ASSISTANT PROFESSOR DEPT OF KAYACHIKITSA HAMC DEHRADUN a n Typhoid Bacilli Reach to small intestine Penetrate mucosa ID: 917218
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TYPHOID (ENTERIC) FEVER
DR. NAMRATA MODIASSISTANT PROFESSORDEPT. OF KAYACHIKITSAHAMC, DEHRADUN
Slide2Slide3Slide4Slide5Slide6Slide7a
n-
Slide8Slide9Slide10Slide11Typhoid Bacilli Reach to small intestine Penetrate mucosa
Enters intestinal
lymphatics
( via
peyer’s
patches)
Blood stream
Disseminated
throuhout
body( intracellular
multipication
takes
palce
) Re-inters bloodstream bacteraemia
Pathophysiology
Slide12Slide13Slide14Slide15Slide16Slide17General-
Toxaemia,DIC, ShockGIT- Perforation of intestine, Intestinal haemorrhage( 3rd or 4
th
week of illness)
Neurological –
Delirium, Psychosis, Coma, Meningitis,
Encephalopathy,peripheral
neuritis, Deafness
Miscellaneous-
Myocarditis,Endocarditis,Pericarditis,Glomerulonephritis,Osteomylitis,Pneumonia, Hepatitis
Complications of Typhoid
Slide18Slide19Slide20Slide21CBC – Leucopenia with relative lymphocytosis.
Blood culture- During 1st week of illness
Stool culture
– During 3
rd
week
Urine culture
– During 4
th
week
INVESTIGATIONS
Slide22Widal test
– Detects agglutinating antibodies to O, H and Vi antigens of S. paratyphi A , and B, other Salmonella species.Antibodies against the O antigen are predominating IgM, rise early in the illness and disappear early
.
In
the absence of recent
immunisation
,
a high
titre
of O antibodies (= 1:320) is useful, but not specific for typhoid
.
The H antigen are
flagellar
antigens of Salmonella
typhi
,
paratyphi
A and B
. Antibodies
to H antigens are both
IgM and IgG, rise late in the illness and persist for longer time.Other Serological tests:Typhi dot- detects IgM and IgG antibodies ( against a outer membrane protein)
Molecular methods – PCR to detect flagellin, sometic gene, Vi gene.
Slide23Slide24Slide25Slide26Slide27Slide28Slide29Chronic carrier state-
Ciprofloxacin for 4 weeks. Cholecystectomy may be necessary in some patients.
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