The document discusses typhoid fever, caused by the Salmonella Typhi bacteria. It is contracted by consuming food or water contaminated with infected feces. Symptoms include prolonged fever for up to 4 weeks, abdominal pain, constipation, and rose-colored spots on the skin. Definitive diagnosis is made by isolating S. Typhi from blood, bone marrow or stool samples. Treatment involves antibiotics like fluoroquinolones or third-generation cephalosporins. Travelers can be vaccinated with either an oral or injectable vaccine to help prevent typhoid.

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2. OVERVIEW
 sole source of S. typhi: human GIT
 organism is ingested in fecally-
contaminated food or water
 major virulence factor of S. typhi is the
Vi antigen
 Endotoxin is another virulence factor
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3. Clinical Course
 incubation: averages: 10–14 days
ranges: 3–21 days
 most prominent symptom:
a. prolonged fever (38.8°–40.5°C)
b. may continue for up to 4 weeks if
untreated
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4. Etiology
 Salmonella serotype typhimurium or
S. Typhimurium
 a cytophilic, gram-negative, aerobic,
noncapsulated, non-spore-forming,
motile rod
 Presumptive identification-serological
tests:
1. somatic (0)
2. flagellar (H) antigens.
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5. Pathogenesis
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6. SYMPTOMS
 Anorexia
 Lethargy
 Body malaise
 Myalgia, headache
 Nosebleed
 Vague abdominal pain and
 Constipation
 Mild diarrhea - 20% of patients
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7. PE:
 Rash ("rose spots"; 30%)
 Hepatosplenomegaly (3–6%)
 Epistaxis
 Relative bradycardia at the peak of high
fever (<50%).
 Coated tongue (51–56%)
 Abdominal tenderness (4–5%).
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8. Diagnosis
 Any febrile traveler from a developing
region
 Rose colored spots on abdomen which
persist for 2-4 days & recur in crops-clue
 Anemia
 Leukopenia & neutropenia are detectable &
absence of eosinophils
 Leukocytosis is more common in
children, during the 1st 10 days of
illness, in intestinal perforation or
secondary infection
 Definitive diagnosis: isolation of S. typhi or
S. paratyphi from blood, bone marrow, rose
spots, stool, or intestinal secretions
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9. DDX:
 Malaria
 Hepatitis
 Bacterial enteritis
 Dengue fever
 Leptospirosis
 Amebic liver abscesses
 Acute HIV infection
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10. TREATMENT http://crisbertcualteros.page.tl

11. Treatment
aOr another third-generation
cephalosporin [e.g., cefotaxime, 2 g q8h
(IV); or cefixime, 400 mg bid (PO)].
bOr ofloxacin, 400 mg bid (PO) for 2–5
days.
cOr 1 g on day 1 followed by 500 mg/d PO
for 6 days.
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12. Prevention and Control
 travelers to developing countries should be
advised to monitor their food and water
intake carefully
 Typhoid vaccines commercially available:
(1) Ty21a, an oral live attenuated S.
typhivaccine (given on days 1, 3, 5, and
7, with a booster every 5 years);
(2) Vi CPS, a parenteral vaccine consisting of
purified Vi polysaccharide from the
bacterial capsule (given in 1 dose, with a
booster every 2 years).
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13.  Salamat…