Typhoid fever: symptoms, tests, pathogen, treatment and prevention

What is it?

Typhoid fever is a long-term infectious disease with a multistage, cyclic course characterized by inflammation of the lymphatic tissue and mucous membrane of the small intestine with the formation of specific ulcers, dangerous development of intestinal bleeding and perforation.

A characteristic feature that appears at the height of the disease is the involvement of the central nervous system and the development of specific inhibition( stupor), as well as obscuring the patient's consciousness with a violation of the space-time orientation. The last symptom is characteristic for severe course.

The susceptibility of the population to typhoid fever is high - the risk of getting sick is especially pronounced in people aged 15 to 40 years. The minimum risk is noted in children under 2 years of age.

Typhoid pathogen, infection routes

Typhoid fever is an infectious disease whose causative agentSalmonella( Salmonella typhi), belonging to the family of intestinal bacteria. This is anthroponous infection, i.e.in its transmission, a person is necessarily involved, while infection occurs from a healthy person.

Typhoid fever is associated with sanitary and hygienic standards - if they are not observed, the risk of being infected increases tenfold. This is due to the isolation of bacteria from the body of the diseased with feces and urine.

There are three main ways of infection:

• Water - danger represents the use of water from water bodies, industrial water from enterprises. This way is the most common. Its risk increases in the summer( when swimming in open reservoirs characterized by poor sanitary conditions);
• Nutritional - it should be borne in mind that the bacterium is well preserved and multiplies in milk and meat. Therefore, these products require heat treatment;
• Contact, sold through household items, contaminated( seeded) by pathogenic microorganisms.

Typhoid fever can cause an epidemic. Most often, its cause is the use of a certain group of people of the same source of water, for example, water from a well. Rapid elimination is possible only if a source of infection is found and its disinfection.

Most infections with typhoid fever occur in the summer and fall. Salmonella ingestion does not necessarily lead to the development of the disease. This is due to the fact that on the way bacteria have protective barriers in the form of hydrochloric acid produced in the stomach and intestinal lymph nodes. In these organs the microorganism can be successfully eliminated, therefore the pathological process will not develop.

But if these barriers are not strong enough or the infection is very massive, then the bacteria are fixed in the lymphoid tissue of the small intestine, where their active multiplication takes place. This stage of the disease( incubation) does not appear clinically and lasts from 3 to 21 days. But there can be various fluctuations in the duration of a given period.

A shorter incubation period is associated with the transmission of the pathogen through food in which their active propagation is already taking place. A longer incubation period is observed when contaminated by water or by contact.

After this period, salmonella from the lymphatic system of the intestine penetrates into the blood, causing bacteremia. This moment marks the initial stage of the disease - a person begins to experience the symptoms of typhoid fever. They force him to see a doctor.

Symptoms of typhoid

The development of clinical symptoms of typhoid is associated with two major pathogenetic moments:

1. Infestation of internal organs, which leads to the formation of specific inflammation in them, called granulomas.
2. The formation of a large amount of specific typhoid endotoxin, which occurs when the Salmonella cells are destroyed by the cells of the immune system. This defensive reaction can turn into a catastrophe - with the massive death of bacteria, the risk of septic shock increases.

These factors have a special effect on the gastrointestinal tract and the central nervous system, and lead to poisoning( intoxication) of the whole organism, provoking a variety of disorders in many organs. The disease goes through a full cycle in 4 stages:

• initial( 5-7 days);
• the height( 2-3 weeks);
• resolution( 1 week);
• recovery( 2-4 weeks).

The onset of can be either sharp or gradual. The heaviest is the peak period, it manifests itself on the 8th-10th day of the disease. At this time, the condition of a person worsens, the already manifested symptoms are manifested as much as possible and new specific symptoms appear.

The first signs of typhoid fever in the initial period and the peak period depend on the lesion of one or another organ. Clinical symptoms are classified into the following classes:

1. Signs of intoxication:

• weakness;
• chills;
• headache;
• the temperature is up to 39-40 ° C( the maximum increases to 5-7 days of the disease, then there is a slight decrease);
• deterioration / lack of appetite.

2. Symptoms from the digestive tract:

• lips are dry and crusts are formed on them;
• "roasted" tongue: thickened, the back is covered with a thick coating, gray or gray-brown, the tip of the tongue and the edge without plaque, but have a bright red color( this is the pathognomonic sign of typhoid fever);
• isolated dryness of the tongue indicates the defeat of the central nervous system;
• abdomen is swollen, painful from the right bottom, there may also be a rumbling at palpation;
• constipation, only in rare cases there is a loose stool, which causes certain difficulties in diagnosis;
• enlargement of the liver and spleen, which is associated with the destruction in these organs of causative bacteria;
  ulceration on the palate.

3. Symptoms from the side of the central nervous system:

• headache;
• retardation( stupor) - the patient slowly answers questions;
• indifference to what is happening - the patient does not complain and perceives his condition as supposedly normal;
• adynamia - a person wants to be constantly in bed;
• disorientation, delirium( the patient does not understand where he is).

4. Symptoms from the cardiovascular system:

• pulse beat;
• low blood pressure( with a critical decrease in pressure, microcirculation disorders occur in various organs with the development of insufficiency).

5. Skin-related symptoms:

• with a sharp pallor;
• appearance on the 8-10th day of rash in the form of rare pink spots( 2-3 mm) on the skin of the abdomen and lower chest. In severe cases, the rash may look like small hemorrhages( petechiae) and spread to the limbs;
• yellow palms, feet( a sign is associated with a violation of the metabolism of vitamin A in the liver).

6. Symptoms from the respiratory system:

• dry cough, indicating the development of bronchitis;
• nasal congestion;
• manifestations of pneumonia.

Laboratory tests also reveal abnormalities on the part of organs that are affected by typhoid bacteria. In the blood there is:

• in the initial period a moderate increase in leukocytes;
• from 4-5 days, the number of white blood cells decreases due to the action of endotoxin on the bone marrow, causing a state of immunosuppression. The symptoms of urinary syndrome are:
  • decrease in the amount of urine, especially during the peak period;
  • appearance of protein, cylinders, a small number of red blood cells;
  • bacteriuria - salmonella discharge in the urine begins on the 7th day. It can lead to the development of cystitis, pyelitis.

  In the feces, salmonella appear on the 10-14th day of the disease - this occurs as a result of the isolation of bacteria with bile.

  During the height of , inflammation of various organs may develop - meningitis, pneumonia, osteomyelitis, mastitis, orchitis( testicular inflammation).Pregnant women are at risk of abortion or premature birth.

  Also the period of heat is dangerous because of bleeding from the intestinal mucosa and perforation of ulcers that occur after the rejection of post-inflammatory necrotic masses of the mucosa and lymphoid tissue at the 3rd week of the disease.

  The success of treating this life-threatening complication depends on the timeliness of the detection. Therefore, it is important for a person to know the basic symptoms of the height of typhoid fever. On the development of intestinal bleeding indicate:

  • sudden increase in heart rate;
  • temperature reduction;
  • clarification of consciousness, which can be mistakenly perceived as an improvement in the condition, although in fact it indicates weighting;
  • appearance of black stool( melena).

  The second formidable complication is perforation of the ulcer. The signs pointing to him are:

  • acute abdominal pain that appears suddenly;
  • abrupt muscular tension of the abdomen;
  • heart rate increase;
  • cold sweat, protruding on the forehead and palms;
  • the disappearance of intestinal motility;
  • bloating.
  

  disorientation - one of the symptoms of typhoid

  The period of high fever of typhoid fever may be complicated by an infectious-toxic shock. It is characterized by a critical decrease in pressure( below 80/50 mm Hg), which is the cause of impaired microcirculation in the organs.

  With septic shock, there is a sharp deterioration in the condition, the blood pressure drops, consciousness is broken, the skin becomes moist and pale blue( cyanosis).This condition is an indication for emergency therapy.

  The resolution period is the last stage of typhoid fever. It begins with a decrease in temperature and a decrease in the severity of the common signs of intoxication. The temperature decreases unevenly( amphibolically) - fluctuations in the numbers can reach 2-3 degrees per day.

  An increase in the amount of urine also indicates the subsidence of the disease and is a favorable prognostic sign. The patient has an appetite, the tongue clears from the plaque. In this case, weakness, weight loss, mental disorders in the form of irritability and emotional lability may remain for a long time.

  The resolution period is still fraught with danger - its complications are thrombophlebitis( inflammation of the venous wall) and acute cholecystitis. With inflammation of the venous wall, the risk of thromboembolism of the pulmonary artery increases.

  If a blood vessel clogs a large diameter vessel, this poses a mortal danger.

  The period of recovery is characterized by the preservation of asthenovegetative syndrome lasting from 2 to 4 weeks. The patient complains about:

  • weakness;
  • increased fatigue;
  • irritability;
  • frequent mood swings;
  • no desire to do anything.

  3-5% of patients with typhoid fever may have lifelong chronic carrier of salmonella. These people represent the greatest danger for spreading the infection. The absence of clinical symptoms in them causes the constant isolation of bacteria with feces.

  Typhoid tests

  A test for typhoid fever is best performed prior to treatment. In this case, it is the most informative, becausethe antibacterial action of the drugs taken is not yet developing. From the first days of temperature increase, blood cultures are sown to nutrient media.

  This method remains the most effective;allows to identify typhoid fever at the very beginning of the disease. From the second week, bacteria are isolated from feces, urine and bile, applying a culture of biological material to media.

  The remaining methods are confirmatory diagnosis:

  • detection of IgM antibodies, starting from the 4th-5th day;
  • carrying out the reaction of indirect hemagglutination( adhesion) of antibodies to the antigenic structures of a bacterial cell( typhoid fever);
  • PCR diagnosis is possible, but is of little informative, since bacterial DNA appears in the test material( feces) only on the 10th day of the disease.

  Therefore, PCR can only be used to confirm a diagnosis in doubtful cases, for example, when there is no clinical improvement during a prolonged intake of antibiotics.

  Treatment of typhoid

  

  When symptoms of typhoid fever appear, treatment is started in an infectious disease setting. Bed rest is observed until the 7th-10th day - until a period of stable temperature normalization.

  Treatment is complex:

  1. Antibiotic. The drugs of choice are ciprofloxacin and ceftriaxone. Klemicetin and ampicillin are often observed stability, but they can be appointed after receiving the results of bacteriological examination.
  2. Detoxification. For this purpose, intravenous administration of glucose, Ringer's solution, and other saline solutions is recommended. Also, a plentiful drink, enterosorbents( enterodesis), taken inside.
  3. Diet - exclusion of irritating mucous and fermenting products.
  4. Immunotherapy is performed only with prolonged secretion of bacteria, exacerbation or relapse of the disease.
  5. Vitamins, antioxidants.
  6. Hemostatic drugs and angioprotectors are indicated in the development of complications.
  7. Adaptogens increase the overall resistance of the body, so they are used in the recovery period.

  Preventive maintenance of typhoid

  An effective preventive measure is a vaccination against typhoid fever. Vaccination is carried out at the age of 2 years, repeated vaccination( revaccination) - after 3 years. In case of threatening conditions for the development of typhoid fever or when going to a place with a high level of disease, vaccination is performed in adults.

  Immune protection after the introduced vaccine lasts from 3 to 10 years( depends on the type of vaccine).When traveling or working in disadvantaged areas, as well as their residents, it is recommended to do revaccination every 1-3 years.

  Nonspecific prevention is compliance with hygiene standards:

  • hand washing;
  • boiling water, especially from unreliable sources( at 100 ° C, salmonella perishes instantly);
  • boiling milk;
  • sufficient meat heat treatment;
  • control of freshness of food products.

  As part of preventive measures, timely identification of the carrier in people whose work is related to food( cooking, production) and children who go to kindergarten is carried out. At the state level, water supply and disinfection of wastewater are monitored.