typhoid
| otherwise known as Salmonella typhi | |
|---|---|
| Etiology | gram-negative, oxidase-negative rod, facultative anaerobe Incubation: 2-3 weeks. Risk factors: ↑ gastric pH (e.g. age, antacids) |
| Epidemiology | Transmission: faecal-oral spread |
| Clinical presentation | enterocolitis: basically gastroenteritis enteric fever: RLQ pain, hepatosplenomegaly rose spot exanthem "relative bradycardia" sure |
| Pathogenesis | enterocolitis: invasion of epi/subepith tissues enteric fever: invasion of intestinal wall → spread to reticuloendothelial system; bacteraemia; can colonise Peyer's patches and pass into systemic circulation of course, sepsis is possible. |
| Investigations | blood cultures ➥ Bloods: ↑ ALT; FBC normal ➥ +ve stool culture; Widal’s test (low sens/spec) detects O, H Ags of S. typhi/paratyphi |
| Management: | 1st line: cipro or cefotaxime azithromycin chronic carrier state - bowel/gallbladder colonisation |
critical complications (deranged physiology)
- Intestinal perforation - classically, the ileum perforates around the third week of illness
- Vasodilated shock
- GI haemorrhage
- Jaundice
- Hepatic and septic encephalopathy
- Neuropsychiatric manifestations
- Septic arthritis
- Pericarditis