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Infectious Diseases (4th year) > Acute infectious diarrheal disease - Salmonellosis - DONE > Flashcards

Acute infectious diarrheal disease - Salmonellosis - DONE Flashcards

1
Q

Salmonella:

A
  • gram negative
  • non-spore forming
  • facultatively anaerobic bacillus
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2
Q

Nontyphoidal serotypes of Salmonella…..

A

Nontyphoidal serotypes of Salmonella are highly adapted for growth in human and animals

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3
Q

What is restricted to human host?

A

Only serotypes S.typhi and S.paratyphi are restricted to human host

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4
Q

How many serotypes of Salmonella are pathogenic to humans?

A

More then 200 serotypes of Salmonella are pathogenic to humans

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5
Q

How does Salmonella infections begin?

A

All Salmonella infections begin with ingestion of organisms, most commonly in contaminated food or water

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6
Q

What causes the transmission of Salmonella?

A

Food-borne or water-borne transmission results from fecal contamination by ill or asymptomatic person

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7
Q

What is important determinant of incubation period and disease severity?

A

Ingested dose of pathogen is important determinant of incubation period and disease severity

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8
Q

Salmonellosis - Risk factors:

A
  • Decreased stomach acidity

- Decreased intestinal integrity

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9
Q

Decreased stomach acidity:

A
  • age less then 1 year
  • antacid digestion
  • achlorhydric disease
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10
Q

Decreased intestinal integrity:

A
  • inflammatory bowel diseases
  • prior gastrointestinal surgery
  • alteration of intestinal flora by antibiotic administration
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11
Q

Typhoid (enteric) fever:

A

Typhoid fever is a systemic disease caused by dissemination of S.typhi or S.paratyphi
- S.paratyphi may cause milder disease

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12
Q

Where does typhoid (enteric) fever occur?

A

Typhoid fever occurs worldwide, primarily in developing nations whose sanitary conditions are poor

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13
Q

Typhoid (enteric) fever is endemic in:

A
  • Asia
  • Africa
  • Latin America
  • the Caribbean
  • Oceania
  • but 80% of cases come from Bangladesh, China, India, Indonesia, Laos, Nepal, Pakistan, or Vietnam
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14
Q

Typhoid (enteric) fever - incubation fever:

A

10-14 days (ranges from 5-21 days)

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15
Q

Typhoid (enteric) fever - symptoms:

A
  • prolonged up to 4 weeks fever (the most prominent symptom) plus fatigue
  • headache, malaise, and anorexia are nearly universal
  • abdominal pain, diarrhea, or constipation are common
  • bronchitic cough is common in the early stage of the illness
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16
Q

What is the most prominent symptom Typhoid (enteric) fever?

A

prolonged up to 4 weeks fever (the most prominent symptom) plus fatigue

17
Q

What is common in the early stage of Typhoid (enteric) fever?

A

bronchitic cough is common in the early stage of the illness

18
Q

Typhoid (enteric) fever - Clinical findings:

A
  • transient, macular rash of rose-colored spots on the trunk on the end of the first weak of disease, resolves after 2-5 days
  • hepatosplenomegaly
  • relative bradycardia at the peak of high fever
  • gastrointestinal bleeding and intestinal perforation
  • meningitis
  • neuropsychiatric syndrome (muttering delirium)
19
Q

Typhoid (enteric) fever - Chronic carriage:

A
  • up to 10% of untreated persons excrete S.typhi in feces for up to 3 months
  • 1-4% of patients for more than 1 year
20
Q

Typhoid (enteric) fever - Chronic carriage are common amongst:

A
  • women
  • infants
  • persons with biliary anatomic biliary abnormalities and concurrent infections
21
Q

Typhoid (enteric) fever - Diagnosis:

A
  • Blood culture is the mainstay of the diagnosis.
    Definitive diagnosis requires isolating of S.typhi or S.paratyphi from blood, bone marrow, other sterile sites, rose spots, stool, intestinal secretions
  • The presence of clinical symptoms characteristic of typhoid fever or the detection of a specific antibody response is suggestive of typhoid fever but not definitive.
  • Antimicrobial susceptibility testing is crucial for the guidance of clinical management.
22
Q

Typhoid (enteric) fever - Diagnosis - Laboratory tests: non-specific:

A
  • leukopenia
  • neutropenia
  • anaemia
  • elevated values of liver function and muscle enzyme levels
23
Q

Typhoid (enteric) fever - Diagnosis - Serologic tests:

A

Salmonellae can be characterized by their somatic (O) and flagellar (H) antigen

24
Q

Widal test:

A
  • For Typhoid (enteric) fever diagnosis
  • Widal test measures agglutinating antibody levels against O and H antigens.
  • Test has only moderate sensitivity and specificity. It can be negative in up to 30% of culture-proven cases of typhoid fever.
25
Q

Typhoid (enteric) fever - Treatment:

A
  • Appropriate antimicrobials should be administer promptly to prevent severe complications
  • Supportive treatment:
    • oral or intravenous hydration
    • the use of antipyretics
    • appropriate nutrition
    • blood transfusions if indicated
26
Q

Drug-susceptible S. typhi and S. paratyphi - treatment:

A
  • fluoroquinolones are the optimal treatment.

- ciproflaxacin or oxofloxacin for 5-7 days

27
Q

MDR S.typhi or S. paratyphi - Treatment:

A
  • ceftriaxon iv for 10-14 days

- or azithromycin p.o. for 5 days

28
Q

Chronic carriers – treatment:

A

4-6 weeks of appropriate oral antibiotic

- e.g. amoxicillin, TMP-SMX, ciprofloxacin, norfloxacin

29
Q

Typhoid (enteric) fever - prevention:

A

Prevention is based on ensuring access to safe water, promoting safe food handling practices and by vaccination.

  • wash hands
  • drink boiled water
  • clean fruits and vegetables
  • get vaccinated!
30
Q

Typhoid (enteric) fever - prevention - vaccination:

A

polysaccharide capsule Vi is present in about 90% of all freshly isolated S.typhi has a protective effect against the bactericidal action of the serum of infected patients

31
Q

How many vaccines do we have against Enteric (typhoid) fever?

A

two currently available improved typhoid vaccines

32
Q

Two currently available improved typhoid vaccines:

A
  • parenteral Vi polysaccharide is given in a single dose with a booster every 2 years subcutaneous or i.m.
  • oral live attenuated Ty21a given on days 1, 3, 5, 7 with a booster every 5 years

Infectious Diseases (4th year) (19 decks)

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