Enteric fever: serious infection marked by intestinal inflammation and ulceration; caused by Salmonella typhosa ingested with food

or water.

Causes of Enteric fever

Some of the causes of Enteric fever are included in the list below:

Salmonella typhi

Symptoms of Enteric fever (Typhoid fever)

Some of the symptoms of Enteric fever incude:

No symptoms - if only a mild exposure; some people become "carriers" of typhoid. Fever Headache Constipation Malaise

Treatments for Enteric fever (Typhoid fever)

Treatments for Enteric fever (Typhoid fever) include:

Hospitalization Antibiotics Chloramphenicol Ampicillin Ceftriaxone

Typhoid fever, also known as enteric fever, is a potentially fatal multisystemic illness caused primarily by Salmonella typhi. The protean manifestations of typhoid fever make this disease a true diagnostic challenge. The classic presentation includes fever, malaise, diffuse abdominal pain, and constipation. Untreated, typhoid fever is a grueling illness that may progress to delirium, obtundation, intestinal hemorrhage, bowel perforation, and death within one month of onset. Survivors may be left with long-term or permanent neuropsychiatric complications. S typhi has been a major human pathogen for thousands of years, thriving in conditions of poor sanitation, crowding, and social chaos. It may have responsible for the Great Plague of Athens at the end of the Pelopennesian War.[1] The name S typhi is derived from the ancient Greek typhos, an ethereal smoke or cloud that was believed to cause disease and madness. In the advanced stages of typhoid fever, the patient's level of consciousness is truly clouded. Although antibiotics have markedly reduced the frequency of typhoid fever in the developed world, it remains endemic in developing countries.[2]

Transmission

S typhi has no nonhuman vectors. The following are modes of transmission:

Oral transmission via food or beverages handled by an individual who chronically sheds the bacteria through stool or, less commonly, urine Hand-to-mouth transmission after using a contaminated toilet and neglecting hand hygiene Oral transmission via sewage-contaminated water or shellfish (especially in the developing world)[3]

An inoculum as small as 100,000 organisms causes infection in more than 50% of healthy volunteers.[4]

Pathophysiology
All pathogenic Salmonella species are engulfed by phagocytic cells, which then pass them through the mucosa and present them to the macrophages in the lamina propria. Nontyphoidal salmonellae are phagocytized throughout the distal ileum and colon. With toll-like receptor (TLR)5 and TLR-4/MD2/CD-14 complex, macrophages recognize pathogen-associated molecular patterns (PAMPs) such as flagella and lipopolysaccharides. Macrophages and intestinal epithelial cells then attract T cells and neutrophils with interleukin 8 (IL-8), causing inflammation and suppressing the infection.[5, 6] In contrast to the nontyphoidal salmonellae, S typhi enters the host's system primarily through the distal ileum. S typhi has specialized fimbriae that adhere to the epithelium over clusters of lymphoid tissue in the ileum (Peyer patches), the main relay point for macrophages traveling from the gut into the lymphatic system. S typhi has a Vi capsular antigen that masks PAMPs, avoiding neutrophil-based inflammation. The bacteria then induce their host macrophages to attract more macrophages.[5] It co-opts the macrophages' cellular machinery for their own reproduction[7] as it is carried through the mesenteric lymph nodes to the thoracic duct and the lymphatics and then through to the reticuloendothelial tissues of the liver, spleen, bone marrow, and lymph nodes. Once there, the S typhi bacteria pause and continue to multiply until some critical density is reached. Afterward, the bacteria induce macrophage apoptosis, breaking out into the bloodstream to invade the rest of the body.[6] The gallbladder is then infected via either bacteremia or direct extension of S typhi infected bile. The result is that the organism re-enters the gastrointestinal tract in the bile and reinfects Peyer patches. Bacteria that do not reinfect the host are typically shed in the stool and are then available to infect other hosts.[6, 2]

Widal test is an agglutination test for the detection of agglutinins (antibodies) for H and O antigen for salmonella in patients with enteric fever. Procedure: Serial dilutions of the patients serum is taken from 1:10 to 1:640. To each equal volumes of Salmonella antigens are added. The tubes are incubated overnight and read.

Result: The highest dilution of the patients serum in which agglutinations occurs is noted, ex. if the dilution is 1 in 160 then the titer is 169. A single test of O titer of 1:100 or more and of H titer of 1:200 or more is significant. A rising titer of four fold or higher in an interval of 7 - 10 days is more meaningful than one test. Cautionary factors: In endemic areas, low titer of agglutinins is present in the serum of normal persons. Immunisation with TAB vaccine will show high titres of antibodies to S. typhi, S. paratyphi A and B. (in an infection there will be rise in only one type of antibodies) Person who have had past enteric infections or immunisations may develop anamestic reaction during unreleated fever like malaria. There is only a transient rise. Bacterial antigens used may contain fimbrial antigens which give false positive results. Cases treated early with chloramphenicol show poor antibody response. Test maybe positive in carriers