伤寒Typoid-Fever.ppt

Typhoid FeverDept.Infectious Disease2nd Affiliated HospitalCMU DefinitionvTyphoid fever is an acute infectious disease of digestive tract caused by typhoid bacillus.vPlace of lesson lymphatics in the terminal ileumvPathological feature proliferation of large mononuclear cells derived from MPS DefinitionvClinical feature sustained fever relative slow pulse toxic symptoms a rose-color rash splenomegaly and hepatomegaly leukopenia vComplication hemorrhage&perforation EtiologyvCausative organism:Typhoid bacillus genus salmonella group DvPathogenicity:endotoxinvResistance:Stable in environment,sensitive to heat,acid,common disinfectants EtiologyvAntigenicity:O antigen:lipopolysaccharide group-specialH antigen:protein,strain-specialVi antigen:polysaccharide EpidemiologyvSource of infection Patient,Carrier,shed bacteria in fecesvRoute of transmission Fecal-oral route:contaminated food or watercontagious spread spread by insectvSusceptibility vEpidemic features sporadic cases high incidence in fall&summer Pathogenesis Bacillus Stomach killed by gastric acid incubation Small intestine penetrate mucosa period Regional lymphatics Blood stream -first bacteremia initial MPS in liver,spleen,bone marrow Blood stream -second bacteremia endotoxin liver spleen regional lymphotics Clinical symptoms absces inflammation Pathology Proliferation of large mononuclear cell 1st week 2nd 3rd week 4th week proliferation necrosis heal edema ulceration no scar Clinical manifestationIncubation period:7-23 day(average 10 to 14 days)Typical typhoid fever:Initial periodFastigiumDefervescenceConvalescenceClinical manifestation Initial periodonset:insidious,gradualfever:T stepwise fashion risingnon-special symptoms:Clinical manifestation Fastigiumsustained fevertoxic symptoms:NS apathy,tinnitus,delirium,lethargy,coma DS anorexia,abdominal Pain,diarrhea Constipation CS relative slow pulse,bradycardia,myocarditisClinical manifestation Fastigiumrose-colored rash:erythematous macules or papules occur on 613 days upper abdomenhepatomegaly and splenomegalyClinical manifestation Devervescence ConvalescenceClinical manifestationvClinical type:Mild typecommon typeprolonged type,ambulatory typefulminate type Clinical manifestation Relapse:It occur 13week after T has reached normal.The illness follows a similar pattern to the primary attach.Blood culture positive.Recurrence:It occur 34 after the illness.T begin to fall,then rise again.Blood culture positive.ComplicationsvIntestinal hemorrhagevIntestinal perforationvToxic hepatitis and myocarditisvPneumonia Laboratory FindingsvBlood picture:leukopenia vBacteria culture:blood bone morrow urine and stoolLaboratory FindingsvWidal test:agglutination of serum reaction 5 Ag:“O”“H”,“HABC”titer:O=1:80 H=1:160 results analysis:DiagnosisvEpidemiological datavClinical manifestationvLaboratory findingsvDefinitive diagnosis:bacteria culture positive Differential DiagnosisvTyphusvrickettsisesvmalariavdisseminated TB TreatmentvGeneral therapyvEtiologic therapyguinolone:first choicecephalosporins:2nd and 3rd generationchloromycetinPreventionvControl of source of infection:isolationvInterruption of route of transmissionvProtection of susceptible population:Vaccinated with vaccine ParatyphoidvParatyphoid A&B are the same as typhoid fevervParatyphoid C:septics or gastro-interitis