Typhoid and paratyphoid Fevers
These are caused by infections with salmonella typhoid and paratyphoid which are specific pathogens for man.
The organisms gain access to the body through ingestion of contaminated food, water and milk. Man is the only true reservoir of the organisms. Incubation period is 5-15 days.
After ingestion the organisms reach the small intestine, pass through the peyer’s patches and reach the blood stream through intestinal lymphatics. Bacteraemia results 24-42 hours after ingestion. The other source is through the blood stream. Small number of infected patients may continue to have organisms in the gall bladder and become a chronic carrier.
After secondary bacteraemia the bacilli localize in the peyer’s patces which become inflamed and ulcerative.
Insidious onset with fever rising in step-ladder pattern during the first week.
This may be sudden in children with chill. Malaise. Increasing headache. Drowsiness.
Constipation and vague abdominal discomfort. Relative bradycardia are common. During the first week.
During the second week temperature becomes continuous or remittent. Occasionally the patient may develop signs of meningism.
Severe cases may develop typhoid state charseterized by cloudiness of sensorium, coma,
Muttering delirium, picking of bedclothes.
Rose-spots appear characteristically between umbilicus and the nipples, during the sixth to twelfth day in crops of two to four, lasting for 2-4 days.
During the third week, the condition gradually improves and defervescence starts unless complicated by haemorrhage or perforation. Blood cultue is positive during the first week
and may remain so for a variable period.
Newer diagnostic methods include indirect haemagglutination and ELISA.
Widal test:
Rising titre is characteristic. Rise of H antibody titre to salmonella typhi, Para A.B.C indicates previous inoculations. Rise of S. typhi antibody alone suggest typhoid infection. The presence of O antibodies against S. typhi also suggest current infection. Persistence of O antibodies for more than six months and or presence of Vi antibodies suggest a carrier state. and more Doctor here
Treatment :
1. Bed rest during febrile period and for 10-14 days after.
2. Diet. Fluid intake should be sufficient. Diet should be low in roughage. Lime
whey. Chicken and vegetable soup. Egg flip during the febrile stage and then
the patient should have gradually soft rice. boiled fish. Vegetables.
3. Drugs:
(a). Ampicillin 500mg—four times daily or
(b). Amoxycillin 500mg-thrice daily for 14 days or 4-5 days after the temperature is normal.
For cases not responding-
(c). Cotrimoxazole 960mg twice daily or
(d). Ciprofloxacin 500mg twice daily.
