Typhoid fever is an acute intestinal infection characterized by a cyclical course with a predominant lesion of the intestinal lymphatic system, accompanied by general intoxication and exanthema. Typhoid fever has an alimentary pathway of infection. The incubation period lasts on average 2 weeks. The typhoid fever clinic is characterized by intoxication syndrome, fever, rashes of small red spots (exanthema), hepatosplenomegaly, in severe cases – hallucinations, lethargy. Typhoid fever is diagnosed when the pathogen is detected in the blood, feces or urine. Serological reactions have only a negative significance.
ICD 10
A01.0 Typhoid fever
General information
Typhoid fever is an acute intestinal infection characterized by a cyclical course with a predominant lesion of the intestinal lymphatic system, accompanied by general intoxication and exanthema.
Characteristics
Typhoid fever is caused by the bacterium Salmonella typhi – a mobile gram-negative rod with many flagella. The typhoid bacillus is able to remain viable in the environment for up to several months, some foods are a favorable environment for its reproduction (milk, cottage cheese, meat, minced meat). Microorganisms easily tolerate freezing, boiling and chemical disinfectants have a detrimental effect on them.
The reservoir and source of typhoid fever is a sick person and a carrier of infection. Already at the end of the incubation period, the release of the pathogen into the environment begins, which continues throughout the entire period of clinical manifestations and sometimes for some time after recovery (acute carrier). In the case of the formation of a chronic carrier, a person can secrete the pathogen throughout his life, presenting the greatest epidemiological danger to others.
The release of the pathogen occurs with urine and feces. The path of infection is water and food. Infection occurs when drinking water from fecal-contaminated sources, food products that are insufficiently treated thermally. Flies carrying microparticles of feces on their paws take part in the spread of typhoid fever. The peak of morbidity is observed in the summer-autumn period.
Typhoid fever symptoms
The incubation period of typhoid fever averages 10-14 days, but can range from 3-25 days. The onset of the disease is more often gradual, but it can also be acute. Gradually developing typhoid fever is manifested by a slow rise in body temperature, reaching high values by day 4-6. Fever is accompanied by increasing intoxication (weakness, bruising, headache and muscle pain, sleep disorders, appetite).
The febrile period is 2-3 weeks, while there are significant fluctuations in body temperature in the daily dynamics. One of the first symptoms developing in the first days is pallor and dryness of the skin. Rashes appear starting from the 8-9 day of the disease, and are small red spots up to 3 mm in diameter, turning pale for a short time when pressed. Rashes persist for 3-5 days, in case of severe course they become hemorrhagic in nature. Throughout the entire period of fever and even in its absence, new rash elements may appear.
During physical examination, there is a thickening of the tongue, on which the inner surfaces of the teeth are clearly imprinted. The tongue in the center and at the root is covered with a white coating. Palpation of the abdomen shows bloating due to intestinal paresis, rumbling in the right ilium. Patients note a tendency to difficulty defecating. From 5-7 days of the disease, there may be an increase in the size of the liver and spleen (hepatosplenomegaly).
The onset of the disease may be accompanied by a cough, with auscultation of the lungs, dry (in some cases wet) wheezing is noted. At the peak of the disease, there is a relative bradycardia with severe fever – a discrepancy in the pulse rate to body temperature. A two-wave pulse (dicrotia) can be recorded. There is a muffling of heart tones, hypotension.
The height of the disease is characterized by an intense increase in symptoms, severe intoxication, toxic damage to the central nervous system (lethargy, delirium, hallucinations). With a decrease in body temperature, patients note a general improvement in their condition. In some cases, soon after the onset of regression of clinical symptoms, fever and intoxication reappear, and a roseolous exanthema appears. This is the so-called exacerbation of typhoid fever.
The relapse of the infection differs in that it develops after a few days, sometimes weeks, after the symptoms subside and the temperature normalizes. The course of relapses is usually lighter, the temperature fluctuates within subfebrile values. Sometimes the clinic of relapse of typhoid fever is limited to aneosinophilia in the general blood test and moderate enlargement of the spleen. The development of relapse is usually preceded by violations of the daily routine, diet, psychological stress, untimely withdrawal of antibiotics.
The abortive form of typhoid fever is characterized by a typical onset of the disease, short-term fever and rapid regression of symptoms. Clinical signs in the erased form are poorly expressed, intoxication is insignificant, the course is short-term.
Complications
Typhoid fever can be complicated by intestinal bleeding (manifested as progressive symptoms of acute hemorrhagic anemia, feces becomes tar-like (melena)). A formidable complication of typhoid fever can be perforation of the intestinal wall and subsequent peritonitis.
In addition, typhoid fever can contribute to the development of pneumonia, thrombophlebitis, cholecystitis, myocarditis, as well as purulent mumps and otitis media. Prolonged bed rest can contribute to the occurrence of bedsores.
Diagnosis
Typhoid fever is diagnosed on the basis of clinical manifestations and epidemiological history and the diagnosis is confirmed by bacteriological and serological studies. Already in the early stages of the disease, it is possible to isolate the pathogen from the blood and sow it on a nutrient medium. The result usually becomes known after 4-5 days.
The feces and urine of the subjects are necessarily subjected to bacteriological examination, and during the convalescence period – the contents of the duodenum taken during duodenal probing. Serological diagnostics is of an auxiliary nature and is performed with the help of iHR. A positive reaction is observed starting from 405 days of the disease, a diagnostically significant antibody titer is 1:160 or more.
Typhoid fever treatment
All patients with typhoid fever are subject to mandatory hospitalization, since a significant factor in successful recovery is quality care. Bed rest is prescribed for the entire feverish period and the 6-7 days following normalization of body temperature. After that, patients are allowed to sit and get up only for 10-12 days of normal temperature. The diet for typhoid fever is high-calorie, easily digestible, mostly semi-liquid (meat broths, soups, steamed cutlets, kefir, cottage cheese, liquid porridges except millet, natural juices, etc.). It is recommended to drink plenty of water (sweet warm tea).
Etiotropic therapy consists in prescribing a course of antibiotics (chloramphenicol, ampicillin). Together with antibiotic therapy, vaccination is often carried out in order to prevent the recurrence of the disease and the formation of bacterial carrier. In case of severe intoxication, detoxification mixtures (colloidal and crystalloid solutions) are prescribed intravenously by infusion. Therapy, if necessary, is supplemented with symptomatic means: cardiovascular, sedative drugs, vitamin complexes. Patients are discharged after full clinical recovery and negative bacteriological tests, but not earlier than 23 days after the normalization of body temperature.
With the current level of medical care, the prognosis for typhoid fever is safe, the disease ends with a complete recovery. Deterioration of the prognosis is noted with the development of life-threatening complications: perforation of the intestinal wall and massive bleeding.
Prevention of typhoid fever
The general prevention of typhoid fever consists in compliance with sanitary and hygienic standards regarding water intake for household use and irrigation of agricultural land, control over the sanitary regime of food industry and catering enterprises, over the conditions of transportation and storage of food products. Individual prevention implies compliance with personal hygiene and food hygiene, thorough washing of raw fruits and vegetables, sufficient heat treatment of meat products, pasteurization of milk.
Employees of enterprises who have contact with food products in the food industry, and other decreed groups are subject to regular examination for the carrier and isolation of the causative agent of typhoid fever, in case of detection of isolation, they are subject to suspension from work until complete bacteriological cure. Quarantine measures are applied to patients: discharge no earlier than 23 days after the fever subsides, after which patients are registered at the dispensary for three months, undergoing a full examination monthly for the carriage of typhoid bacillus. Food industry workers who have had typhoid fever are allowed to work no earlier than a month after discharge, subject to a five-fold negative test for bacterial isolation.
Contact persons are subject to observation within 21 days from the moment of contact, or from the moment of identification of the patient. For preventive purposes, they are prescribed an abdominal bacteriophage. Contact persons who are not related to maternity groups are given a single analysis of urine and feces for the release of the pathogen. Vaccination of the population is carried out according to epidemiological indications by means of a single subcutaneous injection of a liquid sorbed anti-typhoid vaccine.
