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commonly seen in countries with poor sanitary conditions and contaminated water supplies.
Most of the cases are acquired during foreign travel to
underdeveloped countries.
CAUSES
It is caused by infection with Salmonella typhi
a bacteria found in infected animals and transmitted to persons in contaminated food or fluids. It is most often found in countries with poor sanitary conditions or contaminated water supplies. Boiling water and thoroughly cooking food can kill the microorganism. The infection can also be spread asymptomatic carriers. These are people who have the bacteria in their gastrointestinal tract, but do not have symptoms.
TYPES:
Systemic bacterial infection (Enteric Fever)
1.Salmonella typhi (Typhoid fever)
Most common and more severe form
Transmission
Ingestion of contaminated food
Typhoid germs are passed in the feces and, to some extent, the
Epidemiology: Incidence
World: 17 million cases per year U.S.: 400 cases per year (70% in travelers) PHILIPPINES
(Nov 2006) 478 in Agusan del Sur. (May 2004) 292 in Bacolod City
Symptoms:
Incubation (first 7-14 days after ingestion) Usually asymptomatic Diarrhea may occur Active infection Severe Headache Generalized Abdominal Pain Anorexia Constipation more common than Diarrhea Fever [usually higher in the evening]
Intermittent Fever initially Sustained Fever to high temperatures later
COMPLICATIONS
Severe intestinal bleeding Perforation of the intestine Peritonitis Pneumonia Cho cystitis UTI Typhoid psychosis Kidney failure Relapse Death
Signs:
Pulse-Temperature Dissociation (uncommon)
Rose Spots (Pathognomonic, present in 25% of cases)
Blanching pink macular spots 2-3 mm over trunk
For how long can an infected person carry the typhoid germ?
The carrier stage varies from a number of days to years.
Only about 3% of cases go on to become lifelong carriers of
Laboratory Exam
Blood Culture Best Test Sensitivity in first week Bone Marrow culture Higher sensitivity than Blood Culture Fecal culture Low sensitivity (~33%) Salmonella serology (Widal's Test) Poor Test Specificity Low Test Sensitivity (70%)
TREATMENT
Non-pharmacologic
Drinking fluids- it helps prevent the dehydration that
results from a prolonged fever and diarrhea. Eating a healthy diet. Nonbulky high-calorie meals-can help replace the nutrients you lose when you're sick.
TREATMENT
Pharmacologic ORS(Oral Rehydration Salts) - Hydrite Chloramphenicol Drug of Choice -Chloro-V, Penachlor & Iclodex Others : Amoxicillin, Cephalosphorins, Flouroquinolones and Trimethoprim-Sulfamethoxazole
Prevention
Choose foods processed for safety Prepare food carefully Foods prepared by others (avoid if possible) Keep food contact surfaces clean (3 wash cycle) Eat cooked food as soon as possible Maintain clean hands Steam or boil shellfish at least 10 minutes All milk and dairy products should be pasteurized Control fly populations
Vaccines
Typhim Vi Vivotif Berna
live but weakened strain of the Salmonella bacteria that causes typhoid fever. This typhoid vaccine is taken by mouth.
Mary Mallon
(September 23, 1869 November 11, 1938)
Also known as Typhoid Mary was the first person in the United States to be identified as a healthy carrier of typhoid fever.
She seemed a healthy woman when a health inspector knocked on her door in 1907, yet she was the cause of several typhoid outbreaks.
Since Mary was the first "healthy carrier" of typhoid fever in the United States, she did not understand how someone not sick could spread disease -- so she tried to fight back. She was forcibly quarantined twice by public health authorities and died in quarantine. Over the course of her career as a cook, she infected 47 people, three of whom died from the disease. It was also possible that she was born with the disease, as her mother had typhoid fever during her pregnancy.