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Questions and Answers
What constitutes a confirmed case of enteric fever?
What constitutes a confirmed case of enteric fever?
Which of the following factors is NOT associated with the increased incidence of enteric fever during the summer?
Which of the following factors is NOT associated with the increased incidence of enteric fever during the summer?
Which statement regarding carriers of enteric fever is true?
Which statement regarding carriers of enteric fever is true?
What is the primary reservoir for the causative agents of typhoid and paratyphoid fever?
What is the primary reservoir for the causative agents of typhoid and paratyphoid fever?
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Which of the following modes of transmission for enteric fever involves indirect contact?
Which of the following modes of transmission for enteric fever involves indirect contact?
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What is the incubation period range for Typhoid fever?
What is the incubation period range for Typhoid fever?
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Which complication is most likely to occur during the late second or early third week of illness?
Which complication is most likely to occur during the late second or early third week of illness?
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Which sign is associated with relative bradycardia during the first week of illness?
Which sign is associated with relative bradycardia during the first week of illness?
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What symptom is typically noted in children suffering from Typhoid fever?
What symptom is typically noted in children suffering from Typhoid fever?
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During which week of Typhoid fever do mental cloudiness and dehydration typically occur?
During which week of Typhoid fever do mental cloudiness and dehydration typically occur?
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Study Notes
Enteric Fever
- Causative Agent: Salmonella genus, specifically S. typhi and S. paratyphi A, B, and C.
- Gram Negative Motile Bacilli: Aerobes and facultative anaerobes, grow on ordinary media.
- Reservoir: Humans are the only known reservoir, either as cases or carriers.
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Carriers: Can be temporary (incubatory or convalescent) or chronic.
- Convalescent carriers excrete bacilli for 6-8 weeks.
- Less than 4% of cases still excrete organisms after 3 months.
- Average carrier rate is around 3% after one year.
- Chronic carriers harbor the organism in the gallbladder, biliary tract, or rarely the intestine or urinary tract.
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Transmission:
- Common Vehicle: Shellfish from contaminated sewage and milk products.
- Vector: Flies.
- Indirect Contact: Transmission from articles soiled with urine or feces.
- Direct Contact: With patients or carriers.
- Period of Communicability: From the second week throughout convalescence, commonly 1-2 weeks for paratyphoid.
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Susceptibility and Resistance: Gastric achlorhydria and HIV/AIDS patients are more susceptible.
- Relative specific immunity follows clinical disease, unapparent infection, and immunization.
- No solid immunity; second attacks can occur.
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Pathogenesis:
- Primary Bacteremic Phase (7-10 days): Oral route → small intestine → intestinal lymphatic → thoracic duct → blood → disseminated into organs (liver, spleen, bone marrow).
- Secondary Bacteremia: After multiplication in organs, bacteria return to the blood, causing pyrexia and other clinical signs.
- Gallbladder to Intestine: Bacteria from the liver travel through the biliary tract to the gallbladder, then to the intestine.
- Localization in the Kidney: Bacteria can localize in the kidney and appear in the urine.
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Clinical Picture: Incubation period depends on the infective dose and host factors.
- Typhoid: 8-14 days.
- Paratyphoid: 1-10 days.
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Signs and Symptoms:
- First Week: Headache, malaise, anorexia, muscle pains, fatigue, abdominal pain, stepladder fever, relative bradycardia (Faget sign), constipation (diarrhea in children), bronchitis with dry cough.
- Second Week: High and sustained fever (around 40°C), toxic and disoriented, abdominal pain and distension, diarrhea, doughy sensation on abdominal examination, hepatosplenomegaly in 50% of patients, rose spots (7th-10th day), rhonchi and rales heard.
- Third Week: Ill and dehydrated, rapid and thready pulse, disoriented, mental cloudiness, hemorrhage and perforation.
- Fourth Week: Improvement, afebrile.
- Relapse: Occurs in 10% of patients, 1-3 weeks after stopping treatment.
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Complications:
- Intestinal Perforation: Late second or early third week.
- Intestinal Hemorrhage.
- Hepatobiliary: Mild jaundice, asymptomatic typhoid hepatitis with elevated ALT and AST, acute or chronic cholecystitis, pancreatitis.
- Cardiopulmonary: Toxic myocarditis, thrombosis, mild bronchitis, pericarditis (toxic myocarditis may cause Faget sign in the first week).
- Genitourinary: Immune complex mediated glomerulonephritis, nephrotic syndrome, acute tubular necrosis, pyelonephritis, pyelitis.
- Hematological: Subclinical disseminated intravascular coagulation (DIC), thrombocytopenia, anemia, leucopenia, and relative lymphocytosis.
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Description
This quiz covers the essential aspects of Enteric Fever, including its causative agents, transmission routes, and carrier states. Learn about the role of Salmonella in the disease and how it spreads among humans. Test your understanding of this important topic in infectious diseases.
