1. TYPHOID FEVER AL-ABBASI A.M. PhD, FRCP, DCN, DTM&H Professor of Infectious Diseases & Clinical Immunology

2. Salmonella groups ENTEERIC GROUP S.typhi, Sparatyphi, A, B & C ENTERIC LIKE ILLNESS S. enteritidis, S.cholerisuis, S.typhimurium Salmonella food poisoning Hundreds species

4. Typhoid fever gastric fever, abdominal typhus, infantile remittent fever, slow fever, nervous fever and pythogenic fever. Typhoid means "resembling typhus" and comes from the neuropsychiatric symptoms common to typhoid and typhus.typhus Typhoid: putrid malignant fever. Typhus: slow nervous fever.

5. 430–424 BC, a devastating plague killed one third of the population of Athens.plagueAthens During the American Civil War, 81,360 Union soldiers died of typhoid or dysentery.American Civil Wardysentery Mary Mallon Mary Mallon, typhoid Mary in New York. Several outbreaks in Scotland and Croyden in the UK. An outbreak in the Democratic Republic of Congo in 2004–05 recorded more than 42,000 cases and 214 deaths.Democratic Republic of Congo

6. The bacterium spreads through poor hygiene habits and public sanitation conditions, flying insects feeding on feces. According to statistics from the United States, (CDC), the chlorination of drinking water has led to dramatic decreases in the transmission of typhoid fever in thechlorination U.S.A. Carriers are the usual reservoirs of TF. Cystic fibrosis has heterozygous advantage that it confers against typhoid fever.heterozygous advantage

7. ? 4 weeks course? Fever characteristic. Relative Bradycardia in first week. leukopenialeukopenia with eosinopeniaeosinopenia Delirium, typhoid statusDelirium Distended and painful abdomen in the right lower quadrant, where borborygmiborborygmi can be heard. Rose spots Hepatosplenomegaly, painful; Pneumotyphoid

8. Typhoid Fever (Rose Spots) on chest and upper abdomen

9. Traditional Medicine

11. In the third week of typhoid fever, complications can occur: Intestinal hemorrhageIntestinal hemorrhage due to bleeding in congested Peyer's patches; this can be very serious but is usually not fatal.Peyer's patches Intestinal perforation in the distal ileum: this is a very serious complication and is frequently fatal.ileum It may occur without alarming symptoms until septicaemia or diffuse peritonitis sets in.septicaemiaperitonitis Encephalopathy.

12. Neuropsychiatric symptoms "muttering delirium" or "coma vigil"), with picking at bedclothes or imaginary objects. Metastatic abscesses, cholecystitis, endocarditis and osteitischolecystitisendocarditisosteitis The fever is still very high and oscillates very little over 24 hours. DehydrationDehydration ensues, and the patient is delirious (typhoid state). One third of affected individuals develop a macular rash on the trunk. By the end of third week, the fever starts subsiding (defervescence).defervescence

13. Widal test The Widal test is a presumptive serological test for enteric fever or undulant fever. serologicalenteric feverundulant fever whereby bacteria causing typhoid fever are mixed with serum containing specific antibodies obtained from an infected individual. Agglutination occurs. BUT???

14. oral rehydration therapy ciprofloxacin ceftriaxoneceftriaxone or cefotaxime is the first choicecefotaxime azithromycinazithromycin is better at treating typhoid in resistant populations than both fluoroquinolone drugs and ceftriaxone. Resistance to ampicillin, chloramphenicol, trimethoprim- sulfamethoxazole, is now common, not used as first–line treatment for almost twenty years.

15. Salmonellosis Nontyphoidal Salmonella, contracted from: PoultryPoultry, pork, and beef, if the meat is prepared incorrectly or is infected with the bacteria after preparationporkbeef Infected eggs, egg products, and milk when not prepared, handled, or refrigerated properly.eggsmilk ReptilesReptiles, such as turtles, lizards, and snakes, which may carry the bacteria in their intestines.turtleslizardssnakes Tainted fruits and vegetables.

17. Symptoms IP =12 to 72 hours after ingesting the bacterium.bacterium Symptoms are usually gastrointestinal, nausea, vomiting, abdominal cramps, bloody diarrhea with mucus. gastrointestinalnauseavomitingdiarrheamucus HeadacheHeadache, fatigue, and rose spots are also possible.fatiguerose spots Symptoms can be severe, especially in young children and the elderly. Osteomyelitis in sickle-cell anemia patients. Reactive arthritis (Reiters syndrome).