Typhoid Fever

Question 1

Typhoid Fever

Bacteria causing enteric fever

Answer 1

• Salmonella typhi
• Salmonella paratyphi A,B,C

Question 2

Typhoid Fever

Bacteria causing typhoid

Answer 2

Salmonella typhi

Question 3

Typhoid Fever

non typhoid salmonella bacteria causes

Answer 3

gastroenteritis

Question 4

Typhoid Fever

Mode of transmission

Answer 4

feco- oral

Question 5

Typhoid Fever

Source of transmission

Answer 5

humans

Question 6

Typhoid Fever

Infective dose

Answer 6

10^5 organisms

Question 7

Typhoid Fever

3 main antigenic factors of salmonella paratyphi

Answer 7

• O- Somatic Ag
• Vi- encapsulation Ag
• H- flagellar Ag

Question 8

Typhoid Fever

Incubation period

Answer 8

5-21 days

Question 9

Typhoid Fever

Pathogenesis

Answer 9

• Bacteria enters through oral route
• Escape the acidic stomach barrier
• Invade the ileum mucosa
• Phagocytosed but survive the phagocytosis
• Crried to Lymph nodes and multiply there
• Enter the blood stream and cause primary bacteremia
• Reach- liver, GB, Spleen, Kidney, Bone marrow
• Multiply and cause Secondary bacteremia

Question 10

Typhoid Fever

Invading site in human

Answer 10

ileum

Question 11

Typhoid Fever

Sx during the 1st week

Answer 11

• Slow rising temp w relative bradycardia
• Malaise
• headache (mainly frontal)
• cough
• Coated tongue
• constipation
• • blood culture

Question 12

Typhoid Fever

Sx during the second week

Answer 12

• High fever ( Step ladder)
• Diarrhea
• rose spots in lower chest and abdomen
• Hepatosplenomegaly

Question 13

Typhoid Fever

Sx during the third week

Answer 13

• intestinal hemorrhage
• Intestinal perforation and septicemia
• Diffuse peritonitis
• Encephalitis
• Metastatic abscess
• cholecystitis
• Endocarditis

Question 14

Typhoid Fever

Labs during first, second, third week

Answer 14

• First week- blood culture +
• Second week - Stool culture +, widal + for O and H Ab
• Third week- Urine culture +

Question 15

Typhoid Fever

Test done irrespective of the time

Answer 15

Blood culture

Question 16

Typhoid Fever

DDs

Answer 16

Appendicitis

Question 17

Typhoid Fever

Similarities with appenidicits

Answer 17

• RIF Pain
• Coated tongue
• Fever

Question 18

Typhoid Fever

Step ladder fever is seen during

Answer 18

Mainly second week but can be seen during the first week as well

Question 19

Typhoid Fever

Complications

Answer 19

• Some become chronic carriers
• Intestinal perforation
• Intestinal hemorrhage
• Rarely Periosteitis, myocarditis, pneumonia
• Bone marrow suppression

Question 20

Typhoid Fever

Chronic carriers carry the bacteria in the

Answer 20

Mainly the GB, sometimes the Kidney

Question 21

Typhoid Fever

How does the carriers spread the disease

Answer 21

Through excreta time to time

Question 22

Typhoid Fever

Best Ix

Answer 22

Bone marrow culture, Not done though

Question 23

Typhoid Fever

FBC

Answer 23

Can be normal. WBC reduced. Mainly neutrophils

Question 24

Typhoid Fever

Serology tests

Answer 24

SAT ( Standard agglutination tes, Widal test)

Question 25

# Typhoid Fever SAT

Answer 25

* NOt done because of the low sensitivity and specificity * Targets O and H Ag

Question 26

# Typhoid Fever SAT test samples are best taken during

Answer 26

Acute and convalescent phases

Question 27

# Typhoid Fever Rx

Answer 27

* Cefotaxime/ ceftriaxone * Ciprofloxacin * Co- amoxiclav

Question 28

# Typhoid Fever Why is chloramphenicol not given anymore

Answer 28

can further cause bone marrow suppression. Disease itself can cause BM suppression

Question 29

# Typhoid Fever Chronic carriers impose a problem in careers such as

Answer 29

Food handlers

Question 30

# Typhoid Fever Groups more prone to become chronic carriers

Answer 30

* Female * Biliary abnormalities * Co- existing bladder schistosomiasis

Question 31

# Typhoid Fever How does chronic carriers spread the illness

Answer 31

Through urine and fecal excreta for >1 year

Question 32

# Typhoid Fever Why does chronic carriers carry the bacteria for more than one year in urine and feces

Answer 32

Due to the persistent infection in the GB and Kidney

Question 33

# Typhoid Fever Relative bradycardia

Answer 33

Usually in a fever, increase in body temp by one degree will increase the heart rate by 8- 10 bpm. But in typhoid fever HR will increase by ~ 5-6 bpm

Question 34

# Typhoid Fever One difference which sets Typhoid fever sets apart from lepto and typhus

Answer 34

Typhoid will have altered bowel habits. First week will have constipation and then second week will have diarrhea