Typhoid fever diagnosis. Typhoid fever - symptoms and treatment. What complications does typhoid fever cause?

Typhoid fever is an acute infectious disease characterized by a cyclic course, prolonged fever, general intoxication, the presence of a pathogen in the patient’s blood (bacteremia) and ulcerative lesions of the lymphatic system of the small intestines.

Etiology. The causative agent of typhoid fever is Salmonella typhi - a gram-negative rod with a large number of flagella; has an average degree of resistance in the external environment and to disinfectants. Remains viable in water for up to 2 weeks, on fruits and vegetables for 5-10 days, in meat and oil for up to 1-3 months, in white for 25-30 days, in black for 1-2 months.

Epidemiology. Only humans suffer from typhoid fever. The sources of infection are a sick person, a convalescent person and a bacteria carrier. The pathogen is released into the external environment mainly through feces and partly through urine. Infection of a person occurs only through the consumption of infected water (water route) or (food route), as well as through hands contaminated with fecal particles containing the causative agent of typhoid fever (contact route). In the summer months, flies are of great importance in the transmission of infection; they carry particles of feces containing typhoid pathogens on their legs.

The incidence of typhoid fever can be observed throughout the year, but the largest number of cases is usually recorded in September - October.

Pathogenesis and pathological anatomy. Having entered the gastrointestinal tract along with an infected niche (or water), the causative agent of typhoid fever penetrates the intestinal lymphatic system (Peyer's patches and single lymphoid follicles) and then into the mesenteric lymph nodes, while developing. At the end of the incubation period, the pathogen enters the bloodstream from the lymph nodes and spreads throughout the body.

Typhoid fever in adults and children

Typhoid fever is an acute cyclic intestinal anthroponotic infection. It develops after the pathogenic bacterium Salmonella typhi enters the body through nutritional transmission routes. This means that the mode of movement of the infectious agent is from the infected organism to the susceptible immune system. It can get inside through already contaminated water, food or dirty hands. That is why it is important to follow basic personal hygiene rules.

After infection, a person feels a feverish state, and the body is subjected to general intoxication. The body gradually develops a typhoid status, roseola rashes appear on the upper layers of the epidermis, as well as specific damage to the lymphatic system in the lower parts of the small intestine.

Features of the bacterium Salmonella typhi

The main causative agent of typhoid fever, Salmonella typhi, is an active gram-negative rod that has slightly rounded ends. It stains well if you use aniline dyes to identify it. After entering the body, the bacterium begins to produce endotoxin, which is considered pathogenic only for humans; the process occurs without the formation of spores.

Salmonella is quite resistant to environmental conditions. It can be found in bodies of water where there is fresh water. The bacterium retains its vital activity for one month if it is in liquid. But if it is placed in a milky environment, the bacteria begin to actively multiply and gradually accumulate.

How can you get typhoid fever?

The mechanism of transmission of typhoid fever occurs through ingestion of contaminated food or water. Patients who experience this disease can transmit the bacteria through water supplies after going to the toilet. The patient's stool contains a huge number of pathogenic microorganisms that are well preserved in water.

Some people have a mild type and degree of typhoid fever, so they are not even aware of its existence. It is also difficult to identify in everyday life. As a result, they remain carriers of very dangerous microorganisms for a long time.

Bacteria tend to multiply in the gallbladder, ducts and liver. A carrier of typhoid fever Salmonella typhi may not have any signs or symptoms, so he is unaware of his illness and poses a danger to healthy people. The pathogens retain their viability well in wastewater.

Types of typhoid fever

Increasingly, people are faced with the following types of typhoid fever:

• Typhus. It belongs to a separate group of infectious diseases, which in most cases develop after rickettsia enters the body. The main carriers of the disease from a sick person to a healthy person are body, head or pubic lice, which can spread lice. There are several varieties of this disease - this is epidemic typhus of the rickettsia species R.mooseri and Rickettsia prowazekii. Mice and lice act as pathogens and carriers of infections.
• Relapsing fever. This term is used to designate pathogenic spirochetes of the disease when lice and ticks act as carriers. In this case, the infectious disease of typhoid fever occurs with alternating symptoms. A person may suddenly feel an attack of fever, after which the body temperature returns to its normal value.
• Typhoid fever (dysentery). This is an infectious disease or intestinal anthroponosis, which begins to develop after salmonella bacteria enter the body. There are several clinical forms of this disease - typical and atypical.

There are also several stages of typhoid fever - mild, moderate and severe. For any manifestations of this disease, you must seek qualified medical help. It is also worth constantly observing the rules of personal hygiene, especially in public places.

In the initial phase of typhoid fever, the patient feels a lack of appetite, severe headaches, weakness, malaise, fever, diarrhea and a state of apathy. If no measures are taken in time, a person may experience a relapse of typhoid fever.

Are there complications with typhoid fever?

If you do not consult a doctor in time, the disease may develop into a more severe form, which will complicate the treatment and recovery of the patient. Several centuries ago, even before the introduction of chloramphenicol into medicine, typhoid fever became the cause of the development of severe asthenia, and led to rapid weight loss and malnutrition. In extremely severe forms of the disease, patients experienced internal intestinal bleeding and perforation of the large intestine.

In the first case, erosion of blood vessels occurs in Peyer's patches, as well as places where there is a high accumulation of mononuclear cells in the intestinal walls. Patients note the appearance of blood streaks in the feces. Heavy bleeding occurs three weeks after the onset of the disease. The main clinical sign to pay attention to is a rapid decrease in blood pressure, blood pressure, and body temperature. These are specific complications of typhoid fever that need to be addressed immediately.

Intestinal perforation implies the development of a pathological process in the lymphoid tissue. Gradually, the infection spreads to the muscular and serous layers of the intestinal walls, resulting in its perforation. Antimicrobial drugs help to cope with clinical manifestations in the shortest possible time, as well as prevent complications.

The typhoid fever bacterium in some cases is localized in any internal organs, where it causes the formation of a local purulent process. These processes cause the development of meningitis, chondritis, periostitis, osteomyelitis, arthritis, and pyelonephritis.

The most common complications include pneumonia, which occurs after a bacterial infection enters the body.

Which doctor should I contact if I suspect typhoid fever?

If a person notices the first symptoms of typhoid fever, he should immediately seek advice from an infectious disease specialist. He will listen carefully to all the patient’s complaints and prescribe a full examination to determine the causative agent of the disease. The specialist will definitely pay attention to the medical history and also determine the epidemiological history. This includes identifying contact with infected patients or traveling to infected areas. Often, the doctor may require additional examination, after which he will prescribe the necessary treatment.

To determine typhoid fever, you will need to take cultures and smears for microflora, perform PCR diagnostics, biochemical analysis and blood markers. It is important to remember that the incubation period of typhoid fever is about two weeks, after which the disease begins to develop in an acute form. It is necessary to identify the disease in time for a quick recovery.

Typhoid fever in children

The transmission routes for typhoid fever are varied, and young children often do not wash their hands well after walking, so salmonella infections can easily enter the intestines. Parents will be able to notice the first symptoms very quickly. The child’s behavior and condition change, he becomes lethargic, physical activity decreases, as does his attitude towards his favorite toys.

The acute form of typhoid fever in children is characterized by the appearance of high temperature, fever, pronounced symptoms of intoxication, as well as the detection of roseola rashes on the skin. Children, unlike adults, are more likely to experience negative consequences, so it is important to promptly contact an experienced infectious disease specialist for qualified help.

Children require mandatory hospitalization, where they will receive complex treatment and a special diet. It is important to maintain careful oral hygiene and take care of your skin to protect yourself from developing stomatitis.

Symptoms

Symptoms of typhoid fever depend on the clinical form and severity of the disease. There are typical and atypical (abortive, erased) forms, different types of disease course: recurrent, cyclical. Signs of typhoid fever change as the disease progresses:

• Incubation period. Characterized by general weakness, nausea, and a feeling of weakness. May last from three days to three weeks.
• Temperature increase. The temperature rises gradually and can reach 40 degrees a week after the first symptoms of the disease appear in children.
• Rash on the stomach and chest. The rash of typhoid fever is not bright, round, and has clear contours. Appears after two weeks of illness.
• Intoxication of the body. The patient develops dizziness, weakness, delirium, and sweating.
• Damage to the small intestine and lymph nodes. For typhoid fever, the doctor pays attention to Padalka's syndrome. When tapping the abdominal wall, the specialist may notice that the sound changes in the lower right section. Pain appears in the lower abdomen.
• Damage to the liver, spleen. The liver enlarges, and the person begins to develop jaundice.

If treatment is not carried out, intestinal bleeding may develop with typhoid fever. The disease is dangerous due to its complications: peritonitis, meningitis, cholecystitis and other consequences.

Initial stage of the disease

In adults, symptoms of typhoid fever begin to appear during the incubation period. Patients report malaise, weakness, loss of appetite, headaches and muscle pain. The temperature stays between 37.5-38.5 degrees, rising in the evening.

Peak of the disease

The patient's condition is deteriorating rapidly; with typhoid fever, the temperature can reach 39.5-40 degrees. Patients complain of a number of unpleasant symptoms:

• insomnia, lack of appetite;
• thirst, dry mouth, bitterness on the tongue;
• increased heart rate;
• sweating;
• pain in muscles and joints;
• abdominal pain, bloating;
• lethargy, loss of consciousness.

The timing of the appearance of a rash with typhoid fever ranges from one week to two. The rashes are pinkish, with clear contours, most often in the lower chest, on the sides, and in the upper abdomen. The elements of the rash do not cause any discomfort to the patient. The spots disappear after 3-5 days, new elements may be added, the skin remains slightly pigmented for a short period of time.

During the acute period of the disease, the spleen and liver enlarge. The patient's face becomes pale and puffy. With typhoid fever, unstable stools are noted. Constipation alternates with diarrhea. If a complication develops, bleeding in the intestines and bloody diarrhea appear.

In severe cases of the disease, specialists diagnose patients with “typhoid status,” which is accompanied by the following symptoms:

loss of consciousness;

lethargy;

the patient confuses day and night;

hallucinations;

trembling in the limbs;

muscle spasms and cramps.

Reasons for the development of complications: lack of treatment, severe manifestations of the disease.

Fading of symptoms

The acute period of the disease can last about two to three weeks, then the manifestations of typhus begin to gradually fade away. The temperature gradually decreases to normal, stool returns to normal, and symptoms of intoxication disappear. The patient's tongue is cleared of plaque and appetite appears. It is recommended that patients get up only 7-10 days after the temperature has returned to normal.

Complications

If a patient with typhoid fever is not provided with timely medical care, complications may develop with a significant decrease in immunity.

Intestinal bleeding.

Perforation of the wall of the small intestine - occurs in case of excessive development of salmonella.

Meningoencephalitis. The nervous system and brain are affected.

Peritonitis. The peritoneal mucosa becomes inflamed.

Kidney failure.

Typhoid psychosis. Characterized by a disorder of the patient's nervous system.

Pneumonia. Occurs due to lack of movement of a patient with a high temperature.

Cholecystitis. Damage to the biliary tract.

Myocarditis. Disruption of the heart muscle.

Osteomyelitis. Damage to bone tissue and joints.

Damage to the urinary tract.

Death.

After recovery, the causative agent of typhoid fever can live for a long time in the bile ducts and duodenum of a person. Therefore, often a patient who feels absolutely healthy is dangerous to others and can infect healthy family members. Salmonella bacteria can be shed in your stool for more than a year.

Prevention and adherence to hygiene rules will help to eliminate typhoid fever: washing hands after each visit to the toilet, exterminating flies in the premises. If a person’s work involves contact with patients with typhoid fever, it is advisable to get vaccinated.

Diagnostics

The main causative agent of the disease is Salmonella. The bacterium enters the human body through the mouth. The microbe then passes through the large intestine and lymph nodes. It is at this stage that bacteria multiply and enter the circulatory system. In this regard, intoxication syndrome develops.

Diagnosis of typhoid fever. External signs

External indicators are very important when identifying typhoid fever. At the initial stage (duration of the disease is 3-5 days), the patient’s body temperature will reach the highest levels. The face is swollen, the skin is dry, bluish, and roseola-shaped pimples may appear in the chest area.

The patient's tongue is swollen and dry, covered at the base with a blue-gray film, and tooth marks may be found along the edges. The abdomen is swollen, there is rumbling and pain. Testing for typhoid fever in the first 2 days shows a normal white blood cell count. At the last stage of the disease, lymphocytosis, leukopenia, a significant increase in ESR and neutropenia are detected.

Diagnosis using laboratory tests

The most reliable method for detecting the disease is to determine the amount of Salmonella blood culture isolated. Early diagnosis allows one to obtain positive results throughout the entire period of the patient's febrile state.

A typhoid fever test should be performed daily for 3 days. It is recommended to carry out examination on the 1st day before taking antimicrobial drugs. Blood for typhoid fever is taken from the patient in the amount of 5-10 ml per 100 ml of bile-containing medium. For diagnostic purposes, tests are carried out until the patient’s temperature returns to normal. Pus, sputum, exudate fluid, and feces are also subject to examination. They are usually taken for analysis in the 2nd or 3rd week from the onset of the disease. Studies can be repeated if necessary every 5-7 days.

It is worth saying that the bacterial bacillus that caused the disease can be found in the urine and feces not only of a patient with typhoid fever, but also of bacteria carriers during any febrile conditions.

Serological testing for typhoid fever is also of great importance in diagnosis. Research is carried out 7-10 days from the onset of the disease. Serodiagnosis of typhoid fever is aimed at identifying the accumulation of O-antibody titers.

Thus, a positive response with type Vi antigen indicates prolonged carriage of the pathogen. A positive reaction to typhoid fever with the H-antigen indicates that the patient had suffered the disease previously or had been vaccinated. Recently, the disease is increasingly diagnosed using ELISA.

Testing for typhoid fever is carried out by taking stool and bile samples. In this case, diagnosis is aimed at identifying typhoparatyphoid carriage.

Remember: only a doctor should make a diagnosis, since many signs of the abdominal type correspond to symptoms of other diseases. Self-diagnosis (and especially treatment) can lead to irreversible consequences.

Specific prevention of the abdominal type consists of mandatory vaccination enriched with the Vi antigen. Vaccination is carried out for adults and children under 7 years of age. Mandatory and graded vaccination against typhoid fever is carried out for children under 15 years of age and adults.

As for nonspecific prevention, in this case general sanitary measures should be carried out aimed at combating flies (frequent carriers of bacteria), improving the quality of water supply and sanitary cleaning of populated areas, etc.

Treatment

All patients are treated in a hospital setting. Hospitalization is mandatory for the following reasons:

• the disease is infectious;

there is a risk of infecting others;

Availability of quality care is the most important factor for a complete and successful recovery.

At the first suspicion of typhus, etiotropic treatment is prescribed, aimed at eliminating the pathogen.

Use of antibiotics and pathogenetic agents

Salmonella bacteria are eliminated by ceftriaxone or ciprofloxacin (these antibiotic drugs are prescribed for infectious and inflammatory diseases). Treatment of typhoid fever with antibiotics helps lower the temperature and reduce intoxication. In some cases, an allergic reaction is observed: skin rashes, irritation, stomatitis. Drug intolerance may be accompanied by prolonged vomiting, as a result of which the prescription of antibiotics is canceled.

Pathogenetic therapy involves detoxification, which involves the administration of drugs orally or intravenously: hemodez, glucose, vitamin complexes, etc.

Diet

The method of treating the disease includes following a therapeutic diet. Therapeutic nutrition has a gentle effect on the intestines and does not cause fermentation (putrefactive) processes after consumption. For food to be easily digestible, it must be semi-liquid (kefir, liquid cottage cheese, broths, soups) or rubbed through a sieve. The therapeutic diet for typhoid fever is low-calorie; the patient should eat three times a day in small portions. Medical experts recommend drinking plenty of liquid with your servings.

Patient care

In addition to the above measures, the patient is prescribed bed rest for an average of 10 days. The prescription must be strictly followed, otherwise straining the abdominal muscles may lead to bleeding or perforation of the intestine. It is necessary to observe hygienic conditions, both in patient care and in nutrition.

Treatment with folk remedies

The purpose of using traditional medicine for this disease is to reduce the signs and symptoms of the disease and assist in recovery. The following recipes are known, the use of which must be agreed with a doctor.

Young willow bark will help fight the signs of typhoid fever. It has anti-inflammatory and disinfectant properties. Brew two tablespoons of willow bark in boiling water. It is necessary to insist for two hours. Drink the infusion three to five times a day.

To eliminate fever, traditional healers advise washing the patient. Start the process with the face and neck, and immediately wipe with a dry towel. The wet towel should be in a basin of water, the temperature of which does not exceed +27 degrees. Then they wash their hands, chest, stomach, legs.

Valerian preparations are considered very useful and effective due to their antibacterial and choleretic properties.

Treatment of typhoid fever in children

Children and adolescents with this disease are also subject to mandatory hospitalization in an infectious diseases hospital. As a rule, children are isolated in separate boxes in order to prevent an outbreak and spread of infection.

During the period of fever, an infectious disease doctor prescribes bed rest and careful care of the skin and oral cavity. A special diet with the necessary nutrients, vitamins, and microelements is prescribed. Spicy foods are removed from the diet.

The doctor prescribes antibiotics in the usual dosage. If, during long-term treatment, sluggish repair is observed and the child becomes weaker, a blood transfusion is performed.

Preventive measures for typhoid fever

According to epidemiological indications, vaccination of the population is carried out by subcutaneous injection of a liquid anti-typhoid drug into the shoulder. The World Health Organization recommends three types of vaccines. Each of them has its own characteristics, a certain adaptation period of the body and dosage.

Vaccination against typhoid fever is recommended for those traveling abroad, to the countries of Latin America, Africa, and Asia. Doctors recommend vaccination against typhoid fever a week before travel. The average duration of vaccination is 3 years. It is important to consult with your doctor about the age of the last vaccination and the relevance of the new one.

Prevention of typhoid fever

Universal compliance with sanitary and hygienic rules (from personal hygiene to water supply).

Wash your hands often with warm water and soap.

Get the appropriate vaccination.

In areas with poor sanitation, doctors recommend consuming only bottled water.

Consult a doctor immediately if the first signs of the disease are detected.

Prevention of the disease also includes: supplying the population with high-quality water, timely removal of garbage and sewage from populated areas, and control of insects.

Repeated illness is an extremely rare occurrence; typhoid fever usually leaves lasting immunity.

The treatment method for typhoid fever includes:

use of antibiotics and pathogenetic agents;

diet;

patient care;

treatment with folk remedies.

It is also necessary to pay attention to the treatment of the disease in children, measures to prevent the disease and prevention.

All treatment procedures to combat typhoid fever are aimed at neutralizing the infection, increasing the body's immunity and stopping the transmission of the infectious disease.

The disease is diagnosed and treated by infectious disease doctors.

Medicines

A patient with suspected abdominal type is subject to immediate hospitalization in the infectious diseases department. But how and with what to treat typhoid fever? Treatment should be comprehensive and include fighting infection and measures against dehydration, especially with intestinal bleeding.

Antimicrobial drugs that combat typhoid fever are sulfonamides and antibiotics. The active ingredient of a large number of sulfonamide antibacterial drugs is trimethoprim. Co-trimoxazole is prescribed orally, 2-3 tablets per day, for five to fourteen days. Contraindications include breastfeeding and intolerance to trimethoprim. Analogues of Co-trimoxazole are drugs such as Biseptol, Bactrim, Sulfatone.

In medical reference books, the antibiotic chloramphenicol is recommended as an antimicrobial drug in the treatment of typhoid fever. It is taken half an hour before meals (up to four times a day for one to two weeks). Contraindication is intolerance to chloramphenicol. Over time, races of salmonella resistant to chloramphenicol have appeared; in addition, chloramphenicol itself destroys not only pathogenic bacteria, but also beneficial microbes, causing diarrhea (diarrhea).

Among the antibiotics of the penicillin group, Amoxicillin is used in the treatment of typhoid fever. The tablets are taken three times a day. The duration of treatment is prescribed by the doctor; as a rule, treatment with amoxicillin lasts from five to twelve days. Contraindications are intolerance to penicillin and breastfeeding.

Among the new generation of antibiotics, Salmonella are sensitive to cephalosporins: ciprofloxacin, azithromycin, ceftriaxone.

Ciprofloxacin tablets are taken on an empty stomach twice a day for ten days. Contraindications include hypersensitivity, pregnancy and lactation.

Azithromycin (Azitrox) is available in the form of tablets and capsules. Taken between meals: one hour before and two hours after. It is convenient because it is taken once a day, and the course of taking this medicine is only three days. Since azithromycin and ciprofloxacin belong to the same group of antibiotics, the contraindications for their use are similar.

It is known that with complicated typhoid fever, the lungs, intestines and abdominal organs, liver, kidneys, meninges and other organs are affected. Ceftriaxone will cope with both salmonella and secondary microflora. One of the symptoms of typhoid fever is vomiting, which can make taking medications in pill form useless. An important advantage of ceftriaxone is its injection form of administration.

Medicines that combat typhoid fever are not limited to antibiotics. Depending on the severity of the disease, intravenous injections of glucose-saline solutions are prescribed to remove toxins from the blood. To bind poisons in the intestines, sorbents are needed that act like activated carbon.

And to develop beneficial microflora that can fight salmonella in the intestines, probiotics and prebiotics are used. If the course of typhoid fever is complicated by bleeding, then hemostatic drugs such as aminocaproic acid and vikasol are used.

Folk remedies

Folk remedies can only be effective in preventing this disease, but not in the treatment process. If this disease manifests itself, consult a doctor and follow his recommendations. Folk remedies in combination with medications can only speed up the recovery process from typhoid fever.

Here are fairly simple ways to avoid this disease or increase the effectiveness of traditional treatment:

• To protect yourself from typhoid fever, traditional medicine recommends chewing raw calamus root, which has a bactericidal effect.
• In conjunction with drug treatment, it is useful to take burnet root. To prepare a decoction, crushed burnet root is poured with water, then boiled and filtered through cheesecloth. The decoction should be cooled before use.
• To improve heart function in the event of viral diseases, take currant juice.
• St. John's wort has beneficial properties. It promotes faster tissue healing and also has an astringent, antibacterial and immune-strengthening effect. This herb should be consumed as an infusion.

A collection of centaury, medicinal chamomile and sage, which is poured with boiling water and infused, is also popular. It is believed that this remedy has no side effects, however (as with any recipe from traditional medicine), it is imperative to consult a specialist before using it.

Plantain helps with disorders of the gastrointestinal mucosa and bloody diarrhea. A decoction is prepared from it. In this case, the seeds are boiled and consumed shortly before meals; sometimes plantain leaves are also used.

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.

Typhoid is a disease whose name translated from ancient Greek means “cloudness of consciousness.” It is accompanied by mental disorders that occur due to high intoxication and fever. Prevention of diseases is very important, regardless of their degree of complexity. It is easier to prevent infection than to treat it for a long time. And typhus is a dangerous disease, so its prevention is even more important. Complications often occur that can even lead to death.

The history of typhus is quite interesting and is replete with numerous epidemics. This disease has been known for a long time, but its “heyday” occurred in the 18th-19th centuries. Epidemics mainly occurred in European countries and began, as a rule, in poor areas of cities, the so-called slums, where the poorest population lived. In the 19th century, typhoid patients were at least somehow treated, but in the 18th they relied more on God’s will. The priest came, read a prayer and said: “If he is destined to survive, he will be cured, no, this is retribution for his sins.”

In Russia, the last terrible epidemic occurred at the beginning of the 20th century. Then it claimed several million lives. Subsequently, sometimes small outbreaks flared up, but quickly passed. Every second person who became ill died; towards the middle of the 20th century, the situation began to improve significantly thanks to the improvement in the level of medicine.

Types of typhus

There are the following types of typhus: typhus, abdominal and relapsing. Until the 19th century, they were considered one disease that manifested itself in different ways. But already in 1829, the doctors of that time identified typhoid fever as a separate group, and in 1843 they also separated relapsing fever. Initially, these diseases were combined because of a “typhoid” rash that appeared on different parts of the body. But it soon became clear that they were different, and so all three were divided into certain types.

Typhus

This is an acute infectious disease caused by rickettsia bacteria. The carriers of typhus are lice. In past centuries, these insects were very common among the poor population, for this reason the disease was very widespread. If a person fell ill in one house, his relatives and neighbors soon became infected. This type of typhus is characterized by the following symptoms: rash, fever, disruption of the cardiovascular and nervous systems. There are two forms: epidemic typhus and endemic.

The disease is extremely dangerous; there have been many deaths before, but modern medicine has learned to fight it. Typhus spreads quickly, and in Russia alone after the revolution, in 1917-1921, more than three million people died from it. But in 1942, an effective vaccine was developed. As a result, doctors prevented the epidemic.

How is typhus transmitted?

As mentioned above, lice are carriers of this disease, but not all of their species. The main pathogens are clothes. That is, those who live in the folds of clothing. Lice that live in the hair on the head, although to a lesser extent, can also act as distributors of this disease. But pubic ones are very rare. Typhoid is a disease that between epidemics lives in a latent (dormant) state in people who are chronic carriers of rickettsia.

How does infection occur?

The lice bite itself does not lead to infection. It occurs at the moment of scratching the skin, when the secretions left by lice are rubbed into the body. Typhoid is a disease whose incubation period is up to two weeks. Laboratory tests become positive only 7 days after infection.

The disease begins with chills, fever, severe headache and back pain. After a few days, a pink, spotted rash appears in the abdomen. The patient's consciousness begins to fog, speech becomes incoherent and hasty. Some people even sometimes fall into a coma. The temperature constantly remains at 40 degrees and drops sharply after 14 days. When typhoid epidemics occur, almost 50% of patients die.

Brill's disease

This is a relapse, it is a little easier to tolerate, but has all the manifestations of typhus. The causative agent is Provacek's rickettsia, whose properties are completely similar to epidemic typhus bacteria. The disease is named after the person who first described it. It is not epidemic, but is transmitted through lice.

It may reappear after the first disease decades later. Main symptoms: severe headache, hyperesthesia of feelings, clouding of mind. There is facial hyperemia, but weaker than with typhus. In some patients, doctors additionally find Rosenberg enanthema. This is a very profuse rash, but sometimes the disease occurs without it.

Epidemiological typhus

An infectious disease caused by Provacek's rickettsia. This is a classic transmissible anthroponosis. Infection occurs mainly from a person who suffers from typhus. Epidemic typhus is a type of typhus.

To treat this disease, tetracycline antibiotics are used, which should be taken up to 5 times a day. If the form of the disease is severe, chloramphenicol succinate is prescribed, taken 3 times a day. The causative agent of epidemic typhus is bacteria that infect body lice. Through them, infection occurs. Head lice are found in a smaller area than body lice, which is why the epidemic factor is limited.

Symptoms and course of the disease

As mentioned above, the causative agent of epidemic typhus is Provacek's rickettsia. The disease begins very acutely. Within a few days the temperature rises to a critical level. The patient suffers from severe headaches, insomnia and incessant vomiting. Some may experience mental and neurological disorders, when consciousness darkens and even euphoria appears.

The skin of a sick person is hyperemic, and heart function is disrupted from the first days. Typhus often causes hypotension, tachycardia, and irregular heart rhythms. Upon examination, an enlarged spleen and liver are revealed. Sometimes there are problems with urination, liquid comes out drop by drop, with severe pain.

On the fifth day of illness, a rash appears on the body, mainly on the sides and limbs. With a more severe course of the disease, rashes can be observed on the face and neck. Sometimes there are complications in the form of meningitis. If you begin to treat epidemic typhus immediately, without wasting precious time, then it will completely disappear within two weeks.

How to detect typhus

It is very difficult to make a correct diagnosis in the first days of the disease, since the symptoms are similar to those of other diseases. For correct diagnosis, test results are needed to help determine the disease. Typhus may initially resemble syphilis, influenza, measles, pneumonia and a number of other ailments. The person is checked for the presence of lice, contacts with typhus patients, etc. Differential methods are sometimes used, when the doctor separates symptoms from similar diseases.

After 5-6 days, the diagnosis can be made more confidently, based on the nature of the rashes and the timing of their appearance, facial hyperemia, changes in the nervous system and a number of other indicators. Doctors also carefully study blood tests.

Epidemic typhus, treatment

Tetracycline antibiotics are considered the main drugs. If a person is intolerant to them, then the drug "Levomycetin" is used. The drug "Tetracycline" is prescribed more often. Taken orally 4 times a day. If the disease is severe, then for the first two days intravenous or intramuscular injections of chloramphenicol sodium succinate are given 3 times a day.

When the body temperature becomes normal, the medicine is taken in the usual dosage. Sometimes complications may arise due to the use of antibiotics. It occurs as a layering of a second disease, such as pneumonia. In this case, additional medications are prescribed.

Causal therapy usually gives a very rapid effect, and as a result, vaccine therapy and long-term oxygen therapy are not required. Vitamins are used as pathogenetic drugs. Mostly ascorbic acid and vasoconstrictor drugs are prescribed.

Typhoid is a disease that can cause serious complications. They are especially common in older people who have reduced immunity. They are additionally prescribed anticoagulants. They prevent the development of thrombohemorrhagic syndrome. The most effective of these drugs is Heparin. Elderly people need to take it as soon as an accurate diagnosis is established. The duration of taking such medications is from three to five days.

Prevention of epidemic typhus

The causes of diseases lie in lice, so you need to start fighting them. It is advisable to prevent their appearance at all. Early diagnosis is also important. It is necessary to isolate the patient in time and, if possible, hospitalize. In the hospital, he must undergo thorough sanitary treatment. Clothes are disinfected.

For prophylaxis, a formaldehyde-inactivated typhoid vaccine containing dead Provacek's rickettsia is used. Now, thanks to timely and high-quality treatment and prevention of typhus, vaccination is no longer required on a large scale. The incidence has decreased significantly.

Endemic typhus

An acute infectious disease caused by Muzer's rickettsia. The second type of bulk. Typhoid carriers are small rodents (rats, guinea pigs, etc.). That is why it has several other names:

• rat;
• classical;
• lousy;
• prison or ship fever.

Very common among small wild rodents. They are the natural reservoir for the virus. You can become infected not only through contact with them, but also by eating food that contains urine or feces of rat or mouse fleas. And also through scratching the skin, when their feces get into them. The disease can also be transmitted through tick bites on sick rodents.

Typhoid fever

An acute anthroponotic intestinal infection caused by Salmonella bacteria, which produce endotoxin that is pathogenic only for humans. Does not create disputes. The disease is characterized by: fever with general intoxication of the body, skin rash, damage to the lymphatic system and small intestine.

After infection has occurred, the maximum number of viral bacteria is formed in the third week. Transient carriers release the virus into the environment within 14 days. In acute cases of the disease, this process can continue for three months. In the chronic form, typhoid bacillus is secreted for several years.

Typhoid fever is transmitted by the fecal-oral route. Mainly through water, but there is also a possibility of infection at home and through food intake. People are very susceptible to this disease, but if they get sick, they develop strong immunity. Therefore, a typhoid fever vaccination is given in advance.

The disease mainly appears in areas with contaminated water and poor sewage systems. Adults and teenagers most often become infected from water, and small children - during milk outbreaks. The disease usually occurs in summer and autumn.

Symptoms and course of typhoid fever

Divided into several periods. Initially, in the first week, intoxication manifests itself progressively. Typhoid fever symptoms during this period are as follows: the skin turns pale, weakness appears, the headache intensifies, a significant or complete decrease in appetite occurs, and bradycardia begins. A pale coating is visible on the tongue, constipation or diarrhea is tormented.

The height of the disease occurs on the tenth day. The temperature is high and does not decrease, intoxication is pronounced. There is lethargy, irritability, and a pale pink rash appears in the form of roseolae protruding above the skin. It appears on the stomach, chest, side of the body, and on the bends of the limbs. The heart beats dullly, hypotension and bradycardia begin. The coating on the tongue turns brown, and teeth marks are visible along the edges. The stomach becomes bloated and constipation occurs. The spleen and liver enlarge, consciousness is impaired, the patient begins to delirium, and hallucinations appear. Even toxic shock may occur if the condition is very severe.

After the disease begins to recede, the temperature drops sharply. The recovering person has a good appetite, sleep is restored, weakness disappears, and overall health improves greatly.

The period of convalescence is dangerous with relapses, which can occur in 10% of patients. Precursors: the spleen and liver do not normalize, appetite weakens, weakness returns, and general malaise increases again. Clinical manifestations are the same as the course of the underlying disease, but shorter in duration.

Typhoid fever can be mild, moderate or severe. There are also two atypical ones - erased and abortive. They occur more often now, due to the use of antibiotics in treatment and the use of immunoprophylaxis. The fever lasts for a week, but can last three days. Often the onset of the disease is very acute, and serological reactions can be negative throughout the course of the disease.

Prevention of typhoid fever

Prevention is considered the main way to combat this disease. It involves a set of measures, many of which are controlled by the health care system. The causes of diseases can be different and lie in dirty water, contaminated products, and unsanitary conditions. Therefore, strict controls and epidemiological checks are carried out.

Doctors are observing groups of people who may be carriers of typhoid fever. All persons on whom the possible spread of the disease depends are controlled. These are workers of medical institutions, public utilities, water stations and catering.

Disease prevention also involves long-term follow-up of a recovered person. Patients are discharged only after tests have shown negative results five times in a row. After this, the recovered person regularly takes them to the clinic at his place of residence for three months. After this period, he is tested twice a year for typhoid fever.

People who have been ill, even after recovery, must constantly monitor their temperature. And at the slightest increase, even if it’s just a common cold, go to the clinic to check if the disease has returned again. Because such cases sometimes happen.

If a healthy person has been in contact with a sick person, then a 21-day medical observation is prescribed. At this time, blood, feces and urine are examined, typhoid bacteriophage is given, and vaccination is used. The pathogenic bacillus is very resistant to the external environment, so if hygiene rules are not followed, there is a high probability of infection.

Relapsing fever - what is it?

This species combines epidemic and endemic. During illness, fever alternates with normal body temperature. Relapsing fever can be found everywhere in the world, in almost every country. It is only absent in Australia, since this continent is located far from the rest. The highest incidence is observed in African countries and India. Large outbreaks of the disease have been reported in Russia and the Balkan Peninsula. The causative agent of typhus is Borrel spirochetes. Tick-borne relapsing fever is a vector-borne zoonotic disease. Its causative agents are many bacteria called Borrelia.

Relapsing fever is transmitted by ticks and rodents, which are the natural reservoir of the disease. Ticks infected with typhus retain the virus throughout their lives. Viral bacteria can also be transmitted transovarially, penetrating the eggs of arthropods.

Human infection occurs through tick bites. A papule forms at this site, and after some time the disease itself develops. The population of endemic areas has low susceptibility to this disease, but among visitors it is very high. Therefore, tourists are always advised to take appropriate preventive vaccinations and be extremely careful. This is especially true for those people who want to visit African countries.

In epidemic relapsing fever, infection occurs when the bite is scratched and insect feces are rubbed into the skin. If the bacteria remain outside and do not penetrate the blood, they die quickly (within half an hour). Therefore, if you are bitten by a tick, it is strictly forbidden to scratch the area affected by the insect. You have to endure it, even though it’s unpleasant. Epidemic relapsing fever is a disease that affects only humans; animals are not afraid of it.

And finally, here are some tips to help avoid possible infection. It is imperative to maintain personal hygiene and undergo regular medical examinations. It is not recommended to visit places where unsanitary conditions flourish and insects dangerous to humans can be found. Before traveling abroad, it is better to find out if there are any epidemics in the country you want to visit. This is especially true in Asia and Africa. Even if no danger is observed, extreme caution should be exercised.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What is typhoid fever?

Typhoid fever is a disease whose prevalence largely depends on socio-economic conditions. Thus, in the past, outbreaks of this disease occurred during periods of war, economic crisis and other social disasters.

Taking into account statistical data from the World Health Organization, all countries of the world, depending on the prevalence of typhoid fever, are conditionally divided into several groups. The first group includes Canada, Belgium, Sweden and other countries with a high level of economic development. In these regions, there is no more than 1 annual case of this infection per 100,000 people. The last group includes countries such as Chile, Colombia, and Peru. More than 30 cases per 100,000 people are reported annually in these countries.

In the Russian Federation, since 2007, the number of cases of typhoid fever has decreased significantly. If from 2003 to 2006 the annual number of patients varied from 150 to 180, then from 2007 to 2013 this figure did not exceed 80 people. In 2014, 14 patients were registered (13 adults and 1 child).

Causes of typhoid fever

The causative agent of typhoid fever

Salmonella produces and secretes a strong endotoxin, which determines the clinical picture of the disease.

The antigenic structure of Salmonella includes:

• O-somatic antigen, is represented by a liposaccharide complex that is resistant to high temperatures;
• N-flagellar antigen, quickly deteriorating under the influence of high temperatures.

Transmission of typhoid fever

Once in the blood, salmonella leads to the development of bacteremia. Bacteremia refers to the circulation of bacteria in the blood (which is normally sterile). This process coincides with the appearance of the first symptoms of typhoid fever and the end of the incubation period. The more massive the bacteremia, the stronger and more pronounced the symptoms of the disease.

Pathogenesis of typhoid fever

The stages of the pathogenesis of typhoid fever are:

• penetration of salmonella into the gastrointestinal tract along with the source of infection (food, water);
• introduction of bacteria into the ileal mucosa;
• reproduction of Salmonella in solitary follicles and Peyer's patches, from where they migrate to the mesenteric lymph nodes;
• the development of inflammation in the mesenteric lymph nodes and an increase in the concentration of salmonella in them;
• the release of bacteria into the blood and the development of bacteremia;
• spread of bacteria through the bloodstream throughout all organs and tissues;
• the formation of foci of infection in the spleen, liver and other organs.

Thus, a vicious circle develops - bacteria enter the blood, where they die and release endotoxin, and are replaced by new salmonella from internal organs and lymph nodes. At the same time, endotoxin, having a strong neurotropic effect, determines the clinical picture of typhoid fever.

The effects of Salmonella endotoxin are:

• neurotoxic effect with damage to the central nervous system and the development of toxic encephalopathy;
• damage to nerve endings and autonomic ganglia, which leads to the development of ulcers on the intestinal mucosa;
• cardiotoxic effect, which manifests itself in dystrophic changes in the heart, which ultimately leads to the development of toxic myocarditis;
• disturbance of peripheral vascular tone, leading to a drop in blood pressure and the development of collapse;
• development of infectious-toxic shock, which is accompanied by a violation of water and electrolyte balance;
• kidney damage and the development of “shock kidney” syndrome.

Carriage for typhoid fever

The source of infection can also be patients with atypical forms of typhoid fever. In this case, the disease occurs without classic symptoms and is therefore not diagnosed in time. People with such forms of typhoid fever are treated on an outpatient basis (that is, at home) for a long time and remain not isolated from family members. In this case, infection can occur by consuming contaminated food or water. Dairy products pose a great danger, since bacteria can not only survive in them for a long time, but also multiply.

The population's susceptibility to typhoid fever is very high. In areas where an outbreak of typhoid fever is recorded, up to 50–60 percent of the total population may become ill.

Clinical picture of typhoid fever

The periods (stages) of typhoid fever include:

• incubation period;
• initial period;
• period of the height of the disease;
• period of extinction of the main symptoms;
• recovery period.

Incubation period for typhoid fever

The duration of this period depends on the concentration of microbes that initially entered the body and the route of infection. In case of food contamination, the incubation period is short - from 7 to 9 days, and the disease is highly severe. The water route of infection is characterized by a longer incubation period.

Period of onset of the disease

The peak period for typhoid fever

Period of extinction of the main symptoms

Despite the reduction of symptoms, this period of the disease is very dangerous. It is at this moment that the disease can manifest itself again, that is, a relapse of typhoid fever is possible. Therefore, during the period of extinction of the main clinical symptoms, the patient continues to remain in the hospital under constant supervision.

Recovery period

Symptoms of typhoid fever

Symptoms of typhoid fever are:

• fever;
• rash;
• intestinal bleeding;
• damage to internal organs.

Fever due to typhoid fever

Typhoid fever rash

With typhoid fever, the rash appears on the 8th – 9th day from the onset of the disease. It is localized in the upper abdomen and chest. Sometimes elements of the rash can protrude above the skin level and acquire clear boundaries. Most often, the rash is mild and lasts from 3 to 5 days. It may disappear in just one or two days, but then it will appear again. In severe cases of the disease, the rash becomes petechial-hemorrhagic in nature. In this case, the elements of the rash are saturated with blood, which indicates an unfavorable prognosis.

In rare cases, the rash characteristic of typhoid fever may be absent. The absence of a rash on the patient's body should not exclude the diagnosis of typhoid fever.

Intestinal bleeding in typhoid fever

The abdomen of a patient with typhoid fever is swollen and painful on palpation. In moderate and severe cases, intestinal paresis develops, which is characterized by a complete absence of peristalsis. In this case, gases and intestinal contents accumulate in the intestinal lumen, making the abdomen tense and painful.

As a result of the specific effect of Salmonella endotoxin on nerve endings in the intestinal mucosa, trophic and vascular changes develop. They, in turn, lead to malnutrition of the intestinal mucous layer and the development of trophic ulcers. Trophic ulcers are those that develop as a result of impaired nutrition (trophism) of the mucous membrane. Ulcers go through several stages in their development.

The stages of development of ulcers are:

• first week– enlargement of lymphatic follicles of the intestinal mucosa;
• second week– necrosis (death) of enlarged formations;
• third week– rejection of necrotic (dead) masses and the formation in their place of small depressions, that is, ulcers;
• fourth week– stage of clean ulcers;
• fifth week– stage of healing of ulcers.

Intestinal bleeding with typhoid fever usually occurs 3 to 4 weeks from the onset of the disease. An integral symptom of perforated intestinal ulcers is pain. The patient complains of sudden, acute pain.

Often the pain is localized in the lower abdomen on the right, but can also be diffuse. The pain syndrome is accompanied by severe tension in the abdominal muscles, rapid breathing and a drop in blood pressure. Symptoms of ulcer perforation are pronounced in moderate forms of typhoid fever. This is explained by the fact that the patient’s consciousness in this case is not very clouded, and pain sensitivity remains. If intestinal bleeding begins against the background of high fever and foggy consciousness of the patient, then his clinical picture is very blurred.

Upon examination, a pronounced protective tension of the abdominal muscles is revealed. The abdomen is dense and painful, movements of the abdominal wall during the act of breathing are barely noticeable or completely absent. Signs of peritoneal irritation appear, such as the Shchetkin-Blumberg symptom.

Damage to internal organs due to typhoid fever

Heart damage
Salmonella endotoxin leads to dystrophic changes in the heart with the development of toxic myocarditis. The term “myocarditis” means that the inflammatory process involves the muscle layer of the heart. This leads to the fact that the heart ceases to perform its basic functions. Normally, the main function of the heart is the “pump function”, which provides blood supply throughout the body. Due to damage to the muscle layer, the heart stops contracting effectively and pumping blood. Contractions become weak and muffled, which explains bradycardia (rare heartbeats), arterial hypotension (low blood pressure). When examining the patient, heart sounds are dull, weak, blood pressure is low, pulse is within 50 beats per minute.

The consequence of heart damage is hypoxia or oxygen starvation, water-electrolyte imbalance, hypovolemia (decreased circulating blood volume).

Kidney and lung damage
Against the background of hypovolemia, the syndrome of “shock kidney” and “shock lung” develops. Shock kidney is a condition in which all functions of the kidney are disrupted - filtration, secretion and excretion. Diuresis (daily volume of urine) with this complication decreases sharply, up to anuria. Due to impaired excretory function, metabolic products begin to accumulate in the body - creatinine, urea. This further aggravates the course of the disease and causes the development of infectious-toxic shock. Treatment of a shock kidney should be emergency and include measures to restore diuresis and remove toxic metabolic products.

Another consequence of hypovolemia is shock lung. With this syndrome, large amounts of fluid accumulate in the alveoli of the lungs. Thus, the lungs are filled not with air, but with water, which underlies pulmonary edema. It becomes difficult for the patient to breathe, and shortness of breath increases.

Typhus and typhoid fever

Once a louse has bitten a sick person, it can live for 30 to 45 days. A lice bite is very painful, causing a person to begin painfully scratching the bite site. By scratching the bite, he rubs lice feces into the skin, through which infection occurs. Rickettsia then enters the bloodstream and is spread throughout the body. The target for rickettsiae are endothelial cells, that is, structural elements of the vascular wall. Developing inside the vascular wall, rickettsiae destroy it, which leads to the destruction of blood vessels. Typhus is characterized by the phenomenon of vasculitis, that is, damage to the endothelial wall of blood vessels. This causes the development in the clinical picture of the disease of such symptoms as hemorrhages in the skin and mucous membranes, an enlarged spleen, and a decrease in blood pressure.

Another distinctive feature of typhus is damage to the nervous system. The patient's consciousness is confused, and sometimes signs of meningism may develop. An extremely severe manifestation of typhus is typhoid status. During it, the patient experiences psychomotor agitation, memory disorders, and insomnia progresses. If the patient falls asleep, he will have nightmares. Sometimes delusions, hallucinations and other psychotic symptoms may develop.

Forms of typhoid fever

Consequences of typhoid fever

Specific complications of typhoid fever

Toxins also contribute to increased release of adrenaline and other hormones into the blood, which increase vascular spasm. The blood ceases to perform its transport function, which leads to tissue ischemia (insufficient blood supply to tissues) and metabolic acidosis (increased content of acidic products in the blood). All this causes degenerative (destructive) changes in organs and tissues, edema and other pathological conditions that can lead to death. Infectious-toxic shock begins with an increase in body temperature and develops in several stages.

The stages of infectious-toxic shock are:

• Early. The patient's consciousness remains clear, anxiety, motor restlessness, swelling of the face and upper half of the body may be observed. Breathing becomes rapid and blood pressure rises and falls in waves. In children, the early stage is usually accompanied by vomiting, diarrhea, and abdominal (upper) pain.
• Expressed. Anxiety and general excitement of the first stage are replaced by an apathetic state and motor retardation. The patient's skin becomes pale, cold and moist. Over time, hemorrhages may appear on the skin. The limbs take on a bluish tint. Temperature and blood pressure decrease, breathing and pulse become weak. The volume of urine decreases sharply. During this period, various pathologies of the kidneys and respiratory system develop.
• Decompensated. Blood pressure and body temperature continue to fall. The patient suffers from convulsions, loss of consciousness or coma is possible. The skin takes on a pronounced blue tint. There is no urination. Symptoms of dysfunction in all organs begin to appear.

Nonspecific complications of typhoid fever

Nonspecific consequences of typhoid fever include:

• from the respiratory system– pneumonia (inflammation of lung tissue);
• from the side of blood vessels– thrombophlebitis (inflammation of the veins);
• from the side of the heart– myocarditis (inflammation of the heart muscle);
• from the kidneys– pyelitis (inflammation in the renal pelvis), pyelonephritis (inflammation of the kidney tissue);
• from the nervous system– peripheral neuritis (inflammation of the nerves), meningoencephalitis (inflammation of the brain and, in some cases, the spinal cord with subsequent paralysis);
• from the musculoskeletal system– arthritis (inflammation of the joints), chondritis (inflammation of the cartilage tissue), periostitis (inflammation of the periosteum);
• from the genitourinary organs– cystitis (inflammation of the bladder), prostatitis (inflammation of the prostate).

Diagnosis of typhoid fever

The main symptoms, the presence of which raises suspicion of typhoid fever, are:

• dryness and pallor of the skin;

• elevated temperature;
• changes in the tongue - its enlargement, dryness and coating in the center with a coating;
• the appearance of a reddish rash on the body;
• dyspeptic disorders;
• manifestations of intoxication syndrome.

Tests for typhoid fever

The tests that are prescribed for the diagnosis of typhoid fever include:

• general clinical tests;
• bacteriological tests (cultures);
• serological tests.

Tests for typhoid fever

General clinical tests for typhoid fever
General clinical tests for typhoid fever are prescribed from the moment the patient consults a doctor. Changes in tests are not specific to a given disease, but they help determine the condition of the patient’s body as a whole. The main tests are a hemogram and a general urinalysis.

Possible changes in the clinical blood test for typhoid fever are:

• moderate increase in leukocytes (white blood cells);
• leukopenia (decreased number of white blood cells);
• absence of eosinophils (a subtype of leukocytes);
• moderate increase in the number of lymphocytes (a subtype of anucleate leukocytes);
• moderate acceleration of erythrocyte sedimentation.

Possible changes in a general urine test for typhoid fever are:

• presence of protein;
• high levels of red blood cells (RBCs);
• high cylinder level.

Cultures for typhoid fever

Biological fluids that are used for culture for typhoid fever include:

• blood;
• urine;
• feces;
• contents of the duodenum (bile);

Blood culture
In the early diagnosis of typhoid fever, they most often resort to blood culture, in which the pathogen is easily detected even during the incubation period. It is best to take blood samples during periods of increased body temperature. When antibacterial therapy is started, blood is drawn immediately before the next dose of the drug is administered. Up to 20 milliliters of blood are inoculated onto special liquid nutrient media. The most commonly used blood culture medium for typhoid fever is Rappoport's medium, which consists of a bile-based broth with the addition of glucose and a special dye. The nutrient medium with blood is placed in an incubator with a temperature of 37 degrees Celsius for 10 days. Laboratory technicians check the cultures every day for signs of growth of bacterial colonies - turbidity of the liquid, change in its color. If there is no growth at the end of ten days, the test result is negative. If signs of colony growth are detected, seeding is carried out on solid media in Petri dishes. New crops are again incubated at 37 degrees Celsius for 24 hours. As a result, bacterial colonies grow on the surface of a dense medium, which must be identified using a series of biochemical tests. In parallel with this, the sensitivity of bacteria to various antibacterial drugs is also determined. The final blood culture results are obtained after four days.

Urine culture
Urine testing to identify the causative agent of typhoid fever can be carried out throughout the entire period of the disease. Considering the fact that the pathogen is excreted in the urine inconsistently and for a short time, urine cultures should be repeated every 5 to 7 days. Collected urine must be delivered to the laboratory for culture no later than two hours from the moment of collection. The longer the material is stored, the greater the chance of the pathogen dying off or other bacteria growing. Uroculture is obtained by the same method of seeding and incubation as blood culture.

Stool culture
Stool cultures to diagnose typhoid fever are performed starting from the second week of illness. Stool is collected using a sterile spatula, wire loop or spoon. A sterile container is used to transport the material. In the laboratory, coproculture is prepared by inoculating feces on solid nutrient media and incubating at 37 degrees Celsius for 18 to 24 hours.

Serological examination for typhoid fever

The main antigens that are found in the blood of a patient with typhoid fever are:

• O-antigen;
• H-antigen;
• Vi-antigen.

Serological examination reactions for typhoid fever include:

• Vidal reaction;
• indirect hemagglutination reaction;
• fluorescent antibody reactions.

Vidal reaction for typhoid fever

The steps of the Widal reaction are:

• filling a number of test tubes with 1 milliliter of saline solution;
• adding 1 milliliter of serum to the first test tube and obtaining a dilution of 1 to 50;
• sucking 1 milliliter from the first test tube with a pipette and adding it to the second test tube - a dilution of 1 to 100 is obtained;
• repeat the manipulations until solutions are obtained in a ratio of 1 to 800;
• adding a special diagnosticum to each test tube;
• two-hour incubation at 37 degrees Celsius;
• subsequent maintenance of the tubes at room temperature for 24 hours.

Indirect hemagglutination reaction
The indirect hemagglutination reaction is more specific and sensitive for the diagnosis of typhoid fever. With its help, all three main antigens of the pathogen are determined. Red blood cells sensitized to Salmonella antigens serve as diagnostic agents. The reaction technique is similar to the Widal reaction technique, however, dilutions start from 1 to 10. Hemagglutination manifests itself in the form of the formation of a red precipitate at the bottom of the test tube, similar to an inverted umbrella. A reaction is considered positive when a precipitate forms in a test tube with a dilution of 1 to 40 or more. In subsequent tests after 5 and 10 days, antibody titers increase 2–3 times, especially O-antibodies. An increase in the titer of Vi- and H-antibodies is observed in patients during the recovery period. Their levels may also be high in carriers.

Fluorescent antibody reactions
From the first days of the disease, the pathogen can be identified using fluorescent antibody reactions. These reactions involve the detection of pathogen antigens using antibodies marked with fluorescent substances. “Marked” antibodies are added to biological diagnostic material (blood, feces, urine) and studied using special microscopes. When an antibody binds to a pathogen antigen, a glow is visible under the microscope. Preliminary reaction results are ready within one hour, and final results are ready in 10–20 hours. Fluorescent antibody reactions are quite specific and highly sensitive, but are rarely used in the diagnosis of typhoid fever.

Typhoid fever (Typhus abdominalis) is an acute anthroponotic infectious disease of a bacterial nature, characterized by prolonged fever and intoxication, as well as damage to the lymphoid apparatus (especially the intestines, with the formation of ulcers in it).

The name “Typhos”, which means “fog/smoke”, has come to us since ancient times, because previously this was the name for all diseases accompanied by fever and periodic loss of consciousness.

The causative agent of typhoid fever

The causative agent of typhoid fever - Salmonella typhi, is a rod (bacillus), medium in shape, has the following structure, the features of which make it possible to identify the pathogen among other pathogenic salmonella, and this structure determines the characteristics of life activity and methods of interaction with the macroorganism:

O-antigen (determines viability, i.e. how long the pathogen can live under unfavorable conditions);
H-antigen (flagellate – determines the mobility of bacteria);
Vi-antigen (is a specific virulence antigen, i.e. it determines a high degree of infection ability);
Endotoxin (a toxin that is contained inside the pathogen and is released after its death, causing damage);
Villi are formations with the help of which the pathogen is attached and introduced into enterocytes (intestinal cells);
Tropicness (most common lesion) to nervous tissue;
The ability to multiply in cells of the immune system (CMF cells are a system of monocytic phagocytes that can be either fixed in lymphoid organs or move freely)
R-plasmids (genes that determine the synthesis of enzymes that destroy antibacterial drugs), due to this factor, which determines drug resistance, as well as due to the ability of the pathogen to persist (reside) in the body for a long time, new drug-resistant strains are created; Inappropriate use of antibacterial drugs also contributes to this.

Salmonella typh in the intestines

Unlike a number of other bacilli, this pathogen does not form spores or capsules, but this does not detract from its stability in the external environment, since it is relatively stable and dies only at high temperatures (boiling, autoclaving, etc.) 60˚ C – 30 minutes; when boiled, death occurs instantly. It also dies when exposed to disinfectants (phenol, chlorine, lesol) within a few minutes. Low temperatures are not harmful to him; It reproduces well and stays for a long time in dairy products (milk, sour cream, jelly) - it can stay there for several months, and it can spend about the same amount of time in soil and water bodies (in running water for up to several days).

Causes of typhoid fever infection

The disease is widespread, without territorial, age or gender restrictions. Summer-autumn seasonality is typical, because it is during this period that favorable conditions are created for the fecal-oral transmission mechanism.

The source of infection is a sick person or a carrier (especially during 2-3 weeks of the disease, when massive release of the pathogen occurs). Routes of infection – household contact, water, food (when consuming dairy products).

1. Incubation period - from 3-50 days, but on average 10-14. It is characterized by the period from the moment of introduction to the first clinical manifestations. The body receives the infectious dose of the pathogen necessary for the development of the disease (10⁷ bacterial cells). Penetrating through the upper parts of the digestive tract, bypassing all protective mechanisms, the pathogen reaches the small intestine and penetrates into its lymphoid system→ through the lymph vessels it reaches the nearest regional nodes (mesenteric, possibly inguinal), where it multiplies to a critical level, after which a breakthrough occurs into the bloodstream and bacteremia occurs (Salmonella typhi remains in the blood), characterized by the initial period of the disease. There are no symptoms before a breakthrough into the circulatory system, except for enlargement of the inguinal lymph nodes (this may not happen)

2. The initial period lasts for 7 days and is characterized not only by the spread of the pathogen through the bloodstream, but also by a response from the immune system - macrophages begin to absorb the pathogen, as a result, endotoxin is released, toxemia joins the already existing bacteremia, which is accompanied by:

Acute/subacute development of intoxication in the form of persistent headache, an increase in temperature to 39-40⁰C within 5-7 days (can last up to 2 weeks), lethargy, adynamia, loss of appetite.

From the gastrointestinal tract, not only the mucous membrane, but also the nervous tissue of the intestine is damaged, resulting in: cramping and constant abdominal pain, flatulence, constipation and diarrhea (in the form of “pea puree” with a sour smell) replacing each other, coating on the tongue gray-white in color and the tongue is thickened. The gastrointestinal tract is affected so severely, with untimely diagnosis and treatment, that the connective tissue framework of the intestine is practically destroyed, resulting in a high risk of perforated ulcers and peritonitis.

Due to the affinity for nervous tissue, symptoms are not limited to damage to the nervous system of the intestine; damage to the peripheral nerves occurs in the form of coldness/pallor and numbness of the extremities.

Due to the spread of the pathogen and its penetration into the skin, a roseola rash appears on the abdomen and lateral surfaces of the chest in the form of small dots up to 3 mm in diameter, sometimes rising above the skin; when pressed, they disappear and after a few seconds they appear again.

3. Phase of parenchymal dissemination. Lasts for the next 7 days. As it circulates through the bloodstream, the pathogen is absorbed by the cells of the monocytic phagocyte system (including parenchymal organs), but the pathogen can not only continue to exist in these cells, but also multiply in them, and also transform into L-forms (this precedes carriage) . As a result, this leads to IDS (immunodeficiency state), as well as parenchymal dissemination - the release of the pathogen from the parenchymal organs (due to the fact that many macrophages/phagocytes are concentrated there + by being carried from the intestine through communicating vessels, the pathogen passes to these parenchymal organs) .

This explains the following symptoms:

Hepatosplenomegaly (enlargement of the liver and spleen), possible pain, as well as icteric staining of the palms and soles due to a violation of the keratin metabolism of the liver.

Kidney damage may be accompanied by a decrease in excretory function.

From the lungs – hard breathing and scattered wheezing. Since the excretory function of the above organs is practically not affected, the pathogen located in them begins to be released again. Excretion occurs in bile/breast milk in nursing mothers/feces/urine/sweat and salivary glands.

4. Continued release of the pathogen and the formation of allergic reactions. Continues over the next 7 days. But these reactions are not with the standard manifestations of allergies, but they are characterized by the restoration of the reserves of the immune system and the occurrence of specific and nonspecific complications.

5. The recovery phase occurs at the end of the 4th week of illness, and clinical recovery, that is, after the disappearance of symptoms, is not always accompanied by bacteriological clearance of the pathogen. It is characterized by a decrease in body t⁰, restoration of appetite, moistening of the tongue and the disappearance of plaque from it. But carriage is not excluded, because among those who have recovered, 2-3% become carriers, therefore, after recovery, three tests are necessary with an interval of 5 days.

The above symptoms can occur very variably, both with an abortion/erased clinic, and in various combinations with each other.

Diagnosis of typhoid fever

Depending on the stage of the infectious process, at different times, different materials are taken for examination and carried out using various diagnostic methods.

During the incubation period there are no symptoms, so the disease itself is difficult to suspect.

At the first clinical manifestations, corresponding to 1 week (initial stage), the following materials are taken for research using the following methods:
- Bacteriological method with blood/urine/feces culture on nutrient media; The faster the method is carried out, the greater the likelihood of obtaining reliable results. Preliminary results are obtained in 2-3 days, and final results are obtained on the 10th day.
- The serological method is used at the end of the first week - the beginning of the second and until recovery, using the patient’s sera with
> RA (aglutination reaction) according to Widal with O and H antigens: O-antigens appear on the 4th day and decrease during the recovery period, H-antigens appear on the 8-10th day and persist for 3 months after recovery, they may also indicate vaccinations;
> IRHA (indirect hemagglutination reaction) is carried out with O, H and Vi antigens; This method is more often preferred than others, because it is the most specific and highly sensitive, aimed at identifying specific antibodies.
> RIF, ELISA, RSF, RNA, IRA - these methods are also very specific and informative, but they are rarely resorted to, because RNGA is quite sufficient.
- CBC: ↓Lc and Nf, normal ESR, no eosinophils (“E”).

Treatment of typhoid fever

Treatment is continuously related to nutrition and is carried out only in a hospital under a strict pastel regime until the 11th day after the temperature drops (from the 8th day from the normalization of the temperature it is allowed to sit, from the 11th day - to walk).

The patient is partially transferred to parenetal (via intravenous administration of nutrient media) nutrition, so as not to provoke perforation of the intestinal walls.

The diet is as mechanically and chemically gentle as possible, but at the same time quite high in calories (table 4 and 4b, as you recover, the diet can be expanded - 4c and 2). Avoid foods that cause increased peristalsis and gas formation (brown bread, peas, beans, cabbage dishes). The diet includes low-fat boiled meats and fish, egg dishes, white bread, fermented milk products, chopped vegetables and fruits.

As etiotropic therapy (against the pathogen), antibiotics with a specific focus against S. typhi are used: Ampicillin, Levomycetin, Amoxiclav, Amoxicillin, Unazin, Rifampicin. They can be combined with each other.

Immunomodulators are prescribed because they speed up the treatment process and make it more effective.

General restorative treatment: prebiotics, probiotics, symbiotics, possible complex immunoglobulin preparation (CIP), vitamin complexes.

Complications of typhoid fever

Specific: intestinal bleeding, perforation of the intestinal wall, development of peritonitis.

Nonspecific: pneumonia, mumps, cholecystitis, thrombophlebitis, etc.

Prevention of typhoid fever

Specific: For epidemic indications (if more than 25 people per 100,000 population are sick + travel to countries with high incidence + constant contact with carriers) - in this case, the dry alcohol vaccine Tifivak is prescribed, it can be administered from 15-55 years. If the age is from 3-15 years - typhoid vaccine Vi-polysaccharide liquid vaccine (Vianvac), and after 3 years the revaccination is repeated.

Nonspecific prevention:

Compliance with sanitary and epidemiological rules at various levels of the organization (from water supply - wastewater treatment, to personal hygiene);
Examination of food enterprise workers (with the help of RNGA, they are not allowed to work until the results are received);
For each case of a disease, an emergency notification is sent to the sanitary and epidemiological authorities. The patient is hospitalized, contact persons are observed for 21 days, and final disinfection is carried out in the outbreak.
After the illness, no later than 10 days after discharge, 5-fold bacteriological examination of feces and urine is carried out, with an interval of 2 days, then for 2 years, 4 times a year, 3-fold bacteriological examination of feces and urine is carried out. If all the results of the study are negative, people are removed from the register.

General practitioner Shabanova I.E.