1. Dept. Infectious Disease 2nd Affiliated Hospital CMU
Typhoid Fever
Dept. Infectious Disease
2nd Affiliated Hospital
CMU

2. Definition
Typhoid fever is an acute infectious disease of digestive tract caused by typhoid bacillus.
Place of lesson lymphatics in the terminal ileum
Pathological feature proliferation of large mononuclear cells derived from MPS

3. Definition Clinical feature sustained fever relative slow pulse
toxic symptoms
a rose-color rash
splenomegaly and hepatomegaly
leukopenia
Complication hemorrhage & perforation

4. Etiology Causative organism: Typhoid bacillus Pathogenicity: endotoxin
genus salmonella group D
Pathogenicity: endotoxin
Resistance: Stable in environment, sensitive to heat, acid, common disinfectants

5. Etiology Antigenicity: O antigen: lipopolysaccharide group-special
H antigen: protein, strain-special
Vi antigen: polysaccharide

6. Epidemiology Source of infection
Patient, Carrier, shed bacteria in feces
Route of transmission Fecal-oral route:
contaminated food or water
contagious spread
spread by insect
Susceptibility
Epidemic features sporadic cases
high incidence in fall & summer

7. Pathogenesis Bacillus Stomach killed by gastric acid
incubation Small intestine penetrate mucosa
period Regional lymphatics
Blood stream - first bacteremia
initial MPS in liver, spleen, bone marrow
Blood stream -second bacteremia
endotoxin liver spleen regional lymphotics
Clinical symptoms absces inflammation

8. Pathology Proliferation of large mononuclear cell
1st week nd 3rd week th week
proliferation necrosis heal
edema ulceration no scar

9. Clinical manifestation
Incubation period: 7-23 day(average 10 to
14 days)
Typical typhoid fever:
Initial period
Fastigium
Defervescence
Convalescence

10. Clinical manifestation
Initial period
onset: insidious, gradual
fever: T stepwise fashion rising
non-special symptoms:

11. Clinical manifestation
Fastigium
sustained fever
toxic symptoms:
NS apathy, tinnitus, delirium,lethargy, coma
DS anorexia, abdominal Pain, diarrhea Constipation
CS relative slow pulse, bradycardia, myocarditis

12. Clinical manifestation
Fastigium
rose-colored rash:
erythematous macules or papules
occur on 6~13 days
upper abdomen
hepatomegaly and splenomegaly

13. Clinical manifestation
Devervescence
Convalescence

14. Clinical manifestation
Clinical type:
Mild type
common type
prolonged type,
ambulatory type
fulminate type

15. Clinical manifestation
Relapse: It occur 1~3week after T has reached normal. The illness follows a similar pattern to the primary attach. Blood culture positive.
Recurrence: It occur 3~4 after the illness. T begin to fall, then rise again Blood culture positive.

16. Complications Intestinal hemorrhage Intestinal perforation
Toxic hepatitis and myocarditis
Pneumonia

17. Laboratory Findings Blood picture: leukopenia Bacteria culture:
bone morrow
urine and stool

18. Laboratory Findings Widal test: agglutination of serum reaction
5 Ag: “O” “H”, “HABC”
titer:O>=1:80 H>=1:160
results analysis:

19. Diagnosis Epidemiological data Clinical manifestation
Laboratory findings
Definitive diagnosis: bacteria culture positive

20. Differential Diagnosis
Typhus
rickettsises
malaria
disseminated TB

21. Treatment General therapy Etiologic therapy guinolone: first choice
cephalosporins: 2nd and 3rd generation
chloromycetin

22. Prevention Control of source of infection:
isolation
Interruption of route of transmission
Protection of susceptible population :
Vaccinated with vaccine

23. Paratyphoid Paratyphoid A & B are the same as typhoid fever
Paratyphoid C: septics or gastro-interitis