XI.

PATHOPHYSIOLOGY Medical Diagnosis Typhoid fever, Acute Gastroenteritis (AGE) Definition Typhoid fever is a life-threatening illness caused by the bacterium Salmonella typhi. Acute Gastroenteritis (AGE)Gastroenteritis (also known as gastro, gastric flu, tummy bug in some countries, and stomachflu, although unrelated to influenza) is inflammation of the gastrointestinal tract, involving both the stomach and the smallintestine (see also gastritis and enteritis) and resulting in acute diarrhea. Schematic Diagram Predisposing Geographical area tropical islands in thePacific (Philippines) and AsiaYoung adult(19-45) 40yrs old Precipitating Washing of hands inadequatelySharing of food from the same plateDrinking unpurified water Eating foods from the outside source (carinderia) Ingestion of foods or fluids contaminatedwith Salmonella typhi bacteriaBacteria enter the stomach and survive a pHas low as 1.5Bacteria invades the Payers patches of theintestinal wall in the small intestines where itattach (incubation period is first 7-14 days

The bacteria is within themacrophages and survivesBacteria spread via the lymphaticswhile inside the macrophagesBacteria will then injects toxins known asthe effector proteins into the intestinalcells and interrupts with the cellularproteins & lipids & manipulate theirfunction resulting in phagocytization of theepithelial cell membrane until it is engulf down into the inferior part of the host cellsMacrophages & intestinal epithelialcells then attract T cells &neutrophils with interleukin 8 (IL-8causing inflammation of the Typhoid Perforation anddestruction of mucosal lining of theintestinal wall canlead to persistentinflammation The bacteria induced macrophageapoptosis, breaking out into thebloodstream and cause systemicUlceration andbleeding in themucosal lining and Tissue damage andinflammation causesloss of absorptiondue to damaged villicausing an increasein water,electrolytes, mucus,blood, and serum tobe pulled into theintestine fromAbdominal spasm isinduced to limitmucosal injury addingin stimulation of increased peristalsis Diagnostic:Hematology:Neutrophils-74 (50-70) Signs/ symptoms:Febrile: T-38.5CWarmth to touchHeadache of 3/10, bodyweaknessSigns/symptoms:Abdominal painSigns/ symptoms:RUQ Abdominal pain of 5/10 pain scale,guarding behavior,facial grimace,tachypnea-RR of Diagnostic:Fecalysis: reddishbrown color(brown)RBC:2-4/hpf (0-

Typhoid fever is termed as an acute illness accompanied by fever caused by a gram negative bacilli called as Salmonella typhi. It is transmitted via fecal- oral route through contaminated water supply or food. Clients who had harboured this infection may become asymptomatic for a long time and could be called as carrier. Those carriers can then be a cause for future outbreaks of typhoid fever especially if there is improper sanitation and handling of food and poor hygiene. Incubation period from ingestion to presence of fever is between 2- 3 weeks or 3-60 days; this stage is simply asymptomatic until bacteremia occurs.

Clinical Manifestations of Typhoid Fever

a. Gradual Onset

Headache, malaise, poor appetite Chills and fever Rose spots- skin eruptions seen on abdomen, chest, back (within 3-4 days) Splenomegaly in some cases Fever remains consistently high Abdominal distention Constipation and later on diarrhea Lethargy Intestinal bleeding and perforation (after 2-3 weeks)

b. Second week

c. Gradual decline in fever and symptoms subsides, too.

Typhoid Fever Pathophysiology and Schematic Diagram

Typhoid fever is an infection that causes diarrhea and arash -- most commonly due to a type of bacteria calledSalmonella typhi ( S. typhi ). See All NEWS & FEATURES

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REFERENCE FROM A.D.A.M.

Back to TopAlternative Names

Enteric fever

Back to TopCauses
The bacteria that cause typhoid fever -- S. typhi -- spread through contaminated food, drink, or water. If you eat or drink something that is contaminated, the bacteria enter your body. They travel into your intestines, and then into your bloodstream, where they can get to your lymph nodes, gallbladder, liver, spleen, and other parts of your body. A few people can become carriers of S. typhi and continue to release the bacteria in their stools for years, spreading the disease. Typhoid fever is common in developing countries, but fewer than 400 cases are reported in the U.S. each year. Most cases in the U.S. are brought in from other countries where typhoid fever is common.

Back to TopSymptoms
Early symptoms include fever, general ill-feeling, and abdominal pain. A high (typically over 103 degrees Fahrenheit) fever and severe diarrhea occur as the disease gets worse. Some people with typhoid fever develop a rash called "rose spots," which are small red spots on the abdomen and chest.

Other symptoms that occur include:

Abdominal tenderness Agitation Bloody stools Chills Confusion Difficulty paying attention (attention deficit) Delirium Fluctuating mood Hallucinations Nosebleeds Severe fatigue Slow, sluggish, lethargic feeling Weakness

Back to TopExams and Tests

A complete blood count (CBC) will show a high number of white blood cells. A blood culture during the first week of the fever can show S. typhibacteria. Other tests that can help diagnose this condition include:

ELISA urine test to look for the bacteria that cause Typhoid fever Fluorescent antibody study to look for substances that are specific to Typhoid bacteria Platelet count (platelet count will be low) Stool culture

Back to TopTreatment
Fluids and electrolytes may be given through a vein (intravenously), or you may be asked to drink uncontaminated water with electrolyte packets. Appropriate antibiotics are given to kill the bacteria. There are increasing rates of antibiotic resistance throughout the world, so your health care provider will check current recommendations before choosing an antibiotic.

Back to TopOutlook (Prognosis)

Symptoms usually improve in 2 to 4 weeks with treatment. The outcome is likely to be good with early treatment, but becomes poor if complications develop. Symptoms may return if the treatment has not completely cured the infection.

Back to TopPossible Complications

Intestinal hemorrhage (severe GI bleeding) Intestinal perforation Kidney failure Peritonitis

Back to TopWhen to Contact a Medical Professional

Call your health care provider if:

You have had any known exposure to typhoid fever You have been in an endemic area and you develop symptoms of typhoid fever You have had typhoid fever and the symptoms return You develop severe abdominal pain, decreased urine output, or other new symptoms

Back to TopPrevention
Vaccines are recommended for travel outside of the U.S., Canada, northern Europe, Australia, and New Zealand, and during epidemic outbreaks. If you are traveling to an area where there is typhoid fever, ask your health care provider if you should bring electrolyte packets in case you get sick. Immunization is not always completely effective and at-risk travelers should drink only boiled or bottled water and eat well-cooked food. Studies of an oral live attenuated typhoid vaccine are now under way and appear promising. Water treatment, waste disposal, and protecting the food supply from contamination are important public health measures. Carriers of typhoid must not be allowed to work as food handlers.

Back to TopReferences
Giannella Ra. Infectious enteritis and proctocolitis and bacterial food poisoning. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease . 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 107. Lima AAM, Guerrant RL. Inflammatory enteritides. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Elsevier Churchill Livingstone; 2009:chap 97.

Complications
By Mayo Clinic staff Intestinal bleeding or holes The most serious complication of typhoid fever intestinal bleeding or holes (perforations) may develop in the third week of illness. About 5 percent of people with typhoid fever experience this complication. Intestinal bleeding is often marked by a sudden drop in blood pressure and shock, followed by the appearance of blood in your stool. A perforated intestine occurs when your small intestine or large bowel develops a hole, causing intestinal contents to leak into your abdominal cavity and triggering signs and symptoms such as severe abdominal pain, nausea, vomiting and bloodstream infection (sepsis). This life-threatening emergency requires immediate medical care.

Other, less common complications Other possible complications include: Inflammation of the heart muscle (myocarditis) Inflammation of the lining of the heart and valves (endocarditis) Pneumonia Inflammation of the pancreas (pancreatitis) Inflammation of the gallbladder (cholecystitis) Kidney or bladder infections Infection and inflammation of the membranes and fluid surrounding your brain and spinal cord (meningitis) Psychiatric problems such as delirium, hallucinations and paranoid psychosis With prompt treatment, nearly all people in industrialized nations recover from typhoid. Without treatment, some people may not survive complications of the disease.