Podcast
Questions and Answers
What laboratory finding indicates intravascular hemolysis in leptospirosis?
What laboratory finding indicates intravascular hemolysis in leptospirosis?
- Anemia (correct)
- Elevated C-reactive protein level
- Hyperkalemia
- Prolonged prothrombin time
Which of the following abnormalities is NOT commonly seen in the electrocardiographic findings of leptospirosis?
Which of the following abnormalities is NOT commonly seen in the electrocardiographic findings of leptospirosis?
- High voltage (correct)
- Nonspecific ST-T wave changes
- Bradycardia
- Low voltage
Which liver function test is typically abnormal in patients with leptospirosis?
Which liver function test is typically abnormal in patients with leptospirosis?
- Decreased AST
- Raised alkaline phosphatase (correct)
- Raised bilirubin levels (correct)
- Normal ALT
What factor may cause an increased creatinine phosphokinase (CPK) level in leptospirosis?
What factor may cause an increased creatinine phosphokinase (CPK) level in leptospirosis?
What is a typical finding in cerebrospinal fluid (CSF) examination during leptospirosis?
What is a typical finding in cerebrospinal fluid (CSF) examination during leptospirosis?
Which of these findings indicates severe infection in leptospirosis?
Which of these findings indicates severe infection in leptospirosis?
What is the characteristic feature of the fever seen in typhoid fever?
What is the characteristic feature of the fever seen in typhoid fever?
Which complication of typhoid fever is most likely to occur by the third week of illness?
Which complication of typhoid fever is most likely to occur by the third week of illness?
What is the nature of abdominal tenderness in the early stages of typhoid fever?
What is the nature of abdominal tenderness in the early stages of typhoid fever?
In the context of typhoid fever, what do 'rose spots' indicate?
In the context of typhoid fever, what do 'rose spots' indicate?
Which laboratory test is commonly used for diagnosing typhoid fever?
Which laboratory test is commonly used for diagnosing typhoid fever?
What intestinal manifestation may occur by the end of the first week in typhoid fever?
What intestinal manifestation may occur by the end of the first week in typhoid fever?
What is a common symptom that presents with typhoid fever in adults?
What is a common symptom that presents with typhoid fever in adults?
Which of the following is NOT a recognized complication of typhoid fever?
Which of the following is NOT a recognized complication of typhoid fever?
When do typhoid ulcers typically result from the disease process?
When do typhoid ulcers typically result from the disease process?
What is the general duration of continuous fever in untreated typhoid fever patients?
What is the general duration of continuous fever in untreated typhoid fever patients?
What is the primary causative agent of typhoid fever?
What is the primary causative agent of typhoid fever?
Which of the following is a common source of infection for enteric fever?
Which of the following is a common source of infection for enteric fever?
How long is the typical incubation period for typhoid fever?
How long is the typical incubation period for typhoid fever?
What mechanism allows Salmonella to survive in the stomach after ingestion?
What mechanism allows Salmonella to survive in the stomach after ingestion?
Which of the following describes a chronic carrier of typhoid fever?
Which of the following describes a chronic carrier of typhoid fever?
What type of bacteria are Salmonella classified as?
What type of bacteria are Salmonella classified as?
What is a rare mode of transmission for enteric fever?
What is a rare mode of transmission for enteric fever?
Which statement about paratyphoid fever is true?
Which statement about paratyphoid fever is true?
What is the primary manifestation of severe leptospirosis in Weil's syndrome?
What is the primary manifestation of severe leptospirosis in Weil's syndrome?
Which of the following symptoms is most commonly associated with the leptospiremic phase of leptospirosis?
Which of the following symptoms is most commonly associated with the leptospiremic phase of leptospirosis?
What laboratory finding is associated with acute renal failure in Weil's syndrome?
What laboratory finding is associated with acute renal failure in Weil's syndrome?
In the immune phase of leptospirosis, which condition is most likely to occur?
In the immune phase of leptospirosis, which condition is most likely to occur?
Which symptom is NOT typically observed during the early stage of leptospirosis?
Which symptom is NOT typically observed during the early stage of leptospirosis?
What type of hemorrhagic manifestations are common in Weil's syndrome?
What type of hemorrhagic manifestations are common in Weil's syndrome?
What characterizes the first phase of leptospirosis?
What characterizes the first phase of leptospirosis?
Which of the following can result from impaired renal perfusion in Weil's syndrome?
Which of the following can result from impaired renal perfusion in Weil's syndrome?
During the immune phase of leptospirosis, what will the CSF usually show?
During the immune phase of leptospirosis, what will the CSF usually show?
What is not a common finding in the urine during the early part of leptospirosis?
What is not a common finding in the urine during the early part of leptospirosis?
What is the primary source of infection for leptospirosis in humans?
What is the primary source of infection for leptospirosis in humans?
Which of the following statements about the mode of transmission of leptospirosis is incorrect?
Which of the following statements about the mode of transmission of leptospirosis is incorrect?
What are the two phases of illness seen in leptospirosis?
What are the two phases of illness seen in leptospirosis?
In which phase of leptospirosis are leptospirae present in the blood and CSF?
In which phase of leptospirosis are leptospirae present in the blood and CSF?
Which of the following is NOT a synonym for leptospirosis?
Which of the following is NOT a synonym for leptospirosis?
What is the most common reservoir of Leptospira organisms?
What is the most common reservoir of Leptospira organisms?
What clinical feature is most commonly present during the initial phase of leptospirosis?
What clinical feature is most commonly present during the initial phase of leptospirosis?
What is the typical incubation period for leptospirosis?
What is the typical incubation period for leptospirosis?
Which antibiotic should be used to treat multidrug-resistant strains of Salmonella typhi?
Which antibiotic should be used to treat multidrug-resistant strains of Salmonella typhi?
What is the recommended treatment duration for chronic carriers of typhoid using ciprofloxacin?
What is the recommended treatment duration for chronic carriers of typhoid using ciprofloxacin?
Which of the following conditions may indicate the use of corticosteroids in typhoid treatment?
Which of the following conditions may indicate the use of corticosteroids in typhoid treatment?
What complication of typhoid fever usually occurs in the third or fourth week of illness?
What complication of typhoid fever usually occurs in the third or fourth week of illness?
What method is considered the most important for preventing typhoid fever?
What method is considered the most important for preventing typhoid fever?
Which of the following vaccines for typhoid fever involves taking three doses orally?
Which of the following vaccines for typhoid fever involves taking three doses orally?
Which antibiotic is usually prescribed for patients who have NARST strains of Salmonella typhi?
Which antibiotic is usually prescribed for patients who have NARST strains of Salmonella typhi?
What is the correct dosage of ciprofloxacin for treating typhoid fever?
What is the correct dosage of ciprofloxacin for treating typhoid fever?
Chronic carriers of typhoid are often older females with which condition?
Chronic carriers of typhoid are often older females with which condition?
Which of the following antibiotics is NOT effective against resistant strains of S. typhi?
Which of the following antibiotics is NOT effective against resistant strains of S. typhi?
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Study Notes
Enteric Fever Overview
- Acute systemic illness including typhoid and paratyphoid fever.
- Characterized by fever, headache, and abdominal discomfort.
Causative Agents
- Caused by Salmonella typhi and Salmonella paratyphi.
- Both are gram-negative, flagellate, motile bacilli, and nonsporulating.
- Vulnerable to boiling or chlorination of water, and pasteurization of milk.
Source of Infection
- Only humans are natural reservoirs.
- Infection can arise from infected individuals' urine, feces, or secretions.
- Chronic carriers often harbor the bacteria in the gallbladder, urinary bladder, or biliary tree.
Mode of Transmission
- Person-to-person contact and ingestion of contaminated food or water.
- Rare direct spread through the fecal-oral route.
Incubation Period
- Typically 10-14 days for typhoid; shorter for paratyphoid.
Pathogenesis
- Salmonella survives gastric acid, penetrates small intestine mucosa, and reaches submucosa.
- Phagocytosed by macrophages in Peyer's patches, leading to systemic infection and bacteremia.
Clinical Features
- Gradual onset of nonspecific symptoms including fever, anorexia, headache, and abdominal pain.
- Characteristic step-ladder fever with temperatures rising to 40-41°C.
- Early intestinal symptoms may include constipation or mild diarrhea.
Physical Findings
- Abdominal tenderness, hepatosplenomegaly, and lymphadenopathy can occur.
- "Rose spots" (2-4 mm pale-red maculopapular lesions) appear on the chest and abdomen.
- Relative bradycardia: pulse rate slower than expected with high fever.
- By the second week, symptoms can become severe with potential for complications.
Complications
- General: toxemia, dehydration, peripheral circulatory failure, DIC.
- Intestinal: ileus, perforation of ulcers, and gastrointestinal hemorrhage.
- Extraintestinal: neurological (delirium, seizures), cardiac (myocarditis), respiratory complications, etc.
Diagnosis
- Laboratory diagnosis includes blood cultures and serological tests.
- Widal test can help in identifying antibodies against S.typhi.
Treatment
- General management: bed rest, nutrition, fluid maintenance.
- Antibiotics: several effective options; should follow culture and sensitivity results.
- Resistance in strains requires alternative drugs like ciprofloxacin or ceftriaxone.
- Corticosteroids in severe cases (toxemia, CNS involvement).
- Handle complications as they arise.
Carrier State
- 3-5% of individuals become long-term carriers, often without prior infection history.
- Chronic carriers require antibiotic treatment and may need cholecystectomy.
- Vi antigen tests positive in carriers for monitoring.
Prevention
- Improved sanitation, hygiene, clean water supply, and proper sewage disposal are essential.
- Vaccination: inactivated injectable and live attenuated vaccines available, with different methods of administration.
Drugs and Dosages
- Various antibiotics are administered according to resistance profiles and clinical severity, with specific dosage outlined.
- Key drugs include ceftriaxone, chloramphenicol, amoxicillin, and ciprofloxacin.
Summary
- Enteric fever poses significant health concerns, necessitating awareness of its etiology, clinical features, and effective management strategies. Prevention through sanitation and vaccination plays a crucial role in reducing incidence.
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