Typhoid Enteric fever Dr Jyotsna Agarwal Professor Dept

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Typhoid/ Enteric fever Dr. Jyotsna Agarwal Professor, Dept. Microbiology KGMU 1

Typhoid/ Enteric fever Dr. Jyotsna Agarwal Professor, Dept. Microbiology KGMU 1

Salmonella • Salmonella is Gram-negative, rod-shaped • Facultative anaerobe in family Enterobacteriaceae • Motile,

Salmonella • Salmonella is Gram-negative, rod-shaped • Facultative anaerobe in family Enterobacteriaceae • Motile, Non lactose fermenting • Over 2400 serotypes 2

n n Faeco-oral transmission Refrigeration does not kill bacteria, Heat at 600 C destroys

n n Faeco-oral transmission Refrigeration does not kill bacteria, Heat at 600 C destroys 3

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Pathogenesis n n Bacteria penetrates intestinal cell in ileocaecal region Inflammatory response to bacterial

Pathogenesis n n Bacteria penetrates intestinal cell in ileocaecal region Inflammatory response to bacterial multiplication in the cell Prostaglandins secreted Increase in C-AMP 6

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n n n Virtually non existent in developed world In developing countries endemic Typhoid

n n n Virtually non existent in developed world In developing countries endemic Typhoid more common than paratyphoid 8

Pathogenesis of Enteric fever ØM cells on Peyers patches ØInvade intestinal lining cells Øbloodstream

Pathogenesis of Enteric fever ØM cells on Peyers patches ØInvade intestinal lining cells Øbloodstream (primary bacteremia) ØPhagocytosis ØTransported (R E system), continue to replicate 9

Pathogenesis n n contd… Second week: re-enter bloodstream (secondary bacteremia) endotoxemia Second to third

Pathogenesis n n contd… Second week: re-enter bloodstream (secondary bacteremia) endotoxemia Second to third week: gallbladder, secreted in bile, re-infect intestinal tract 10

n n Complications: Intestinal haemorrhage, perforation, cholecystitis Less commonly: Bronchopneumonia, arthritis, osteomyelitis 11

n n Complications: Intestinal haemorrhage, perforation, cholecystitis Less commonly: Bronchopneumonia, arthritis, osteomyelitis 11

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Early 1900 - Mary Mallon 13

Early 1900 - Mary Mallon 13

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Diagnosis of Typhoid Fever n n 1. 2. 3. 4. Clinical: For Lab diagnosis,

Diagnosis of Typhoid Fever n n 1. 2. 3. 4. Clinical: For Lab diagnosis, specimen & diagnostic tests according to duration of fever: Blood for Culture WIDAL Stool culture Urine culture 15

Blood Culture n n n In blood culture bottle Repeated cultures may be required

Blood Culture n n n In blood culture bottle Repeated cultures may be required Subculture on Mac. Conkey medium (NLF colony) Clot culture- put clot in blood culture bottle, lyse it with streptokinase in B/C bottle Use serum for WIDAL 16

n n Selective media for subculture from blood culture bottle: Mac. Conkey, Wilson Blair,

n n Selective media for subculture from blood culture bottle: Mac. Conkey, Wilson Blair, Tellurite blood agar Enrichment broth for culture of stool/urine: Selenite F broth, Tetrathionate broth 17

Serological test- WIDAL n n 1. 2. n n For detecting antibody Agglutination test

Serological test- WIDAL n n 1. 2. n n For detecting antibody Agglutination test Endemic titre Paired sera For carriers - antibody against Vi antigen Rapid test- Typhi dot 18

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Salmonella vaccines n TAB: Salmonella typhi, paratyphi A &B, killed whole cell n Oral

Salmonella vaccines n TAB: Salmonella typhi, paratyphi A &B, killed whole cell n Oral Ty 21 -A: Live attenuated, Salmonella typhi vaccine n Vi capsular polysaccharide vaccine 20

Summary- Enteric fever n n n S. typhi / S. paratyphi Mode of spread

Summary- Enteric fever n n n S. typhi / S. paratyphi Mode of spread /Pathogenesis Clinical features / Complications Laboratory diagnosis Treatment/vaccines 21

UNIT V Typhoid Fever Typhoid Fever Typhoid feverUNIT V Typhoid Fever Typhoid Fever Typhoid fever
Typhoid Enteric Fever Typhoid fever is a systemicTyphoid Enteric Fever Typhoid fever is a systemic
Brucellosis Malta fever Undulent fever Typhoid fever EntericBrucellosis Malta fever Undulent fever Typhoid fever Enteric
TYPHOID Definition of Typhoid fever n Acute entericTYPHOID Definition of Typhoid fever n Acute enteric
Typhoid fever Enteric fever is an acute systemicTyphoid fever Enteric fever is an acute systemic
Enteric fever Typhoid and paratyphoid fever Is aEnteric fever Typhoid and paratyphoid fever Is a
TYPHOID ENTERIC FEVER DR NAMRATA MODI ASSISTANT PROFESSORTYPHOID ENTERIC FEVER DR NAMRATA MODI ASSISTANT PROFESSOR
Staphylococcus Dr Jyotsna Agarwal Professor Dept of MicrobiologyStaphylococcus Dr Jyotsna Agarwal Professor Dept of Microbiology
Bacterial Taxonomy Dr Jyotsna Agarwal Professor Dept ofBacterial Taxonomy Dr Jyotsna Agarwal Professor Dept of
Bacterial Taxonomy Dr Jyotsna Agarwal Professor Dept ofBacterial Taxonomy Dr Jyotsna Agarwal Professor Dept of
Enteric Typhoid fever Epidemic louse borne typhus LeptospirosisEnteric Typhoid fever Epidemic louse borne typhus Leptospirosis
Typhoid Enteric fever Digital Pathology Collection Case 8Typhoid Enteric fever Digital Pathology Collection Case 8
Spirochetes Dr Jyotsna Agarwal Dept Microbiology KGMU ClassificationSpirochetes Dr Jyotsna Agarwal Dept Microbiology KGMU Classification
Vibrio cholerae Dr Jyotsna Agarwal Dept Microbiology CholeraVibrio cholerae Dr Jyotsna Agarwal Dept Microbiology Cholera
Streptococcus Prof Jyotsna Agarwal Dept Microbiology KGMU StreptococciStreptococcus Prof Jyotsna Agarwal Dept Microbiology KGMU Streptococci
E coli Prof Jyotsna Agarwal Dept Microbiology KGMUE coli Prof Jyotsna Agarwal Dept Microbiology KGMU
CASE PRESENTATION ON TYPHOID WITH ACUTE GLOMERULONEPHRITIS TyphoidCASE PRESENTATION ON TYPHOID WITH ACUTE GLOMERULONEPHRITIS Typhoid
Brucellosis Undulant Fever Malta Fever Mediterranean Fever EnzooticBrucellosis Undulant Fever Malta Fever Mediterranean Fever Enzootic
Ephemeral Fever Bovine Epizootic Fever Ephemeral Fever ThreeDayEphemeral Fever Bovine Epizootic Fever Ephemeral Fever ThreeDay
Rheumatic Fever Rheumatic Fever Rheumatic fever is anRheumatic Fever Rheumatic Fever Rheumatic fever is an