By ABABO TOM ENTERIC FEVER OBJECTIVES Intro Epidermiology

By ABABO TOM ENTERIC FEVER

OBJECTIVES � Intro � Epidermiology � Clinical presentation � Investigatins � Ddx � Tx � Prognosis � Complications � Prevention.

INTRO. � Bacteremia –S. typhi / S. paratyphi A, B or C. � Salmo only human host. � Typhi- mainly water born. � Paratyphi-mainlt food borne. � Contamination by feces. � Other names, gastric fever, abd typhus, infantile remittent fever, slow fever, nervous fever pyogenic fever.

EPIDEMIOLOGY. � 1990 -181, 000 deaths � 2000 -21. 7 m infnx, 217, 000 deaths. � 2013 -161, 000 deaths � Most, children and young adults. � Out breaks freg reported –sub saharan Africa, south east Asia.

CLINICAL PRESENTATION. � Wk 1 � Fever fluct relative brdycardia. � Malaise � headache. � Cough � Epistaxis 1/4 cases � Abd pain possible.

WK 2 � Pt lies prostrate � High fever � Bradycardia � Dicrotic pulse wave � Delirium freq � Rose spots 1/3 cases � Rhochi � Abd disten

WK 2 CONT… � Rt lower quadrant pain � Borbogym � Diarrhoae � Constipation � Tender hepatosplenomegally

WK 3 � Intestinal bleeding � Intestinal perforation � Metastatic abscess(cholecystitis) � Osteitis � De. H 2 O � Delirius � End 3 rd wk fever↓ � Maculopapular rash trunk � Bleeding.

WK 4 � fever↓

INVESTIGATIONS. � Blood cult; wk 1 50 -80%, wk 3 30% � Fecal cult; wk 2 40 -50% wk 3 80% � Urine cult; 25% in those with schistomiasis. � Ig. M antibody assay, in absence of culture. � Widal not suff sensitive/specific. � O somatic, reactive 6 -8 d � H flageller, reactive, 10 -12 d

CONT… � � � False pos Other salmonela serovars. Enterobactericae Prev sal infx Chronic salm ass wd schistosomiasis Vaccination Acute falciparum malaria Xronic liver dse ass ↑globulin RA Myelomatosis Nephrotic syndrome