What is typhoid fever?
Typhoid fever is an acute intestinal infection characterized by a cyclic course with a primary lesion of the lymphatic system of the intestine, accompanied by general intoxication and exanthema. Typhoid fever has an alimentary pathway of infection. The incubation period lasts an average of 2 weeks. The clinic of typhoid fever is characterized by intoxication syndrome, fever, rashes of small red spots (exanthema), hepatosplenomegaly, in severe cases - hallucinations, retardation. Typhoid fever is diagnosed when a pathogen is detected in the blood, feces or urine. Serological reactions have only an auxiliary meaning.
Characteristics of the pathogen
Typhoid fever is caused by the bacterium Salmonella typhi - a mobile Gram-positive rod with a number of flagella. The typhoid rod is able to remain viable in the environment for up to several months, some food products are an enabling environment for its reproduction (milk, cottage cheese, meat, minced meat). Microorganisms easily tolerate freezing, boiling and chemical disinfectants act on them fatal. The reservoir and source of typhoid fever is a sick person and an infection carrier. Already at the end of the incubation period, the excretory is released into the environment, which continues throughout the period of clinical manifestations and sometimes for some time after recovery (acute carriage). In the case of the formation of chronic carriage, a person can isolate the pathogen throughout life, presenting the greatest epidemiological danger to others.
Excretion of the pathogen occurs with urine and feces. The path of infection is water and food. Infection occurs when water is consumed from sources contaminated by feces, food that is not thermally processed. In the spread of typhoid fever, flies take part, transporting the fecal microparticles on the paws. The peak incidence is observed in the summer-autumn period.
Symptoms of typhoid fever
The incubation period of typhoid is on average 10-14 days, but it can fluctuate within 3-25 days. The onset of the disease is more often gradual, but can be acute. Gradually developing typhoid fever is manifested by a slow rise in body temperature, reaching high values by 4-6 days. Fever is accompanied by increasing intoxication (weakness, weakness, headache and muscle pain, sleep and appetite disorders). The febrile period is 2-3 weeks, with significant fluctuations in body temperature in daily dynamics. One of the first symptoms developing in the early days is blanching and dry skin. Eruptions appear starting from the 8-9th day of the disease, and represent small red spots up to 3 mm in diameter, with pressing briefly pale. Eruptions persist for 3-5 days, in case of severe course get hemorrhagic. Throughout the period of fever and even in its absence, the appearance of new elements of the rash.
In the physical examination, there is a thickening of the tongue, on which the internal surfaces of the teeth are clearly imprinted. The tongue in the center and at the root is covered with a white coating. When palpation of the abdomen, swelling due to paresis of the intestine, rumbling in the right iliac is noted. Patients report a tendency to obstruct bowel movements. From 5-7 days of the disease, there may be an increase in the size of the liver and spleen (hepatosplenomegaly).
The onset of the disease can be accompanied by a cough, with auscultation of the lungs dry (in some cases wet) rales are noted. At the peak of the disease, there is a relative bradycardia with severe fever-a discrepancy between the heart rate and body temperature. A two-wave pulse (dicrotia) can be recorded. There is a muffling of cardiac tones, hypotension.
The height of the disease is characterized by an intensive increase in symptoms, pronounced intoxication, toxic lesions of the central nervous system (inhibition, delirium, hallucinations). With a decrease in body temperature, patients note a general improvement in the condition. In some cases, soon after the onset of regression of clinical symptoms, fever and intoxication reappears, and rose-oolean exanthema appears. This is the so-called exacerbation of typhoid fever.
The recurrence of infection is different in that it develops after a few days, sometimes weeks, after the symptoms subsided and the temperature is normalized. The course of relapses is usually easier, the temperature fluctuates within the subfebrile values. Sometimes the clinic for recurrence of typhoid fever is limited to aneosinophilia in a general blood test and a moderate increase in the spleen. The development of recurrence is usually preceded by violations of the order of life, diet, psychological stress, untimely cancellation of antibiotics.
The abortive form of typhoid fever is characterized by a typical onset of the disease, a short-term fever and a rapid regression of symptoms. Clinical signs with erased form are weak, intoxication is insignificant, the flow is short-term.
Treatment and prognosis of typhoid fever
All patients with typhoid fever are subject to mandatory hospitalization, since a significant factor in successful recovery is quality care. The bed regimen is prescribed for the entire febrile period and subsequent for the normalization of body temperature 6-7 days. After that, patients are allowed to sit and only on the 10-12th day of normal temperature - to get up. The diet for typhoid fever is high-calorie, easily digestible, mostly semi-liquid (meat broths, soups, steam cutlets, kefir, cottage cheese, liquid cereals except millet, natural juices, etc.). It is recommended a plentiful drink (sweet warm tea).
Etiotropic therapy consists in the appointment of a course of antibiotics (chloramphenicol, ampicillin). Together with antibiotic therapy to prevent the recurrence of the disease and the formation of bacterial transport, vaccination is often carried out. In severe intoxication, detoxification mixtures (colloidal and crystalloid solutions) are administered intravenously infusion. Therapy, if necessary, is supplemented by symptomatic means: cardiovascular, sedative drugs, vitamin complexes. The patients are discharged after complete clinical recovery and negative bacteriological tests, but not earlier than 23 days after the normalization of body temperature.
With the current level of medical care, the prognosis for typhoid fever is favorable, the disease ends with complete recovery. Deterioration of the forecast is noted with the development of life-threatening complications: perforation of the intestinal wall and massive bleeding.