2. Enteric fever is a systemic disease which
includes Typhoid fever caused by S.typhi, and
Paratyphoid fever caused by S,paratyphi A
and B.
In India,the disease is endemic with an
incidence ranging from 102 to 2219 per
100,000 population.
In the early 1800s, typhoid fever was clearly
defined pathologically as a unique illness on
the basis of its association with enlarged
Peyer's patches and mesenteric lymph nodes.
3. All Salmonella infections begin with ingestion
of organisms, most commonly in
contaminated food or water.
Once S. typhi and S. paratyphi reach the
small intestine, they penetrate the mucus
layer of the gut and traverse the intestinal
layer through phagocytic microfold (M) cells
that reside within Peyer's patches.
4. After crossing the epithelial layer of the
small intestine, S. typhi and S.
paratyphi, which cause enteric (typhoid)
fever, are phagocytosed by macrophages.
These salmonellae survive the antimicrobial
environment of the macrophage by sensing
environmental signals that trigger alterations
in regulatory systems of the phagocytosed
bacteria.
5. Once phagocytosed, typhoidal salmonellae
disseminate throughout the body in
macrophages via the lymphatics and colonize
reticuloendothelial tissues
(liver, spleen, lymph nodes, and bone
marrow).
Signs and symptoms, including fever and
abdominal pain etc, result from secretion of
cytokines by macrophages and epithelial
cells in response to bacterial products that
are recognized by innate immune receptors.
Over time, the development of
hepatosplenomegaly , marked enlargement
and necrosis of the Peyer's patches.
7. The incubation period ranges from 3–21 days.
prolonged fever (38.8°–40.5°C; 101.8°–
104.9°F), which can continue for up to 4
weeks if untreated.
Abdominal pain
headache (80%), chills (35–45%), cough
(30%), sweating (20–25%), myalgias
(20%), malaise (10%), and arthralgia (2–4%).
Gastrointestinal symptoms included anorexia
(55%), abdominal pain (30–40%), nausea (18–
24%), vomiting (18%), and diarrhea (22–28%)
more commonly than constipation (13–16%).
Physical findings included coated tongue (51–
56%), splenomegaly (5–6%).
8. Early physical findings of enteric fever
include rash ("rose spots";
30%), hepatosplenomegaly (3–
6%), epistaxis, and relative bradycardia at
the peak of high fever (<50%).
Complications include
toxaemia,dehydration,PCF,DIC,intestinal
perforation&haemorrhage,delirium,psychosis
,coma,meningitis,encephalopathy,myocarditi
s,endocarditis,pericarditis,pyelonephritis,glo
merulonephritis,arthritis,pneumonia,hepatiti
s,thrombophlebitis.
9. Diagnosisis made by
blood, bone marrow, or
stool.
The Widal test is
commonly used to
diagnose Typhoid.
Looks for salmonella
antibodies against antigens
O-somatic and H-flagellar)
10. Leucopenia with relative
lymphocytosis.
A blood culture the shows
the bacteria
A stool culture
An ELISA test to show the
Vi antigen
A platelet count (low
platelet count)
A fluorescent antibody
study and molecular
methods like PCR
11. 3%-5% of people who have
been infected become
carriers of the disease.
Carriers are treated with
prolonged antibiotics.
Removal of the
gallbladder(cholecystecto
my) or the site of the
Typhoid Carrier undergoes treatment infection will usually cure
the patient.
12. To study the…
Sensitivity
patterns of S. enteritica and
response to antimicrobial therapy.
The clinical and laboratory profile of patients
suffering with enteric fever.
13. Thiswas a retrospective chart review of all
cases of enteric fever carried out at a
tertiary care private hospital in
Mumbai, India.
The records of all patients discharged from
our hospital with a diagnosis of enteric
fever(typhoid fever or paratyphoid fever)
were assessed for suitability for inclusion in
our study.
16. DIAGNOSTIC TEST PERCENTAGE
WBC COUNT NORMAL 85
LEUCOPENIA 11.4
LYMPHOCYTOSIS 4 PATIENTS
ABSOLUTE EOSINOPENIA 76.9
THROMBOCYTOPENIA 25.9
HYPERBILIRUBINEMIA 28.7
CULTURE POSITIVE 73 PATIENTS
WIDAL TEST 64 PATIENTS
17. Ceftriaxone was the most common antibiotic
used to treat patients in hospital 74 of 119
patients (62.1%).
A combination of ceftriaxone (2 gm bd IV)
and azithromycin (500 mg od PO) was used in
16 patients (13.4%).
Rest of the patients (25%) received various
other antibiotics singly or in combination.
The mean duration of receipt of
antimicrobials after hospitalization was 11
days.
18. Theoverall mean time to defervescence
when ceftriaxone alone was used as therapy
was 4.2 days.
Themean time to defervescence in those
patients who received a combination of
ceftriaxone and azithromycin was 5.1 days
and did not differ significantly from those
who received ceftriaxone alone.
19. As many as 46.2% patients in our study
received antibiotics either single or in
combination for as long as 10 days before
being admitted to the hospital. Despite this
they were still culture positive.
There is high prevalence of nalidixic acid
resistance and return of sensitivity to
chloramphenicol,ampicillin and
cotrimoxazole. We did not observe any
resistance to third generation
cephalosporins.
20. The mean fever clearance time with
ceftriaxone used as single therapy observed
in our study was 4.2 days as against 6.1 days
in literature.
Resultsof our study however suggest that
combination therapy may not be superior to
single drug therapy, as we did not observe
any significant difference in the time to
defervescence in those patients who
received ceftriaxone alone or in combination
with azithromycin.
21. Importance of absolute eosinopenia as a
diagnostic marker of typhoid.
High culture positivity despite receipt of
prior antibiotics, high prevalence of nalidixic
acid resistance (79%), return of susceptibility
to chloramphenicol (96%), 100% sensitivity to
ceftriaxone and non superiority of
combination therapy versus single agent
therapy.
22.
23. Antonius Musa :
A Roman physician who
achieved fame by treating
the Emperor Augustus
2,000 year ago, with cold
baths when he fell ill with
typhoid.
rabiezahran@gawab.com
24. Thomas Willis:
who is credited
with the first
description of
epidemic typhoid
in 1659 .
rabiezahran@gawab.com
25. William Wood Gerhar :
who was the first to
differentiate clearly
between
typhus & typhoid
in 1837.
rabiezahran@gawab.com
26. Carl Joseph Eberth
who discovered
the typhoid
bacillus in 1880.
rabiezahran@gawab.com
27. Georges Widal:
who describes
‘Widal
agglutination
reaction’
in 1896.
rabiezahran@gawab.com
28. The Diazo test had a sensitivity of 81% and specificity 90% .
No other studies have attempted to highlight the usefulness of
this test. It is often not possible in clinical practice to submit
blood for culture in the first week of a febrile illness before
starting antibiotics. Besides, blood culture is not routinely
available everywhere.
Diazo test became positive from day 5 of fever and remained
positive till day 31 of fever.
The average duration of test positivity was 6-16 days of fever.
We believe that this is a simple bedside test which can be used
to diagnose typhoid fever where facilities for blood culture
and Widal test are not available.
rabiezahran@gawab.com
29. Around 430-426 B.C. it is
believed that Typhoid Fever
killed 1/3 of the population in
Athens.
This was long disputed but
after a DNA discovery in
2006, it was determined that it
was the Typhoid Fever
bacterium.
Between 2004-2005 an
outbreak in the Dominican
Republic occurred with 42,000
cases and 214 deaths.
30. In the late 19th
century, a typhoid fever
outbreak in Chicago
occurred killing 65 per
100,000 people.
In 1891, the worst
mortality rates were 174
per 100,000 people.
In 1907, the first
American carrier was
discovered - Mary Mallon
aka Typhoid Mary.
31. A carrier is usually a healthy
person who survived the
disease but in whom the
bacteria are able to survive
without causing further
symptoms.
Carriers continue to spread the
disease through their
excrement without realizing it.
32. She infected 47 people and killed
3
She constantly changed her
employment but the members of
the household always got sick.
She was forced into containment
for two years and then released
under the conditions that she
could no longer be a cook.
She assumed a false name and
began cooking again and of
course, infecting numerous
people.
She was forced into life-time
containment where she died 26
years later of pneumonia.
33. Avoid risky foods or drinks
Get vaccinated
Use only clean water
Ask for drinks without ice
unless you know where
it’s coming from
Only eat foods that have
been thoroughly cooked
Avoid raw fruits and
vegetables
Avoid food and drinks
from street vendors
