Typhoid: symptoms, diagnosis, treatment and prevention
Features of development and progression of typhoid fever
Systemic disease typhoid fever is a disease belonging to the group of acute intestinal infections. It is accompanied by severe intoxication, fever and rash. Every year in the world recorded up to 20 million cases of human infection with a fever. The lack of timely treatment, combined with low immunity in 12% of cases leads to death of patients.
Characteristics of the causative agent
The causative agent of typhoid fever, is a gram-positive Bacillus, characterized by high resistance to external conditions. On soil and in aqueous medium it retains viability for up to 5 months in fecal excretions of up to 3 weeks in food – 2-3 weeks. The freezing causes the bacteria Salmonella typhi no harm, and boiling or exposure to disinfectants causes her death.
Penetrating the human organism, the microorganism begins to produce toxins that have a General toxic effect and cause pathology in the functioning of certain organs and systems.
Disease caused by Salmonella is characterized by the absolute susceptibility of the human organism to the pathogen. After its treatment in humans produces stable immunity.
In recent years, increasingly there are cases of re-infection of a person with typhoid fever. Doctors believe the cause of this phenomenon the long-term effects on the body antibiotics having immunosuppressive effects. As a result the duration and severity of the acquired immune system become lower.
Reasons and ways of infection with typhoid
A carrier of typhoid is the infected person. In the final stage of the incubation period, there is a selection coli pathogen into the environment. This process lasts for the development of the disease during the period of clinical symptoms. In acute infection; it can continue for some time after treatment, and for chronic life.
The disease is characterized by the fecal-oral route transmission, which is carried out in three ways:
- Water transfer method is realized by eating contaminated with Salmonella water from open reservoirs, or water networks. One of the reasons for this phenomenon can become an emergency in the water distribution network, due to which drinking water penetrate the sewers and infected ground water. As a result of such circumstances may occur in focal outbreaks of acute or chronic nature, which is able to cover a large number of the population.
- Dietary method of transmission of the pathogen brusnetsov is taking infected food. This is possible by eating fruits or vegetables, which are used for irrigation of sewage or fertilizer-enriched water. Typhoid germs may be present and multiply in foods such as milk, cheese, sour cream, minced meat, jelly.
- Contact-household path of spread of the disease involves infection of the surrounding objects an infected person as the result of a lack of quality of hygiene. Subsequently contaminates food and penetration of the pathogen in the food system of the body.
Stage of development of the disease
After penetration of Salmonella into the human body is such a sequence and its distribution and impact:
- The admission of a certain quantity of pathogen required for the development of the disease, the terminal ileum.
- The occurrence of chronic inflammation as a result of penetration of bacteria into the mucosa of the small intestine.
- The introduction of bacteria in lymphoid tissue with the lesion of Peyer’s patches and regional lymph nodes.
- The flow of infection into the bloodstream and spread throughout the body. In the liver and the spleen occurs the reproduction of the bacteria that is resulting defeat of these bodies.
- The immune reactions of an organism in response to the circulation of bacterial pathogens in the systemic circulation. At this time begins the destruction of pathogens by the immune system, resulting in the release of toxins and the General intoxication of the organism.
Describes the stage of the disease can be repeated. The complete destruction and neutralization of bacteria that causes typhus, occurs after sufficient strengthening the immune system.
Typhoid in most cases has pronounced symptoms, which depends on the stage of the disease.
The incubation period
Penetration of the causative agent of typhoid fever until the first signs of the disease often takes 10 to 15 days. However, in some cases the incubation period may take up to 3-5 weeks. It depends on the amount trapped in the body of the pathogen and its method of penetration. So, contamination through food is characterized by a small latent period of about 7-8 days. With the penetration of infection from water the incubation period is 2 weeks. In the case of acute onset of the disease the latent period does not exceed 1-2 days, after which exhibit pronounced clinical symptoms.
At this stage, is the promotion of the pathogen in the small intestine through the digestive tract and penetration into the lymphoid system. The bacteria actively multiply and after some time go into the systemic circulation. At this point the latent period ends and the person has the primary symptoms.
During the incubation period of infected person no specific symptoms, but may experience weakness, high fatigability.
The initial stage
The stage of the disease involves dissemination of the causative agent of typhoid fever in the bloodstream and enhancing immune system to fight it. The result of this process is the selection of pathogenic microorganisms endotoxins, which cause intoxication. The duration of this stage is around 7 days.
Symptoms of the onset of the disease is sufficiently weak. The person may slightly increase the body temperature with the maximum mark to 5-6.
Gradually, the person experiences the following symptoms of typhoid fever:
- Slow increase in body temperature, reaching a peak of 39-40 degrees for 5-6 day.
- General poisoning of the body manifests itself in headaches, muscular and joint pain, weakness, deterioration of sleep and appetite, dizziness. Blood pressure often decreases, and breathing quickens, there is tachycardia.
- The defeat of the digestive system show intense cramping pain in right side of abdomen, indigestion, reflected in alternating diarrhea and constipation. In some cases, there is intestinal bleeding. The lack of treatment at this stage can lead to the destruction of connective tissue skeleton of the intestine, the formation on its walls perforated ulcer and development of peritonitis. At external examination, the specialist will diagnose the increase in the thickness of the tongue with teeth marks, stood on its side surfaces. Muscular organ covered with a coating of grayish-white color, the throat is red, and the tonsils considerably enlarged.
- Central nervous system indicates intoxication these symptoms: pallor, numbness and cooling of the limbs, apathy. In many patients there is a disorientation in space and time. In acute development of the disease at this stage may experience a mental disorder – delirium, and as a consequence coma.
Stage the height of the disease
The current expanded period of typhoid fever lasts for 5-7 days, but in severe disease can reach two weeks. At this time occurred the absorption of the causative agent of special cells in the body. While bacteria continue to grow and multiply. This situation leads to disruption of the functioning of the human immune system.
Under the height of the disease the defeat of the gastrointestinal tract is expressed by the following symptoms:
- dryness and rasterscanned lips;
- language education bleeding cracks;
- swelling and severe pain of the abdomen;
- signs of cholecystitis.
In this period there is increase in size of liver and spleen, their pain, especially on palpation. Because of irregularities in the functioning of the liver the palm acquires a yellow tint.
Response of the kidney to the spread of Salmonella is reduced amount of urine passed. In the future, a person may experience symptoms of pyelitis and cystitis.
Lose captures and respiratory system of the body. The man tapped rales, breathing becomes hard. In some cases development of bronchitis, which left untreated becomes pneumonia.
Stage the height of the disease is characterized by the development of bradycardia, a split pulse wave, a pressure reduction. Have the affected person may experience heart failure.
The spread of the pathogen on the skin causes the appearance on chest and stomach rash – small pale pink spots the size of about 3 mm. They disappear when clicked and soon re-emerge. The average duration of the presence of such lesions is 3-5 days. After their disappearance on the skin for some time noticeable soft spots.
The reaction of the Central nervous system to increase in toxicity of the organism becomes drowsiness and apathy, lack of initiative of the patient. Man falls into a state of stupor, is poorly oriented in space, barely recognize the people around them.
The period of weakening of the symptoms
The resolution stage of the disease often lasts no more than weeks. At this time the man weakens all the symptoms of typhoid fever. Body temperature decreases, but does not reach the normal level. There is a normalization of sleep and appetite, decreases headaches and increases the amount of urine. Language takes on a natural appearance: the cracks heal and the plaque disappears.
Signs of improvement of the human condition accompanied by weakness, emotional instability, weight loss. This period can be detected late complications like cholecystitis or thrombophlebitis.
The recovery period
The healing is characterized by the normalization of body temperature, restoration of all disturbed functions and elimination from the body of the causative agent. However, in 2-5% of cases, the ill person becomes a chronic carrier of the bacteria Salmonella typhi. Irregularities in functioning of the autonomic system is often observed 3-4 weeks after recovery.
8-10% of people infected with typhoid fever, can happen relapses. They often occur at 2-3 weeks after normalization of body temperature and may repeat one time or many times.
Predicitive the condition is characterized by low grade fever, maintaining the increased size of the spleen and liver, by slowing down the release of the tongue from plaque. Gradually, the man returned with clinical symptoms stage the height of the disease with a more rapid increase in body temperature and a less acute course.
Forms of the disease
Not always the symptoms of typhoid fever can be expressed in the form described above, and sequences. Some forms of the disease can include nonspecific signs of infection:
- The abortive form of typhoid fever is characterized by a classic start of the disease, which is characterized by fever, General weakness, disturbance in the functioning of the digestive tract. By 5-6 days after the onset of the symptoms of the disease they abruptly disappear, and the normalization of the human condition.
- Erased and atypical forms of typhoid fever characterized by mild symptoms. Body temperature rarely exceeds 38 degrees, pain in the abdomen slight, and skin rashes may be missing.
Intoxication caused by the development and death in the bacteria, causing disruption of the functioning of most organs and systems. Complications of typhoid fever can be specific and nonspecific. Their severity depends on the complexity of the disease, patient’s age, state of immunity and the presence of comorbidities.
General or non-specific complications of typhoid fever are diseases, which can be a consequence of many diseases:
- inflammation of the lungs;
- inflammation of the veins;
- inflammation of the joints.
Specific complications represent the effects of the disease, which is inherent only in abdominal typhus. Experts identify three key disorders that can have a serious impact on human health:
- Intestinal bleeding can occur in the middle 2-3 weeks of the disease. In some cases this complication aktiviziruyutsya at the stage of recovery. The feces contains blood, clots and becomes tarry. If the bleeding is minor, its timely diagnosis and treatment the prognosis is favorable. Extensive bleeding can lead to hemorrhagic shock.
- Perforative peritonitis is a very dangerous, specific complication of typhoid fever, which can occur both in severe and in mild course of disease. To perforation may cause increased bowel movements, severe flatulence. The risk of pathology is that pronounced symptoms appear quite late. Surgery should be performed within 6 hours after perforation of the intestine. In other cases, the prognosis is poor.
- Toxic shock stage is accompanied by high fever. It starts with fever and leads to gradual disruption of the functioning of all organs and systems and their failure may result in death.
For typhoid fever in children
Typhoid fever in children under one year is very rare and is characterized by high severity of. Key symptoms of the disease are acceleration of the pulse, a peaceful heartbeat and a high degree of intoxication.
In children under 5 years of onset of the disease is urgent. The gastro-intestinal tract have symptoms similar to gastroenteritis: repeated vomiting, diarrhea. It may be dehydration. There are often convulsions and delirium, increased weakness, reduced pressure, disturbance of consciousness. Among the complications of diseases such as bronchitis, otitis, pneumonia. Specific consequences of typhoid fever in the form of a perforation of the walls of the intestine and bleeding is usually not observed.
In children older than 5 years, the development of typhoid fever is gradual and does not differ from the characteristics of the flow in adults. Among the complications can develop a perforation and intestinal bleeding.
Diagnosis of typhoid fever is a complex of activities, including collection of anamnesis, clinical examination of the patient and survey methods. At this stage it is important to differentiate the disease from hipopotamo forms of salmonellosis, paratyphoid, asanteni infections.
In accordance with clinical guidelines laboratory confirmation of typhoid fever is carried out using clinical, bacteriological and serological analyses
- Clinical tests are blood and urine tests, they can identify the presence of inflammation and the General condition of the body.
- Bacteriological analyses aimed at identifying the causative agent using blood cultures, urine, feces and bile.
- Serological tests designed to detect in the blood of an infected person antibodies and specific antigens.
In case of suspicion on defeat of certain organs and systems in typhoid diagnostics is used a tool. Depending on symptoms the patient may be given the following studies:
- Ultrasound examination of abdominal cavity organs, kidneys, lymph nodes;
- chest x-ray;
- ultrasonic examination of the heart;
Patients with suspected typhoid subject to compulsory hospitalization in infectious Department of medical institutions. Under the height of the disease the requirement is strict bed rest, the patient is allowed to sit since the 8th day of cold weather to go after 10 days.
Treatment of typhoid fever includes a combination of the following measures:
- The antibiotic therapy. In a health facility used drugs by targeting the bacteria Salmonella typhi. Among them include chloramphenicol, ampicillin, ciprofloxacin, amoxicillin, cephalosporins 3rd and 4th generation.
- Detoxification therapy. Patients are injected colloid and crystalloid solutions to correct the signs of intoxication: ringer solution, 5% glucose solution. For severe course of disease using corticosteroids and oxygen therapy.
- Symptomatic therapy. Patient prescribe medicines aimed at stabilization of hemodynamics, treatment of renal failure, improvement of blood circulation.
- Restorative therapy. In addition to specific treatment, the patient is assigned vitamin complexes, immunomodulators, adsorbents, probiotics.
- Dietotherapy. During treatment of typhoid fever must adhere to clinical nutrition, which contributes to a more gentle effect on the intestines. Food must be fractional and frequent, do not contain products that cause fermentation processes.
Statement of patients admitted with a diagnosis «typhoid fever», is based on the results of bacteriological samples that should be negative. Often, this occurs not earlier than 3 weeks after lowering the body temperature to normal.
Most cases of typhoid fever be a complete cure of an infected person and restore all the functions of his body. Negative prognosis may occur in cases of delayed treatment in a medical facility, resulting in the development of complications such as extensive intestinal bleeding or perforation of the intestinal wall.
Prevention of infection of typhoid fever include the steps for decontamination of the source of infection, preventing transmission to others and increased immunity.
The key event for the specific prevention of typhoid fever is vaccination. There are several indications for its implementation:
- visits to countries and areas with a high incidence of fever;
- contact with the pathogen as a result of working with him;
- regular interaction with the infected with typhus people.
There are two types of vaccines used for the prevention of disease in children and adults:
- tablets with high content of live, but weakened bacteria Salmonella typhi;
- injection containing the inactive pathogen.
General prevention of typhoid fever includes the following activities:
- personal hygiene, thorough processing of food products, quality control of water consumed;
- mandatory compliance with sanitary and epidemiological rules when working in catering establishments;
- regular bacteriological examination in case of transfer of the disease to prevent the relapse.
The complexity of the occurrence of typhoid fever requires thorough compliance measures to prevent being infected by his agent. Upon the slightest suspicion of infection should immediately contact the medical facility.