Typhoid Fever Past Paper PDF

Translated from Russian to English - www.onlinedoctranslator.com TYPHOID FEVER Typhoid fever is an acute anthroponous infectious disease from the group of intestinal infections, characterized by bacteremia (the presence of the path...

Translated from Russian to English - www.onlinedoctranslator.com TYPHOID FEVER Typhoid fever is an acute anthroponous infectious disease from the group of intestinal infections, characterized by bacteremia (the presence of the pathogen in the blood), damage to the lymphatic apparatus of the intestine and manifested by fever,intoxicationand damage to a number of body systems. Exciter - Salmonella typhi of the genus Salmonella, a motile gram-negative rod. Produces an endotoxin that is pathogenic only for humans.ka. Contains somatic O-antigen, flagellar H-antigen, Vi-antigen (virulence antigen). Typhoid bacilluscan form L-shapes. Typhoid bacteria are resistant in the external environment. They survive in fresh water for up to 30 days, on vegetables and fruits - up to 10 days, in milk and dairy products they can multiply and accumulate. Sensitive to disinfectants. Reservoir and sources of the pathogen:Human, Period of infectiousness.within 1-5 weeks of illness with a maximum on the 3rd week, with urine - 2-4 weeks. In 10%For those who have recovered, this process continues for up to 3 months (acute carriage), 3-5% become chronic carriers, releasing the typhoid bacillus for a number of years. Transmission mechanism-feco-oral. The route of transmission is mainly waterborne. Food and household routes of transmission are possible. Natural receptivitypeoplehigh. The disease left behind leaves a lasting immunity. Main epidemiological features - the incidence of the disease is predominant in areas with poor water supply and sewerage systems. In waterborne outbreaks, adolescents and adults are most often affected, while in milkborne outbreaks, young children are most often affected. The seasonality is summer-autumn. Pathogenesis.Salmonella penetrates into the lumen of the small intestine. From the lumen of the intestine through the lymphoid formations of its mucous membrane (solitary follicles) they penetrate into the regional lymph nodes (mainly mesenteric), where they multiply intensively. During this period, the body becomes sensitized, bacteremia develops, which coincides with the onset of the febrile period of the disease. When some bacteria die, endotoxins are released, causing general intoxication, which have a damaging effect on the central nervous system. Damage to the autonomic nervous system leads to vagotonia, the development of flatulence, abdominal pain, trophic disorders, damage to internal organs, and exanthema. Roseola rash in typhoid fever appears as a result of productive-inflammatory changes in the superficial layers of the skin along the blood and lymphatic vessels. Typhoid-paratyphoid bacteria are found in roseola scrapings. The pathogen can also be excreted from the body through urine, feces, sweat, saliva, breast milk.milk. During the first week of the disease, swelling of the lymphoid tissue of the small intestine is observed. In the 2nd week, necrosis of the central parts of the swollen lymphatic formations begins (the period of necrosis). On the 3rd week, the rejection of necrotic masses and the formation of ulcers occur (the period of ulcer formation). By the end of the 3rd - beginning of the 4th week of the disease, the rejection of necrotic tissues ends and the period of "clean ulcers" begins. Ulcers with clean, smooth bases and slightly swollen edges form along the ileum. 5-6 weeks of illness, characterized by healing of ulcers without contracting cicatricial changes. Clinic.The incubation period for typhoid fever ranges from 7 to 25 days, most often 9-14 days. Typical forms proceed cyclically. Initial period of the disease. Characterized by the development of intoxication syndrome. With the gradual development of symptoms of the disease in the first days, patients note increased fatigue, increasing weakness, chills, increasing headache, decreased or no appetite. Body temperature, increasing stepwise every day, reaches 39- 40 ° C by the 5th-7th day of the disease, intoxication symptoms increase, significant weakness and adynamia develop, headache becomes persistent, sleep is disturbed, anorexia and flatulence occur. Sometimes diarrhea is observed with errors in the diet. Stool is rarely more than 2-4 times a day. Lethargy and adynamia are noticeable. Patients are indifferent to their surroundings, answer questions in monosyllables, not immediately. The face is pale, sometimes a little pasty. Relative bradycardia is observed, sometimes pulse dicrotia. Arterial pressure is decreased. Diffuse bronchitis develops in the lungs. The tongue is usually thickened, with teeth marks on the lateral surfaces. The back of the tongue is covered with a grayish-white coating, the edges and tip are free of coating, The abdomen is distended due to flatulence. On palpation in the right iliac region, there is rumbling and pain along the terminal ileum, indicating the presence of ileitis. On percussion, a shortening of the percussion sound in the ileocecal region is noted (Padalka's symptom), which is caused by hyperplasia of the inflammatoryly altered lymph nodes of the mesentery. By the end of the first week of the disease, an enlargement of the liver and spleen is detected. In the hemogram after a short-term (in the first 2-3 days) moderate leukocytosis from the 4th-5th day of the disease, leukopenia with a shift in the leukocyte formula to the left, aneosinophilia, relative lymphocytosis and thrombocytopenia are noted. ESR is moderately increased. Changes in the hemogram are a consequence of the effect of toxins of typhoid bacteria on the bone marrow. The period of the peak of the disease. By the end of the 1st - beginning of the 2nd week, the period of the peak of the disease begins, when all symptoms reach their maximum development. It lasts 1-2 weeks. The body temperature, having risen to 39-40 ° C, may subsequently have a constant character. Headache and insomnia often become excruciating. Status typhosus develops, characterized by severe weakness, adynamia, apathy, impaired consciousness from stupor to stupor or coma. Infectious delirium may develop. On the 8th-10th day of the disease, a characteristic exanthema appears on the skin, localized mainly on the skin of the abdomen and lower chest. The rash is scanty, roseolous, At the height of the disease, the amount of urine excreted decreases. Proteinuria, microhematuria, and cylindruria are determined. Bacteriuria occurs, which sometimes leads to inflammation of the mucous membrane of the renal pelvis and urinary bladder. In some cases, yellowing of the skin of the palms and feet is observed (Filipovich's symptom). During this period of the disease, dangerous complications such as perforation of typhoid ulcers and intestinal bleeding may occur. In some cases, death may occur due to severe intoxication and dangerous complications. The period of resolution of the disease. The body temperature decreases. The headache stops, sleep normalizes, appetite improves, the tongue becomes moist, the coating disappears, diuresis increases. The duration of the disease resolution period does not exceed 1 week. Recovery period. Asthenovegetative syndrome is typical for this period, which lasts for 2-4 weeks. Among those who have had typhoid fever, 3-5% of patients become chronic typhoid bacteria excretors. Relapses(7-9% of patients) most often occur in the 2-3rd week of normal temperature, but can also appear at a later date (1-2 months) regardless of the form and severity of the disease. They can be single or multiple. The duration of fever during a relapse can vary from 1-3 days to 2-3 weeks. Complications.Of the specific complications of typhoid fever, the most significant for the outcome of the disease are intestinal bleeding, perforated peritonitis and infectious toxic shock. Intestinal bleeding, which occurs in 1-2% of patients, is most often observed in the 3rd week of the disease. It is caused by erosion of the typhoid ulcer vessel. The stool becomes tarry (melena), contains blood clots or fresh blood. Minor bleeding ends well with timely treatment. With massive bleeding, body temperature suddenly drops to normal or subnormal, thirst occurs, pulse quickens, blood pressure decreases. Massive bleeding can lead to hemorrhagic shock, which always has a serious prognosis. Perforative peritonitis develops in the 2nd-4th week of the disease. It occurs in 0.5-1.5% of patients. Infectious toxic shock usually develops during the peak of the disease and occurs in 0.5-0.7% of patients. Its occurrence is caused by the massive entry of typhoid bacteria and their toxins into the blood. Non-specific complications include: pneumonia, thrombophlebitis, meningitis, pyelitis, mumps, stomatitis, etc. ForecastIn uncomplicated cases of typhoid fever, the prognosis is favorable. If complications develop, it may be unfavorable (especially in perforative peritonitis). Mortalityis 0.1-0.3%. Features of typhoid fever in young children Moderately severe and severe forms prevail. The younger the child, the more severe the disease. Characteristic features include a rapid onset of the disease, early CNS damage with symptoms of meningitis and meningoencephalitis, and rapid development of intoxication. Lethargy, adynamia, and sleep disturbances are most common, while anxiety, irritability, convulsions, and delirium are rare. Dry mucous membranes, coated tongue, and loose, abundant, green stools up to 10-15 times a day are observed. Some children experience vomiting, which, in combination with enteritis, leads to exsicosis and, later, to dystrophy. Characteristic features include bloating, enlarged liver and spleen. Tachycardia, muffled heart sounds, and systolic murmur at the apex of the heart are common. Roseola rash is rare, there is no pulse dicrotia or typhoid status. Specific complications rarely develop. Clinical characteristics of paratyphoid fever. The incubation period for paratyphoid A is shorter, 8-10 days. The onset is often acute, sometimes accompanied by a runny nose and cough. Examination reveals facial hyperemia, vascular injection of the sclera, and herpes on the lips. The temperature curve is irregular. Fever is often accompanied by chills, and then profuse sweat. The rash in paratyphoid A appears earlier (4-7 days of illness). The rash can be roseola, measles-like, and petechial. Intoxication is usually moderate, there is no characteristic typhoid status. In most patients, the disease is of moderate severity. Relapses of paratyphoid A are quite common. The incubation period for paratyphoid B is 5-10 days. The disease often begins acutely, accompanied by severe chills, muscle pain and sweating. In the initial period, it is combined with symptoms of acute gastroenteritis. The temperature reaction is short, often wave-like. The typhoid state of patients is absent, the symptoms of intoxication quickly disappear. The rash appears early, is often abundant. In some cases, the course of paratyphoid B can be severe, with septic manifestations in the form of purulent meningitis, meningoencephalitis, septicopyemia. DiagnosticsIn laboratory diagnostics of typhoid fever, bacteriological and serological research methods are used, which are carried out taking into account the period of the infectious process. In the 1st-2nd week of the disease, the pathogen is easiest to isolate from the blood, from the 2nd-3rd week - from feces and urine, throughout the entire disease - from duodenal contents (in the acute period of the disease, duodenal intubation is contraindicated, biliculture is performed during the convalescence period). Blood culture can be performed from the first day of illness and throughout the febrile period. When blood is sown on a nutrient medium, it is necessary to maintain a ratio of 1:10 between the blood and the medium; with a smaller volume of the nutrient medium, the blood can have a bactericidal effect on the pathogen. Special serum media are used to isolate L-forms of bacteria from blood and bone marrow. For serological diagnostics of typhoid fever and paratyphoid A and B from the 5th to 7th day of the disease, RNGA with erythrocyte diagnosticums (O-, H-, Vi-antigens) is mainly used. A reaction with a titer of 1:200 or higher is considered positive. To identify carriers of bacteria, RNGA with Vi-antigen is used. The Widal reaction, which was widely used in the past, is gradually losing its diagnostic value. Differential diagnostics. Typhoid-paratyphoid diseases must be differentiated from typhus, malaria, brucellosis, listeriosis, pneumonia, sepsis, tuberculosis, lymphogranulomatosis. TreatmentThe course and outcome of typhoid fever depend on proper care, diet and timely administration of antibacterial and pathogenetic agents. Treatment of patients with typhoid and paratyphoid diseases is carried out in an infectious diseases hospital. The patient must be provided with rest and good hygienic conditions. Oral and skin care are also important. Bed rest must be observed until the 6th-7th day of normal temperature. From the 7th-8th day, sitting is allowed, and from the 10th-11th day of normal temperature, in the absence of contraindications, walking is allowed. During the febrile period and during the first 7-8 days of normal temperature, the patients' diet should be as mechanically and chemically gentle as possible in relation to the intestines. Diet No. 4 meets these requirements. The most effective antibiotic for typhoid-paratyphoidal diseases is levomycetin. Antibiotic therapy is carried out during the entire febrile period and the first 10 days after the temperature has returned to normal. Levomycetin is prescribed orally at 0.5 g 4 times a day. However, the use of antibiotics does not always prevent relapses of the disease and the formation of chronic carriage of bacteria. Detoxification and symptomatic therapy is carried out. Prevention. Early diagnosis, timely isolation and hospitalization of the patient, and effective therapy are of great importance in the prevention of typhoid fever. During the recovery period, three control bacteriological examinations of feces and urine and a single examination  of bile are carried out at intervals of 5 days. Discharge of a bacterial isolate is possible only with the permission of an epidemiologist. After discharge, all convalescents are subject to outpatient observation. The focus undergoes routine disinfection before the patient or bacteria carrier is hospitalized. After hospitalization, the focus undergoes final disinfection. Persons who have had contact with patients are placed under medical observation for 21 days with daily thermometry. A single, or if indicated, double bacteriological examination of feces and urine is performed. Specific prophylaxis in the outbreak area includes the administration of bacteriophage to all contacts. Specific vaccination against typhoid fever is carried out according to epidemiological indications. Bibliography: 1. Lectures on infectious diseases. Two-volume. 4th reprinted and supplemented. N.D. Yushchuk. Yu.Ya. Vengerov. 2016. 2. National Guide. Infectious Diseases. Academician N.D.Yushchuk. Academician Yu.Ya.Vengerov.2019. 3. Infectious diseases in children edited by V.N. Timchenko.