GENERAL AWARENESS OF PATHOLOGY WITH SPECIAL REFERENCE TO TYPHOID DISEASE

Department of Biosciences Maharaja Ranjit Singh College Of Professional Sciences Indore, M.P. In the partial fulfillment of requirement For the award of the degree of Master of Science In Microbiology 2011-2012 Submitted by: Ms.Nivedita Pandey M.Sc. III Semester Microbiology Maharaja Ranjit Singh College Of Professional Sciences Indore, M.P. Guided by: Dr.Bharat Ratnani MBBS DCP Pathologist Gurjar hospital,Indore

PROJECT ON GENERAL AWARENESS OF PATHOLOGY WITH SPECIAL REFERENCE TO TYPHOID DISEASE

Department of Biosciences Maharaja Ranjit Singh College Of Professional Sciences Indore, M.P. In the partial fulfillment of requirement For the award of the degree of Master of Science In Microbiology 2011-2012 Submitted by: Ms.Nivedita Pandey M.Sc. III Semester Microbiology Maharaja Ranjit Singh College Of Professional Sciences Indore, M.P. Guided by: Dr.Bharat Ratnani MBBS DCP Pathologist Gurjar hospital,Indore

CERTIFICATE
This to certify that Miss Nivedita Pandey Msc. Micrbiology III semester has undergone training at Gurjar Hospital.The present project report entitled General awareness of pathology labs with special reference to typhoid disease is her authentic work under my guidance after completion of her internship.

Dr.Sheetal Bhasin HOD Life science department

DECLARATION OF THE STUDENT

I Nivedita Pandey student of MSc.Microbiology III semester of Maharaja Ranjit Singh College of Professional Sciences state that I have completed the training at Gurjar Hospital from 2oth September to 20th November and project report prepared by me is my personal and authentic work.

Signature:. Name of student: Nivedita Pandey Class:MSc.III Sem Address:-122, Indrapuri pearl hostel Bhawarkua square, Indore (M.P.)

ACKNOWLEDGEMENT

It is obvious that writing a thesis on project work is really a tough task and in this endeavour many people have lent their helping hands for the success in completing it. First of all I want to thanks to Dr.BHARAT RATNANI for giving me permission to complete my internship of two months at their pathology department in GURJAR Hospital.Without whom support and guidance I am unable to complete this well and smoothly.I would like to acknowledge the contribution of and support provided by the Lab Technicians present over there and my friends who always support and help me. I am grateful to our principal sir Dr.N.Anand, Head of the Department Prof.Sheetal Bhasin for preparing me to face such kind of exposure and new kind of experience in the field. I am also thankful to my parents for their blessings,encouragement and permission in completing this internship smoothly.Their moral support,in moments of despair and doubt has given me the necessary backing and confidence. Lastly, I deeply thanks to each and every person for supporting me to complete this report.

Index
1.Aim and profile of the working place 2.Patholgy and its types 3.Sections in pathology lab 4.Instruments which are used in pathology 5.Test kits which are used in pathology 6.Tests generally performed in pathology lab 7.Lab tests 8.Why doctors suggest lab test ? 9.Analysis of lab tests. 10.What do lab tests show? 11.Disease 12.Procedure of Collecting Blood sample from the patient: 13.Typhoid fever 14.Conclusion 15.Reference

PROFILE OF THE WORKING PLACE

An 1S0 9001-2000 Certified Hospital situated in the prime Location A.B. Road, Bhanvarkua, Indore. Gurjar Hospital is committed to bring the Latest advances in medical care within every individual reach. It is Primarily a multi speciality hospital covering every major area of medicine. Specially - Gastroenterology, Trauma and Obst. Gynecology. We perceive it as part of our cause to provide improved healthcare delivery system under one roof. It is having 60 bedded hospital with centrally AC 8 bedded ICU to take care of critically ill patient. PICU & NICU to take care of Pediatric and Neonental patients. Hospital is fully equipped with endoscopy unit. We promise to provide the most comprehensive Diagnostic and Therapeutic GI Endoscopic facility in the city. Hospital is also having 2 major and minor operation theater equipped with latest monitors, c-arm, ventilators compatibLe for ailtypes of major surgeries. ERCP facility and laparoscopic surgery for GI & Gynecology. Fully equipped Orthopedic & Trauma Center. Well equipped Path Labs, X-Ray unit, Sonography round the clock.

ABOUT THE DIRECTOR Dr. C.L. Gurjar passed his MS in 1985 from MGM Medical College, Indore; he is an accomplished surgeon with a wide-ranging experience. After his MS, he worked with Dr. Shrikhande [Bombay Hospital, Bombay]. He took extensive training in diagnostic and therapeutic endoscopy in ENGLAND and GERMANY. During his tenure as a STEP fellow at Goodhope Hospital Birmingham [England] He worked with Dr. Bearn a renowned endoscopic surgeon. He has received training in Laparoscopic surgery from Sir Gangaram Hospital, Delhi. He received training in advanced Laparoscopic surgery with Dr. Palanivellu from Coimbtore. He has received training in Laparoscopic surgery from Apollo Hospital, Hyderabad and worked with Dr. Ravindra Nath, a noted Laparoscopic surgeon of India. At present he is Director of Gurjar Hospital & Endoscopy Center Pvt. Ltd., Indore

INTRODUCTION
In medicine, pathology is the study and diagnosis of disease. The related scientific study of disease processes is called "general pathology". Medical pathology is divided into two main branches, anatomical pathology and clinical pathology. Medical pathologists work through examination of organs, tissues,bodily fluids, and whole bodies The term "pathology" has a broader meaning in the sciences to refer to the study of disease, not specifically in the domain of biology. For example in psychology, the term "psychopathology", or General pathology, also called investigative pathology, experimental pathology, or theoretical pathology,is a broad and complex scientific field which seeks to understand the mechanisms of injury to cells and tissues, as well as the body's means of responding to and repairing injury. Areas of study include cellular adaptation to injury, necrosis, inflammation, wound healing, and neoplasia. It forms the foundation of pathology, the application of this knowledge to diagnose diseases in humans and animals. Anatomical pathology (Commonwealth) or anatomic pathology is a medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, chemical, immunologic and molecular examination of organs, tissues, and whole bodies (autopsy). Anatomical pathology is itself divided in subspecialties, the main ones being surgical pathology, cytopathology, and forensic pathology. To be licensed to practice pathology, one has to complete medical school and secure a license to practice medicine.

Anatomical pathology is one of two branches of pathology, the other being clinical pathology, the diagnosis of disease through the laboratory analysis of bodily fluids and tissues. Often, pathologists practice both anatomical and clinical pathology, a combination known as general pathology. The distinction between anatomic and clinical pathology is increasingly blurred by the introduction of technologies that require new expertise and the need to provide patients and referring physicians with integrated diagnostic reports. Similar specialties exist in veterinary pathology

Types of pathology:

1.Clinical pathology 2.Dermatopathology 3.Forensic pathology 4.Veterinary pathology 5.Psycho pathology 6.Plant pathology 7.Molecular pathology

Clinical pathology Clinical pathology is a medical specialty that is concerned with the diagnosis of disease based on the laboratory analysis of bodily fluids such as blood and urine, and tissues using the tools of chemistry, microbiology, hematology and molecular pathology. Clinical pathologists work in close collaboration with medical technologists hospital administrations and referring physicians to ensure the accuracy and optimal utilization of laboratory testing.

Dermatopathology Dermatopathology is a subspecialty of anatomic pathology that focuses on the skin as an organ. It is unique in that there are two routes which a physician can use to obtain this specialization. All general pathologists and general dermatologists are trained in the pathology of the skin; however, the dermatopathologist is a specialist in this organ

Forensic pathology Forensic pathology is a branch of pathology concerned with determining the cause of death by examination of a cadaver. The autopsy is performed by the pathologist at the request of a coroner usually during the investigation of criminal law cases and civil law cases in some jurisdictions Forensic pathologists are also frequently asked to confirm the identity of a cadaver. Veterinary pathology Veterinary pathologists are doctors of veterinary medicine who specialize in the diagnosis of diseases through the examination of animal tissue and body fluids. As with medical pathology, veterinary pathology is divided in two branches, anatomical pathology and clinical pathology. Veterinary pathologists are critical participants in the drug development process. Psychopathology In psychology and psychiatry, psychopathology is the study of mental illness, mental distress and abnormal, maladaptive behavior. The term is most commonly used within psychiatry where pathology refers to disease processes. Abnormal psychology is a similar term used more frequently in the non-medical field of psychology

Plant pathology

Powdery mildew a biotrophic fungus Plant pathology (also phytopathology) is the scientific study of plant diseases caused by pathogens (infectious diseases) and environmental conditions (physiological factors). Organisms that cause infectious disease include fungi, oomycetes, bacteria, viruses, viroids, virus-like organisms, phytoplasmas, protozoa, nematodes and parasitic plants. Not included are insects, mites, vertebrate or other pests that affect plant health by consumption of plant tissues. Plant pathology also involves the study of pathogen identification, disease etiology, disease cycles, economic impact, plant disease epidemiology, plant disease resistance, how plant diseases affect humans and animals, pathosystem genetics, and management of plant diseases Molecular pathology Molecular pathology is an emerging discipline within pathology, and focuses in the study and diagnosis of disease through the examination of molecules within organs, tissues or bodily fluids. Molecular pathology shares some aspects of practice with both anatomic pathology and clinical pathology, molecular biology, biochemistry, proteomics and genetics, and is sometimes considered a "crossover" discipline. It is multi-disciplinary in nature and focuses mainly on the sub-microscopic aspects of disease and unknown illnesses with strange causes.

PATHOLOGIST
Pathologists are doctors who diagnose and characterize disease in living patients by examining biopsies or bodily fluids. In addition, pathologists interpret medical laboratory tests to help prevent illness or monitor a chronic condition.

The vast majority of cancer diagnoses are made by pathologists. Pathologists examine tissue biopsies to determine if they are benign or cancerous. Some pathologists specialize in genetic testing that can, for example, determine the most appropriate treatment for particular types of cancer. In addition, a pathologist analyzes blood samples from a patient's annual physical and alerts their primary care physician to any changes in their health early, when successful treatment is most likely. Pathologists also review results of tests ordered or performed by specialists, such as blood tests ordered by a cardiologist, a biopsy of a skin lesion removed by a dermatologist, or a Pap test performed by a gynecologist, to detect abnormalities.Pathologists work with other doctors, medical specialty societies, medical laboratory professionals, and health care consumer organizations to set guidelines and standards for medical laboratory testing that help improve a patient's medical care and guide treatment, as well as ensure the quality and safety of domestic and international medical laboratories.Pathologists may also conduct autopsies to investigate causes of death. Autopsy results can aid living patients by revealing a hereditary disease unknown to a patient's family. Pathology is a core discipline of medical school and many pathologists are also teachers. As managers of medical laboratories(which include chemistry, microbiology, cytology, the blood bank, etc.), pathologists play an important role in the development of laboratory information systems. Although the medical practice of pathology grew out of the tradition of investigative pathology, most modern pathologists do not perform original research.Pathology is a unique medical specialty. Pathology touches all of medicine, as diagnosis is the foundation of all patient care. In fact, more than 70 percent of all decisions about diagnosis and treatment, hospital admission, and discharge rest on medical test results.Pathologists play a critical role on the patient care team, working with other doctors to treat patients and guide care. To be licensed, candidates must complete medical training, an approved residency program, and be certified by an appropriate body. In the US, certification is by the American Board of Pathology or the American Osteopathic Board of Pathology. The organization of subspecialties within pathology varies between nations, but usually includes anatomic pathology and clinical pathology.

Lab Technician:- He or She is the person who done diploma in lab techniques and skilled in
handling all the instruments and able to perform all the tests which has been performed in pathology lab.He is also trained in taking sample i.e. blood etc. from the patient.

Sections in pathology lab

1. Sample collection department (Phlebectomy)

2. Haematology.

3. Immuno Hematology . 4. Clinical Biochemistry.

5. Clinical Pathology.

6. Serology or Immunology.

7. Histology and Cytology.

8. Microbiology.

9. Blood Bank

1.Collection department:- Here lab technicians are present who will collect the samples of the patient like blood ,pus,csf fluid, pleural fluid,stool,urine,etc. in sample containers like EDTA tubes,Vaccum plane tubes, Sodium citrate tubes to put blood samples in it .Culture tubes(sterilize),etc.Disposable injections, spirit soap and using tunicate for taking blood of patient. 2.Haematology:-In this section we study about the blood cells,blood forming tissues and their diseases.for this section we use the samples present in EDTA tubes.Some tests which is performed here are as Complete blood cell count,Erythrocytes sedimentation coefficient rate,Malaria parasite test by making the smear on the slide of blood etc. 3.Immunohaematology:-In this we study the compatibility of the blood and blood group to donate some one else. 4.Clinical Biochemistry:-In this we study about the body fluids like serum, plasma,urine,semen chemical analysis of it.Micro-organisms related to heart,kidney,liver,pancreas disease diagnosis by using electrolyte analyser,biochemical analyser etc. 5.Clinical Pathology:-In this we study or perform the microscopic examinations of urine,stool,CSF fluid,semen examination for kidney, meningitis,reproductive ability,worms infestation etc diagnosis. 6.Microbiology:-In this we study about the micro-organisms by preparing the slide from the sample obtained from the patient for routine and microscopic examination and by culturing and p performing sensitivity.Here we use glucose broth ,blood agar plates,muller hinton agar plates,mac-conkey agar plates for culture of stool,urine,pleural fluid,pus,blood culture etc. 7.Histology and Cytology:-In this we study about the abnormalities found in tissues under microscope by performing it section cutting through microtome and by using special staining techniques. Cytology:-In this we study the fluids collect from the body by making it smear then study about the cells present in it under the microscope. 8.Serology:-In this we study about the antibodies present in the serum due to some diseases or else.To obtain the serum we have to centrifuge the blood sample present in plain tubes and sodium citrate tubes sample. 9.Blood Bank:-In this section we have to perform screening tests to collect and donate the blood,plasma,and platelets to the needy patient to save his or her life.Screening includes mainly these tests which are as blood group,HIV,HCV,Syphillis,Hepatitis B,Haemogram,Blood pressure,Body weight etc.

INSTRUMENTS WHICH ARE USED THERE

1.Centrifuge
2.Automated complete cell counter 3.Semi automated biochemical analyser 4.Fully automated biochemical analyser 5.Electrolyte analyser 6.Axsym for thyroid screening 7.Platelet agitator with incubator 8.ESR 9.Incubator 10.Microtome 11.Hot plate 12.Water bath 13.Elisa reader 14.Blood storage cabinet 15.Thawing water bath 16.Quick freezer

Axsym for thyroid screening

Platelet agitator with incubator

Autoclave

Hot plate

Elisa reader

Blood collection and weighing

TEST KITS WHICH ARE USED THERE 1.ASO Titre kit 2.HIV Microlisa kit 3.Hepatitis B 4.Hepatitis C 5.Blood grouping 6.Latex agglutination kit 7.Malaria reagent kit 8.Stained salmonella antigen test 9.Dengue IgG/IgM 10.Bilirubin direct kit 11.Field stain kit 12.Grams stain kit 13.Acid fast stain kit 14.Glycosylated haemoglobin kit 15.HCV microlisa kit 16.Haemtest kit 17.Syphilis kit 18.Reticview stain kit 19. Alpha amylase kit 20. Lipase kit

TESTS GENERALLY PERFORMED IN PATHOLOGY LAB Absolute eosinophil count Activated Partial Thromboplastin Time (aPTT) Anti D Titre Bleeding Time Blood Group and Rh typing Clotting Time Complete Blood Count (CBC) Coombs, Direct Coombs, Indirect D Dimer, Latex Agglutination Erythrocyte Sedimentation Rate (ESR) Ferritin Fibrinogen Fibrinogen Degradation Products D Dimer Foetal Haemoglobin Glucose 6 Phosphate Dehydrogenase (G6PD) Glycosylated Haemoglobin Haemoglobin & PCV Haemoglobin (Hb) Iron Iron - binding capacity, Total (TIBC) L E Cell Malaria, Rapid Test

Malarial Parasite Microfilaria Platelet Count Rapid Malaria Antigen Test Reticulocyte Count Sickling Test Transferrin Saturation BIOCHEMISTRY Acetone, serum quantitative Acetone, urine qualitative Acid phosphatase, prostatic Acid phosphatase, total Adenosine Deaminase Alanine aminotransferase ALT (SGPT) Albumin Albumin/Globulin Ratio Alkaline phosphatase Ammonia Amylase Aspartate aminotransferase AST (SGOT) Bilirubin, Direct Bilirubin, Total Bilirubin, Total, Direct, Indirect Blood Urea Nitrogen (BUN)

Calcium Chloride Cholesterol Cholesterol HDL CK-MB CK-NAC Cortisol Creatinine Creatinine Clearance, 24 hours Electrolytes Gamma Glutamyl Transferase (GGT) Globulin Glucose - Fasting Glucose - Fasting & Post prandial Glucose - Post prandial Glucose - Random Glucose Tolerance Test Lactate Dehydrogenase Lipid Profile Liver Function Tests Mantoux Test Microalbumin, urine Phosphorous Potassium Prostate Specific Antigen

Protein ,Total Protein Electrophoresis Troponin I, Rapid Test Triglycerides Urea Uric acid HORMONES 17 Alpha hydroxyprogesterone Androstenedione Cortisol DHEA-S Di hydrotestosterone Estradiol, E2 Follicle Stimulating Hormone Lutenising Hormone Prolactin Sex Hormone Binding Globulin (SHBG) T3, Total T4, Total Testosterone Thyroid Profile

Thyroid Stimulating Hormone

MICROBIOLOGY / SEROLOGY Acid Fast Bacilli Stain (AFB) Anti Nuclear Antibody (ANA) ASO Titre Australia Antigen Beta hCG Culture & Antibiotic Sensitivity Culture, Body Fluid Culture, Urine Culture, Blood Culture, Stool CLINICAL PATHOLOGY Asctic Fluid Analysis Bence Jones Protein (Urine) Bile Salts and Bile Pigments, urine Cerebrospinal Fluid Analysis Fructose, Semen Ketone, urine Lactose, urine Occult Blood, Stool pH, urine Pleural Fluid Analysis Pregnancy Test Semen Analysis

Stool Examination Synovial Fluid Analysis Urinalysi HISTOPATHOLOGY Biopsy of any part of our body like: Tissues Cells Organ

What are lab tests?

Laboratory tests are medical procedures that involve testing samples of blood, urine, or other tissues or substances in the body. Why doctors suggest lab test ?

Your doctor uses laboratory tests to help:

identify changes in your health condition before any symptoms occur diagnose a disease or condition before you have symptoms plan your treatment for a disease or condition, evaluate your response to a treatment, or monitor the course of a disease over time.

How are lab tests analyzed?

After a blood sample is collected from your body, it is analyzed in a laboratory. Laboratories perform tests on the sample to see if it reacts to different substances. Depending on the test, a reaction may mean you do have a particular condition or it may mean that you do not have the particular condition. Sometimes laboratories compare your results to results obtained from previous tests, to see if there has been a change in your condition.

What do lab tests show? Lab tests show whether or not your results fall within normal ranges. Normal test values are usually given as a range, rather than as a specific number, because normal values vary from person to person. What is normal for one person may not be normal for another person.

What factors affect your lab test results?

Disease:- It may be defined as `a disorder in the proper functioning of the body organs. Causes of disease:1. 2. 3. 4. 5. 6. Biological agents or pathogens: such as bacteria, viruses, fungi, protozoans, mycoplasma. Chemical agents: urea, uric acid, tobacco, pollutants, industrial wastes, pollens, spores etc. Physical agents: heat, cold, humidity, electricity, etc. Mechanical agents: chronic infections, injuries trauma, dislocations, fractures, etc. Nutrient agents deficiency: carbohydrates, minerals, protiens, fats, and vitamins. Other factors: such as harmones, enzymes, etc

Reservoir of Infections 1. Vectors or carriers: through which the pathogen transfer from infected to healthy person 2. such as plasmodium in Female anopheles. 3. Air: It serve as reservoir of viruses of measeles, mumps, bacterial cysts, etc 4. Soil: reservoir of tetanus causing bacteria . 5. Food and Water: reservoir of polio virus, helminthes, etc

Modes of Transmission 1. Direct transmission:which includes contact between infected and healthy person. Bite of animal, droplet infection by talking, spitting, sneezing, and coughing, etc.

2. Indirect transmission:includes by dirty hands and fingers, vehicle borne like ice,water, food. Air borne i.e. by wind current, dust and aerosol sprays.Formite bornes like through contaiminated garments,crockery,soap,syringe,needle.

Factors influencing infection: 1. The virulence of the organisms: It depends on the ability of the organism to invade the host. 2. Number of invading organinsm:a person whose body is invaded by large no.of micro organisms is likely to be infected by disease. 3. The resistance of body to the disease: If the resistance of the body is lower than micro organism can easily grow there. 4. Immunity:when the person is vaccinated or inoculated against a disease he has higherdegree of Immunity than a non treated person.

Classification of diseases: broadly classified into two categories are as 1. Congenital disease: which are present since birth and caused due to metabolic disorder by defective Development or by genetic disorders which may be due to presence of abnormal gene or abnormal Number or structure of chromosomes and are heritable, eg. Diabetes, haemophilia, etc 2. Acquired diseases: which are acquired by the individuals any time after birth. It may be of both type ie.communicable and non communicable disease.

Disease caused by bacteria: Name of disease 1.Tuberculosis 2. Leprosy 3. Typhoid 4. Diphtheria 5. Tetanus 6. Plague Causing agent Mycobacterium tuberculosis Mycobacterium Leprae Salmonella typhi Corynebacterium Diptheriae Clostridium tetani Rodents (rats) Incubation period 2-10 weeks up to 5 years 1-3 weeks 2-6 days 3-21 days 2-6 days

Disease caused by viruses 1.Poliomyelitis 2.Chicken pox 3.Measeles Enterovirus Varicella or Herpes zoster Rebeola virus 7-14 days 12 days 12-14 days

Disease caused by Protozoans 1.Malaria a)Quarten severe malaria caused by plasmodium malariae Incubation period: 28-30 days b)Beningn tertiary malaria caused by plasmodium vivax Incubation period: 13-15 days 2.Amoebiasis: caused by Entamoeba histolytica

Disease caused by Helminthes 1.Taeniasis: caused by taenia solium 2.Ascariasis: caused by Ascaris lumbricoides 3. Filariasis: caused by Waucheria bancrofti

Sexually transmitted disease 1.AIDS: caused by Human deficiency syndrome 2.Non-gonococcal urethritis: caused by Neisseria gonorrhea

Disease transmitted through blood transfusion: 1. Hepatitis A 2. Hepatitis B 3. Malaria 4. Syphilis 5. AIDS

Procedure of Collecting Blood sample from the patient: 1.First told the patient to sit there and see the advice written in form. 2.Then tie the tunicate in the patient hand at above elbow joints. 3.After it touch and feel the vien if not easily seen. 4.Then wipe the area from where you put the syringe. 5.Take the disposable 5 ml syringe and put it into the vien . 6.Inject out the blood untie the tunicate immediate. 7.put the spirit soap upon the prick area and put off the syringe. 8.After it put the blood sample in Vaccutainer.

Vaccutainer are of three types: 1.Plane vaccum tubes. 2.EDTA- tubes 3.Sodium citrate tubes

Urine and stool sample container are of two types: 1.Non-sterilized 2.Sterilized

For Pus culture , Pleural fluid and CSF fluid 1.Sterilized disposable swab tubes 2.Disposable injections

Syringes which are used : 1.Syringe of 5 m 2.Syringe of 1 ml 3.Pricking needle

Typhoid & Paratyphoid Fever

Infectious agent
Typhoid fever is an acute, life-threatening febrile illness caused by the bacterium Salmonella enterica serotype Typhi. Paratyphoid fever is a similar illness caused by S. Paratyphi A, B, or C.

Mode of transmission
Humans are the only source of these bacteria; no animal or environmental reservoirs have been identified. Typhoid and paratyphoid fever are most often acquired through consumption of water or food that has been contaminated by feces of an acutely infected or convalescent person or a chronic, asymptomatic carrier. Transmission through sexual contact, especially among men who have sex with men, has rarely been documented.

Epidemology
An estimated 22 million cases of typhoid fever and 200,000 related deaths occur worldwide each year; an additional 6 million cases of paratyphoid fever are estimated to occur annually. Approximately 300 cases of typhoid fever and 150 cases of paratyphoid fever are reported each year in the United States, most of which are in recent travelers. The risk of typhoid fever is highest for travelers to southern Asia (630 times higher than for all other destinations). Other areas of risk include East and Southeast Asia, Africa, the Caribbean, and Central and South America. The risk of paratyphoid fever is also increasing among travelers to southern and Southeast Asia. Travelers to southern Asia are at highest risk for infections that are nalidixic acidresistant or multidrug-resistant (resistant to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole). Travelers who are visiting friends and relatives (VFRs) are at increased risk Although the risk of acquiring typhoid or paratyphoid fever increases with the duration of stay, travelers have acquired typhoid fever even during visits <1 week to countries where the disease is endemic.

Clinical Presentation
The incubation period of typhoid and paratyphoid infections is 630 days. The onset of illness is insidious, with gradually increasing fatigue and a fever that increases daily from low-grade to as high as 102F104F (38C 40C) by the third to fourth day of illness. Headache, malaise, and anorexia are nearly universal. Hepatosplenomegaly can often be detected. A transient, macular rash of rose-colored spots can occasionally be seen on the trunk. Fever is commonly lowest in the morning, reaching a peak in late afternoon or evening.

Untreated, the disease can last for a month. The serious complications of typhoid fever generally occur after 23 weeks of illness and may include intestinal hemorrhage or perforation, which can be life threatening.

Diagnosis
Infection with typhoid or paratyphoid fever results in a very low-grade septicemia. A single blood culture is positive in only half the cases. Stool culture is not usually positive during the acute phase of the disease. Bone marrow culture increases the diagnostic yield to about 80% of cases. The Widal test is an old serologic assay for detecting IgM and IgG to the O and H antigens of salmonella. The test is unreliable but is widely used in developing countries because of its low cost. Newer serologic assays are somewhat more sensitive and specific than the Widal test but are infrequently available. Because there is no definitive serologic test for typhoid or paratyphoid fever, the diagnosis often has to be made clinically. The combination of a history of risk for infection and a gradual onset of fever that increases in severity over several days should raise suspicion of typhoid or paratyphoid fever.

Treatment
Specific antimicrobial therapy shortens the clinical course of typhoid fever and reduces the risk for death. Empiric treatment in most parts of the world would use a fluoroquinolone, most often ciprofloxacin. However, resistance to fluoroquinolones is highest in the Indian subcontinent and increasing in other areas. Injectable third-generation cephalosporins are often the empiric drug of choice when the possibility of fluoroquinolone resistance is high. Patients treated with an appropriate antibiotic may still require 35 days to defervesce completely, although the height of the fever decreases each day. Patients may actually feel worse when the fever starts to go away. If fever does not subside within 5 days, alternative antimicrobial agents or other foci of infection should be considered.

PREVENTIVE MEASURES FOR TRAVELERS Vaccine

Indications for Use CDC recommends typhoid vaccine for travelers to areas where there is an increased risk of exposure to S.Typhi. The typhoid vaccines do not protect against S. Paratyphi infection. Both typhoid vaccines protect 50%80% of recipients; travelers should be reminded that typhoid immunization is not 100% effective, and typhoid fever could still occur.

Vaccine Administration
The table below provides information on vaccine dosage, administration, and revaccination. The time required for primary vaccination differs for the 2 vaccines, as do the lower age limits. Primary vaccination with oral Ty21a vaccine consists of 4 capsules, 1 taken every other day. The capsules should be kept refrigerated (not frozen), and all 4 doses must be taken to achieve maximum efficacy. Each capsule should be taken with cool liquid no warmer than 98.6F (37C), approximately 1 hour before a meal. This regimen should be completed 1 week before potential exposure. The vaccine manufacturer recommends that Ty21a not be administered to infants or children aged <6 years. Primary vaccination with ViCPS consists of one 0.5-mL (25-mg) dose administered intramuscularly. One dose of this vaccine should be given 2 weeks before expected exposure. The manufacturer does not recommend the vaccine for infants and children aged <2 years.

Vaccine Safety and Adverse Reactions

Adverse reactions to Ty21a vaccine are rare and mainly consist of abdominal discomfort, nausea, vomiting, and rash. ViCPS vaccine is most often associated with headache (16%20%) and injection-site reactions (7%). No information is available on the safety of these vaccines in pregnancy; it is prudent on theoretical grounds to avoid vaccinating pregnant women. Live, attenuated Ty21a vaccine should not be given to immunocompromised travelers, including those infected with HIV. The intramuscular vaccine presents a theoretically safer alternative for this group. The only contraindication to vaccination with ViCPS vaccine is a history of severe local or systemic reactions after a previous dose. Neither of the available vaccines should be given to people with an acute febrile illness.

Precautions and Contraindications

Theoretical concerns have been raised about the immunogenicity of live, attenuated Ty21a vaccine in people concurrently receiving antimicrobials (including antimalarial chemoprophylaxis), viral vaccines, or immune globulin. The growth of the live Ty21a strain is inhibited in vitro by various antibacterial agents, and vaccination with Ty21a should be delayed for >72 hours after the administration of any antibacterial agent. Available data do not suggest that simultaneous administration of oral polio or yellow fever vaccine decreases the immunogenicity of Ty21a. If typhoid vaccination is warranted, it should not be delayed because of administration of viral vaccines. Simultaneous administration of Ty21a and immune globulin does not appear to pose a problem.

Table : Dosage and schedule for typhoid fever vaccination

VACCINATION

AGE (y)

DOSE/MODE OF ADMINISTRATION

NUMBER OF DOSES

DOSING INTERVAL

BOOSTING INTERVAL

Oral, Live, Attenuated Ty21a Vaccine (Vivotif)1 Primary series Booster 6 1 capsule,2 oral 1 capsule,2 oral 4 48 hours Not applicable Every years 5

48 hours

Vi Capsular Polysaccharide Vaccine (Typhim Vi) Primary series Booster 2 0.50 mL, intramuscular 0.50 mL, intramuscula 1 Not applicable Not applicable

Typhoid fever according to WORLD HEALTH ORGANISATION(WHO)

Typhoid fever is a bacterial disease, caused by Salmonella typhi. It is transmitted through the ingestion of food or drink contaminated by the faeces or urine of infected people. Symptoms usually develop 13 weeks after exposure, and may be mild or severe. They include high fever, malaise, headache, constipation or diarrhoea, rose-coloured spots on the chest, and enlarged spleen and liver. Healthy carrier state may follow acute illness. Typhoid fever can be treated with antibiotics. However, resistance to common antimicrobials is widespread.

CONCLUSION
A successful project is a masterpiece of co-ordinated effort. It is about mastering paradox and managing trade-offs, activities that require a particular mindset, skill set and attitude. We all are good at discovering at a particular hindsight,but why projects go wrong. Were less adapted at preventing them from going wrong in the future. Thus ultimately such project enhance our personality. In pathology lab I was friendly with each and everything like operating instrument to diagnosis of diseases with each criteria.

REFERENCES
1.Anant narayan and panicker 2.Wikipedia 3.Robbins,Stanley(2010). Robbins and Cortron pathologic basis of disease(8th ed). 4.Agrios,George N(1997) Plant Pathology(4th edition)New York Academic Press. 5.Easman C(2005-04-01) Typhoid fever and Paratyphoid fever. 6.Medline Plus Encyclopedia typhoid fever 7.Barons medical microbiology(Baron S et al,eds) (4th edition),university of texas. 8.http://www.cdc.gov/ncidod/dbmd/diseaseinfo/Typhoid fever_g.htm 9.Oxford English dictionary,typhoid adjective and n.and typhus,n.Online version March 2011.

RESULT

In a pathology lab several kinds of tests are being performed to diagnose,study and cure various kinds of diseases. Pathology addresses 4 components of disease:i)cause/etiology ii)mechanism of development(pathogenesis) iii)structural alteration of cells(morphologic changes) iv)consequence of changes(clinical manifestation) I have performed tests generally pertaining to typhoid because those cases were quite prevalent during my internship period.So mostly I performed widal test.