signup and view all the answers

Enteric fever can lead to ______ of the brain.

<p>Encephalopathy</p> Signup and view all the answers

Enteric fever complications include kidney failure.

<p>True (A)</p> Signup and view all the answers

Osteomyelitis is a common complication of enteric fever.

<p>True (A)</p> Signup and view all the answers

Which of the following is considered the gold standard for diagnosing enteric fever?

<p>Blood culture (C)</p> Signup and view all the answers

A decreased white blood cell count with more lymphocytes can be a sign of enteric fever.

<p>True (A)</p> Signup and view all the answers

The presence of rose spots on the trunk is a diagnostic sign for enteric fever.

<p>False (B)</p> Signup and view all the answers

Which of the following is NOT a differential diagnosis for enteric fever?

<p>All of the above are differential diagnoses (H)</p> Signup and view all the answers

Which of the following treatments is NOT a common recommendation for uncomplicated typhoid fever?

<p>Steroid treatment (F)</p> Signup and view all the answers

Which of the following antibiotics is commonly used to treat uncomplicated typhoid fever?

<p>All of the above (E)</p> Signup and view all the answers

Ceftriaxone is a recommended antibiotic treatment for severe typhoid fever.

<p>True (A)</p> Signup and view all the answers

Gatifloxacin is only recommended for treating mild cases of typhoid.

<p>False (B)</p> Signup and view all the answers

Enteric fever typically leads to a good prognosis.

<p>True (A)</p> Signup and view all the answers

What is one of the main factors that determines the prognosis in Enteric fever?

<p>Age</p> Signup and view all the answers

Chronic carriers of enteric fever can excrete the bacteria for over 3 months.

<p>True (A)</p> Signup and view all the answers

Which of the following is NOT a key prevention strategy for enteric fever?

<p>Using antibiotics as a preventative measure (D)</p> Signup and view all the answers

The TAB vaccine is still commonly used for typhoid fever.

<p>False (B)</p> Signup and view all the answers

The Typhoid Vi Polysaccharide vaccine is recommended for children under 2 years of age.

<p>False (B)</p> Signup and view all the answers

The Typhoid Conjugate Vaccine is recommended for infants as young as 6 months old.

<p>True (A)</p> Signup and view all the answers

Flashcards

Enteric fever

A bacterial infection caused by Salmonella enterica typhi or Salmonella paratyphi. It is spread through contaminated food and water.

Salmonella enterica typhi

The bacteria responsible for causing enteric fever, commonly known as typhoid fever.

Salmonella paratyphi A, B, and C

Bacteria closely related to Salmonella enterica typhi, also causing enteric fever, but less common.

typhi: paratyphi = 10:1

The ratio of Salmonella enterica typhi to Salmonella paratyphi infections, usually 10:1 meaning typhoid fever is much more common.

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Faecal-oral route

The primary way enteric fever spreads from person to person: through contaminated food or water.

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Frequent in Summer season

Enteric fever is more frequent during the summer months.

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Can occur from infancy to old age

Enteric fever can affect people of all ages, from infancy to old age.

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Children 2 to 15 years very commonly affected

Children between 2 and 15 years old are particularly susceptible to enteric fever.

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High grade fever

A high body temperature, a common symptom of enteric fever.

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Coated tongue

A white coating on the tongue, typical of enteric fever.

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Anorexia

Loss of appetite, another symptom of enteric fever.

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Vomiting

Vomiting, frequent during enteric fever.

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Diarrhoea/ constipation

Diarrhea or constipation, both possible with enteric fever.

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Abdominal pain

Pain in the abdomen, a symptom of enteric fever.

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Headache

Headache, a frequent symptom of enteric fever.

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Obtundation

A symptom where a patient has impaired consciousness or alertness, often observed in enteric fever.

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Relative bradycardia

A slower heart rate than expected for the level of fever, characteristic of enteric fever.

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Rose spots on trunk ( 1st week)

Small, flat, pink spots appearing on the trunk during the first week of enteric fever.

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Hepatosplenomegaly

An enlarged liver and spleen, a common finding in enteric fever.

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Tympanic abdomen

Sounds of gas in the abdomen, a sign of enteric fever.

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Encephalopathy

A serious complication of enteric fever that affects the brain, causing swelling, confusion, muscle coordination issues, and seizures.

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Leukopenia with relative lymphocytosis

A condition marked by a decreased white blood cell count, particularly lymphocytes, often seen in enteric fever.

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Deranged LFT

Abnormal liver function test results, indicating liver damage, a potential complication of enteric fever.

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Blood culture (gold standard)

The most accurate way to confirm enteric fever, involving the identification of bacteria in a blood sample.

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Agglutination test

An alternative test to blood culture, using antibodies to detect Salmonella in a blood sample.

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Widal test

A specific type of agglutination test used to detect enteric fever.

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Stool culture

Identifying bacteria in a stool sample, a test for enteric fever.

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Urine culture

A test to detect bacteria in urine, sometimes used to diagnose enteric fever.

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Bone marrow culture

A test to detect bacteria in bone marrow, less commonly used for enteric fever.

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Monoclonal Antibody

A treatment that uses specific antibodies to fight the bacteria causing enteric fever.

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Amoxycillin

A drug that is effective against uncomplicated enteric fever.

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Fluroquinolones

A category of drugs used to treat severe enteric fever.

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Chronic carriers

A condition where someone continues excreting Salmonella typhi for longer than 3 months, usually due to persistent bacteria in the gallbladder.

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Proper sewage/ sanitation

The best way to prevent enteric fever is to maintain proper hygiene and sanitation.

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Hand washing

Washing hands carefully, particularly after using the bathroom, can help prevent the spread of enteric fever.

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Treatment

Enteric fever can be effectively managed with rest, hydration, and appropriate antibiotics.

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Prognosis

The long-term outcome of enteric fever depends on factors such as age, overall health, and complications.

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Dexamethasone

A steroid medication sometimes given to treat severe complications like encephalopathy or shock associated with enteric fever.

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Antibiotic treatment

Antibiotics are crucial for the treatment of enteric fever, with specific choices depending on the severity of the illness.

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Study Notes

Enteric Fever

  • Also known as "typhoid fever"
  • Caused by Salmonella species:
    • Salmonella enterica typhi
    • Salmonella paratyphi A, B, C
    • Ratio of typhi to paratyphi is approximately 10:1
  • Transmission route: fecal-oral
  • Incubation period: 7-14 days

Epidemiology

  • Commonly occurs during summer months
  • Affects patients of all ages, but children aged 2-15 are most susceptible

Pathogenesis

  • Oro-fecal route
  • M cells in the terminal ileum mucosa are infected
  • Infection spreads to Peyer's patches
  • Then to mesenteric lymph nodes
  • Primary and secondary bacteremia follow
  • Dissemination of infection throughout the body
  • The reticuloendothelial system (RES) is affected, leading to secondary bacteremia.

Clinical Features

  • High-grade fever
  • Coated tongue
  • Anorexia
  • Vomiting
  • Diarrhea or constipation
  • Abdominal pain
  • Headache
  • Confusion or obtundation (altered mental status)

Examination

  • Relative bradycardia
  • Rose spots on the trunk (first week of illness)
  • Hepatosplenomegaly (enlarged liver and spleen)
  • Tympanic abdomen (abdomen sounds hollow upon percussion)

Complications

  • Central nervous system (CNS): encephalopathy, delirium, ataxia, seizures
  • Cardiovascular system (CVS): endocarditis, myocarditis, congestive heart failure
  • Respiratory: pneumonia, empyema
  • Gastrointestinal: complications related to the gastrointestinal tract
  • Hepatobiliary: cholecystitis, hepatitis, hepatic/splenic abscess
  • Genitourinary: urinary tract infection (UTI), renal abscess, prostatitis
  • Bones: osteomyelitis, septic arthritis

Investigations

  • Leukopenia with relative lymphocytosis
  • Liver function test (LFT) abnormalities
  • Blood cultures (gold standard)
  • Agglutination tests (e.g., Widal test)
  • Stool cultures
  • Urine cultures
  • Bone marrow cultures
  • Serological tests (monoclonal antibodies)
  • Polymerase chain reaction (PCR)

Differential Diagnosis

  • Viral fever
  • Malaria
  • Tuberculosis
  • Septicemia
  • Brucellosis
  • Leptospirosis
  • Dengue
  • Infectious mononucleosis
  • Acute hepatitis

Treatment

  • Adequate rest
  • Hydration
  • Antipyretics (fever reducers)
  • Soft diet
  • Antibiotic therapy:
    • Uncomplicated typhoid: amoxicillin, fluoroquinolones, cefixime, azithromycin
    • Severe typhoid: ampicillin (IV), ceftriaxone (IV), gatifloxacin
  • Encephalopathy/shock: dexamethasone

Prognosis

  • Factors influencing prognosis: patient age, general health status, presence of chronic carriers
  • Chronic carriers: exhibit gall bladder infection and excretion of S. typhi for >3 months post infection.

Prevention

  • Proper sewage and sanitation
  • Hand hygiene
  • Vaccination

Vaccination for Typhoid

  • TAB vaccine (killed bacteria): obsolete
  • Typhoid Vi polysaccharide vaccine (0.5 ml IM): 70% effective (for those >2 years old)
  • Typhoid conjugate vaccine (TCV) (0.5 ml IM): 95% effective (for those 6 months-45 years old)

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Enteric Fever PDF

Description

Dive into the details of enteric fever, commonly known as typhoid fever, including its causative agents, transmission routes, and epidemiology. This quiz covers the clinical features, pathogenesis, and examination details related to this significant infectious disease.

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