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Enteric Fever
fever
is potentially (^) fatal multi system illness caused by
Salmonella Typhi (
typhoid fever )^
& 5. Paratyphi.
General characteristics^ :
Gram
- (^) ne
- Motile &^ Flagellated
- Non -^ lactose^ fermenting microbe.
- Oxidase
- ve
Ability
to Produce
Has
- Growth medium - Eosin methylene
blue ( EMB )
, Mac Conkey
- (^) Associated diseases (^) : Typhoid Fever . Gastroenteritis. Bacteremia Clinically Relevant
sp
.
- (^) Salmonella enterica (^) is the primary species^ with following serotypes :
Typhoid al^ (^
cause typhoid fever )
( as^ 5.^ enterica^ serotype typhi (b) So paratyphi
Non - Typhoid al (^) ( cause other
foodborne
diseases (^) ) cc ,^
- enteritidis (d) S^. typhimurium Pathogenesis : Reservoir (^) :
Typhoid al - Human GI^ tract
typhoid
al -^ Farm^ animals (^) , pets.
Transmission :
( is^ Fecal^ -^ oral^ route in Ingestion of^ Food products (^ contaminated (^) ) (
iii, S^.^ enterica^ is^ inactivated^
by acids (^). Smaller (^) inocula can
infect
individuals on antacids or
patients with (^) achlorhydria. Virulence (^) :
capsular polysaccharide
antigen
- (^) H (^) ( flagellar ) antigen
(^0) ( lipopolysaccharide )
Clinical Manifestations :
- Incubation^ period is about^ to^ -^ days .
Manifestations seen are largely extra intestinal :
ii. Fever^ (^ stepladder pattern of remittent^ fever )
ciis Other^
symptoms
like Headache (^). chills (^). cough. sweating myalgia & arthralgia .
( Iii^ , Rashes^ ( called^ Rose^ spots)
( in^ Early intestinal (^) manifestations
( Abdominal^ Pain^. nausea^.
vomiting (^4) anorexia (^) ) ( vs^ Hepa to^ splenomegaly. Bradycardia ( ri)^ GI^ Bleeding &^ Intestinal^ perforation (via^ Neurological manifestations like Meningitis , Cerebellar (^) Ataxia &
Neuropsychiatric
symptoms . Course of Disease (^) : 1st (^) week - Gradually (^) rising Fever
- (^) Relative bradycardia
- (^) Pulse - temperature
dissociation.
2nd (^) lnleek. Persistent Fever
spots
: Salmon^ - colored macules
3rd lnleek - Ileocecal
lymphatic hyperplasia of
Peyer
's
patch
splenomegaly
- Bacteremia -^ Altered^ mental^ status^.
Bleeding
Laboratory Diagnosis
:
Treatment :
Widal Test
agglutination
test where^ H and (^) O antibodies
against
s. Typhi and s^. Paratyphi A and B are detected and (^) measured in (^) the
patient
's (^) sera by (^) using 0 &^ H
antigens
. Antigens used :
antigens
are used^ - in 0 Antigens (^) of
Typhi (
To )
(2) H^ Antigens
of
Typhi & Party phi^ A &^ B- (TH^ ) ( Atl) (BH (^) )
Procedure :
- (^) Patient 's (^) serum (^) is serially diluted (^) in normal saline in test^ tubes from 1- in to to 1- in 640 dilutions^.
- To (^) each set
. respective
four (^) antigen suspensions ( TO^ ,^ TH^ ,^ AH^ ,^ BH^ )^ are^ added^.
- (^) Test (^) tubes are (^) incubated in water bath (^) at 37°C overnight .
Results :
- 0 agglutination Compact^ chalky granular clumps
- H^ agglutination (^) large loose fluffy cotton woolly
clumps.
Interpretation :
of
serum is noted where there^ in
agglutination .
- The lnlidal test is Positive^. ii,^97 ' O'
antigen
tier >^1 :^160 =^ Active
infection
iii. if H
antigen
ties (^) > 1 : (^160) ,^ it^ indicates^ past infection or in immune's ed^ persons . Ciii ,^ A^ fourfold increase^ in^ titer^ (As^1 :^40 to^1 :^160 )^ in diagnostic .
- The lilies of 0 - antibodies 1- : (^) so in^ suspicious in unvaccinated
individuals.
