Typhoid fever

Posted by e-Medical PPT Thursday, November 11, 2010
Typhoid fever is a common worldwide illness, transmitted by the ingestion of food or water contaminated with the feces of an infected person, which contain the bacterium Salmonella typhi. The organism is a Gram-negative short bacillus that is motile due to its peritrichous flagella.
Classically, the course of untreated typhoid fever is divided into four individual stages, each lasting approximately one week. In the first week, there is a slowly rising temperature with relative bradycardia, malaise, headache and cough.Epistaxis is seen in a quarter of cases and abdominal pain is also possible. There is leukopenia, a decrease in the number of circulating white blood cells, with eosinopenia and relative lymphocytosis.The classic Widal test is negative in the first week.
In the second week of the infection, the patient lies prostrate with high fever in plateau around 40 °C (104 °F) and bradycardia (sphygmothermic dissociation), classically with a dicrotic pulse wave. Delirium is frequent, frequently calm, but sometimes agitated.The abdomen is distended and painful in the right lower quadrant where borborygmi can be heard. Diarrhea can occur in this stage,green with a characteristic smell, comparable to pea soup. However, constipation is also frequent. The spleen and liver are enlarged (hepatosplenomegaly) and tender, and there is elevation of liver transaminases. The Widal reaction is strongly positive with antiO and antiH antibodies.
In the third week of typhoid fever, a number of complications can occur:
    * Intestinal hemorrhage due to bleeding in congested Peyer's patches; this can be very serious but is usually not fatal.
    * Intestinal perforation in the distal ileum: this is a very serious complication and is frequently fatal.
    * Encephalitis
    * Metastatic abscesses, cholecystitis, endocarditis and osteitis

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