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Typhoid fever: symptoms, tests, pathogen, treatment and prevention

What it is?

Typhoid fever is a long-term infectious disease with a multi-stage, cyclical course, the distinctive features of which are inflammation of the lymphatic tissue and the mucous membrane of the small intestine with the formation of specific ulcers, dangerous for the development of intestinal bleeding and perforation.

A characteristic feature that appears in the midst of the disease is the involvement of the central nervous system and the development of specific inhibition (stupor), as well as misting the mind of the patient with impaired spatial and temporal orientation. The last symptom is characteristic of a severe course.

The susceptibility of the population to typhoid fever is high - the risk of getting sick is especially pronounced in people aged 15-40 years. The minimum risk is observed in children under 2 years of age.

Content

Causative agent of typhoid fever, ways of infection

Causative agent of typhoid fever

salmonella - causative agent of typhoid fever, photo

Typhoid fever - an infectious disease, the causative agent of which is Salmonella (Salmonella typhi), belonging to the family of intestinal bacteria. This is an anthroponotic infection, i.e. a person necessarily participates in its transfer, and the infection comes from a healthy person.

Typhoid fever is associated with sanitary and hygienic norms - if they are not followed, the risk of being infected increases tenfold. This is due to the release of bacteria from the body of the patient with feces and urine.

There are three main ways of infection:

  • Water - the danger is the use of water from reservoirs, industrial water from enterprises. This path is the most common. Its risk increases in the summer (when swimming in open water bodies characterized by sanitary disadvantage);
  • Food - while it should be borne in mind that the bacterium is well preserved and multiplies in milk and meat. Therefore, these products require heat treatment;
  • Contact, implemented through household objects contaminated (patronized) by pathogenic microorganisms.

Typhoid fever can cause an epidemic. Most often, it is caused by a certain group of people using the same water source, for example, water from a well. Rapid elimination is possible only when the source of infection is detected and disinfected.

Most infections with typhoid fever occur in summer and autumn. Salmonella ingestion in the body will not necessarily lead to the development of the disease. This is explained by the fact that on the way in bacteria there are protective barriers in the form of hydrochloric acid produced in the stomach and intestinal lymph nodes. In these organs, the microorganism can be successfully eliminated, so the pathological process will not develop.

But if these barriers are not strong enough or the infection is very massive, then the bacteria are fixed in the lymphoid tissue of the small intestine, where their active reproduction occurs. This stage of the disease (incubation) does not manifest itself clinically and lasts from 3 to 21 days. But there may be different variations in the duration of this period.

A shorter incubation period is associated with the transmission of the pathogen through food, in which they are already actively reproduction. A longer incubation period is observed upon infection by water or by contact.

After this period, salmonella from the lymphatic system of the intestine enter the bloodstream, causing bacteremia. This moment marks the initial stage of the disease - a person begins to experience symptoms of typhoid fever. They make him consult a doctor.

Symptoms of typhoid fever

Symptoms of typhoid fever

The development of clinical symptoms of typhoid fever is associated with two main pathogenetic moments:

  1. Seeding the internal organs, which leads to the formation in them of specific foci of inflammation, called granulomas.
  2. Formation of a huge amount of specific typhoid endotoxin, which occurs when Salmonella is destroyed by cells of the immune system. This defensive reaction can turn into a catastrophe - with the massive death of bacteria increases the risk of septic shock.

These factors have a special effect on the gastrointestinal tract and the central nervous system, and also lead to poisoning (intoxication) of the whole organism, provoking various disorders in many organs. The disease passes a full cycle in 4 stages:

  • initial (5-7 days);
  • the height (2-3 weeks);
  • resolution (1 week);
  • recovery (2-4 weeks).

The onset of the disease can be both abrupt and gradual. The most difficult is the period of height, it appears on the 8-10th day of illness. At this time, the condition of the person worsens, the already existing symptoms appear as much as possible and new specific symptoms appear.

The first signs of typhoid fever in the initial period and the period of height depend on the damage of one or another organ. Clinical symptoms are classified into the following classes:

1. Signs of intoxication:

  • weakness;
  • chills;
  • headache;
  • temperature up to 39-40 ° С (rises as much as possible by 5-7 days of illness, then there is a slight decrease);
  • deterioration / lack of appetite.

2. Symptoms of the gastrointestinal tract:

  • lips are dry, and crusts are formed on them;
  • “Roasted” tongue: thickened, lined with thick patina, gray or gray-brown, the tip of the tongue and edges without bloom, but have a bright red color (this is a pathognomonic sign of typhoid fever);
  • isolated dryness of the tongue indicates damage to the central nervous system;
  • the abdomen is swollen, painful on the lower right, there may also be a rumbling on palpation;
  • constipation, only in rare cases, there is loose stools, which causes certain difficulties in diagnosis;
  • enlarged liver and spleen, which is associated with the destruction of the causative bacteria in these organs;
    ulceration in the palate.

3. Symptoms of the central nervous system:

  • headache;
  • inhibition (stupor) - the patient is slow to answer questions;
  • lack of participation in what is happening - the patient does not complain and perceives his condition as supposedly normal;
  • adynamia - a person wants to be constantly in bed;
  • disorientation, delirium (the patient does not understand where he is).

4. Symptoms of the cardiovascular system:

  • pulse rate reduction;
  • low blood pressure (microcirculation disorders occur in various organs with the development of insufficiency with a critical decrease in pressure).

5. Skin symptoms:

  • severe pallor;
  • appearance on the 8-10th day of a rash in the form of rare pink spots (2-3 mm) on the skin of the abdomen and lower chest. In severe cases, the rash may be in the form of small hemorrhages (petechiae) and spreads to the extremities;
  • yellow palms, feet (a sign associated with a violation of the metabolism of vitamin A in the liver).

6. Symptoms of the respiratory system:

  • dry cough, indicating the development of bronchitis;
  • nasal congestion;
  • manifestations of pneumonia.

Laboratory tests also reveal abnormalities on the part of organs that are infected with typhoid bacteria. In the blood is observed:

  • in the initial period, a moderate increase in leukocytes;
  • From the 4th to the 5th day, the number of leukocytes decreases due to the action of endotoxin on the bone marrow, causing a state of immunosuppression.

Signs of urinary syndrome are:

  • decrease in the amount of urine, especially during the heat;
  • the appearance of protein, cylinders, a small number of red blood cells;
  • bacteriuria - urine excretion of salmonella begins on the 7th day. It can lead to the development of cystitis, pyelitis.

Salmonella appears in the fecal masses on the 10-14th day of the disease - this occurs as a result of the secretion of bacteria from the bile.

During the height of the period, inflammation of various organs may develop - meningitis , pneumonia , osteomyelitis, mastitis, orchitis (inflammation of the testicles). Pregnant women are threatened with miscarriage or premature delivery.

Also, the peak period is dangerous when bleeding from the intestinal mucosa and perforation of ulcers occur after rejection of post-inflammatory necrotic masses of the mucous and lymphoid tissues at the 3rd week of illness.

The success of treatment of this complication, life-threatening, depends on the timeliness of detection. Therefore, it is important for a person to know the main symptoms of typhoid fever. On the development of intestinal bleeding indicate:

  • sudden increase in pulse rate;
  • decrease in temperature;
  • clarification of consciousness, which may be mistakenly perceived as an improvement in the condition, although in reality it indicates a worsening;
  • appearance of black stools (melena).

The second terrible complication is ulcer perforation. Signs pointing to it are:

  • acute pain in the abdomen, appearing suddenly;
  • abdominal muscle strain;
  • increased heart rate;
  • cold sweat on his forehead and palms;
  • the disappearance of intestinal peristalsis;
  • bloating.
signs of typhoid

disorientation - one of the symptoms of typhoid fever

The period of peak typhoid fever may be complicated by infectious-toxic shock. It is characterized by a critical decrease in pressure (below 80/50 mm Hg), which is the cause of impaired microcirculation in the organs.

In septic shock, a sharp deterioration occurs, the blood pressure drops, consciousness is disturbed, the skin becomes moist and pale bluish (cyanosis). This condition is an indication for emergency treatment.

The period of resolution is the last stage of typhoid fever. It begins with a decrease in temperature and a decrease in the severity of general signs of intoxication. The temperature decreases unevenly (amphibolically) - fluctuations in numbers can reach 2-3 degrees per day.

An increase in the amount of urine also indicates that the disease has subsided and is a favorable prognostic sign. The patient has an appetite, cleansing the tongue from plaque. At the same time, weakness, weight loss, mental disorders in the form of irritability and emotional lability can remain for a long time.

The resolution period is still fraught with danger — its complications are thrombophlebitis (inflammation of the venous wall) and acute cholecystitis . When inflammation of the venous wall increases the risk of pulmonary thromboembolism .

If a blood clot closes a large-diameter vessel, it is deadly.

The recovery period is characterized by the preservation of asteno vegetative syndrome lasting from 2 to 4 weeks. The patient complains of:

  • weakness;
  • increased fatigue;
  • irritability;
  • frequent mood swings;
  • no desire to do anything.

In 3-5% of patients with typhoid fever, life-long chronic carriage of Salmonella can persist. These people are most at risk for scattering infection. Their lack of clinical symptoms causes a constant release of bacteria with feces.

Tests for typhoid fever

Examination for typhoid fever is best done before treatment. In this case, it is the most informative, because The antibacterial effect of the drugs taken is not yet developed. From the first days of raising the temperature, blood cultures are carried out on nutrient media.

This method remains the most effective, because allows you to identify typhoid fever at the very beginning of the disease. Starting from the second week, bacteria are released from feces, urine, and bile, using a seeding of biological material on the media.

The remaining methods are confirmatory diagnosis:

  • detection of IgM antibodies, starting from the 4th-5th day;
  • conducting the reaction of indirect hemagglutination (gluing) of antibodies with antigenic structures of a bacterial cell (typhoid salmonella);
  • PCR diagnostics is possible, but uninformative, since the DNA of bacteria appears in the test material (feces) only on the 10th day of the disease.

Therefore, PCR can only be used to confirm the diagnosis in doubtful cases, for example, when there is no clinical improvement over the course of long-term use of antibiotics.

Typhoid treatment

Typhoid treatment

When symptoms of typhoid fever appear, treatment begins in the conditions of the infection department. Bed rest is observed until the 7-10th day - until the period of stable normalization of temperature.

Treatment is carried out complex:

  1. Antibiotic therapy. The drugs of choice are ciprofloxacin and ceftriaxone. Klevomitsetinu and ampicillin is often observed resistance, but they can be appointed after obtaining the results of bacteriological research.
  2. Detoxification. For this purpose, intravenous administration of glucose, Ringer's solution, and other saline solutions is recommended. Also shown is abundant drinking, enterosorbents (enterodez), taken orally.
  3. Diet - the exception of irritating mucous and fermenting foods.
  4. Immunotherapy is carried out only with prolonged isolation of bacteria, exacerbation or recurrence of the disease.
  5. Vitamins, antioxidants.
  6. Hemostatic drugs and angioprotectors are indicated with the development of complications.
  7. Adaptogens increase the overall resistance of the body, therefore, are used in the recovery period.

Prevention of typhoid fever

An effective preventative measure is typhoid vaccine. Vaccination is carried out at the age of 2 years, re-vaccination (revaccination) - after 3 years. With a threatening situation for the development of typhoid fever or when leaving the area with a high level of the disease are vaccinated in adults.

Immune protection after the introduced vaccine lasts from 3 to 10 years (depending on the type of vaccine). When traveling or working in disadvantaged areas, as well as their residents, it is recommended to do revaccination every 1-3 years.

Non-specific prevention is the observance of hygienic norms:

  • washing hands;
  • boiling water, especially from unreliable sources (at 100 ° С salmonella dies instantly);
  • boiling milk;
  • sufficient heat treatment of meat;
  • control the freshness of food.

As part of preventive measures, timely identification of carriage is made for people whose work is related to food (cooking, production) and children who go to kindergarten. At the state level, water supply control and wastewater disinfection are carried out.

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