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Typhoid fever

Typhoid fever is an acute infectious disease that is caused by Salmonella bacteria and is characterized by damage to the intestinal lymphatic system. The disease proceeds with severe intoxication, an increase in the liver and spleen, and a rash.

In the external environment, typhoid paratyphoid bacteria are relatively stable. In water and soil, they can persist from several days to several months. A favorable environment for bacteria is food products (milk, sour cream, cottage cheese, minced meat, jelly), in which they are not only preserved, but also able to reproduce. The spread of infection is facilitated by the long-term preservation of viable typhoid bacilli in foods. Flies can play an important role in food contamination. Sometimes infection can also occur through the contact-domestic way, while the factors of transmission of the infection are surrounding objects. The disease has a predominantly waterborne transmission. Inadequate sanitary supervision and water supply malfunctions contribute to the waterway of the spread of infection. Oysters and shellfish grown in water bodies contaminated with sewage can be a source of infection if they are not subjected to appropriate heat treatment. Bacteria are well tolerated and low temperatures, but when heated quickly die. Disinfectants in normal concentrations kill the pathogen within minutes.

The source of infection is only a sick person and a bacterium carrier. The causative agents of typhoid fever are excreted from the patient’s body into the external environment along with bowel movements, urine and saliva. Massive excretion of the pathogen from the patient’s body begins after the 7th day of the disease, as much as possible - at the height of the disease and decreases during recovery. Often carriage. A seasonal increase in the incidence in the summer-autumn period is characteristic. Most often people fall ill between the ages of 15-45, mostly men, which is associated with greater mobility of the male population. After the infection, persistent immunity persists, but in some children repeated diseases are possible after a few years.

Clinical manifestations. Vomiting, bloating, and diarrhea are commonly observed. Body temperature can rise to 40.5 ° C, convulsions, as well as an increase in the liver, yellowness, lack of appetite, and body weight may decrease. The incubation period of the disease in older children ranges from 5 to 40 days, but usually is 10-20 days. This is followed by the initial period of the disease, which is characterized by a gradual increase in body temperature, malaise, muscle, headaches and abdominal pain. Children also have diarrhea or constipation. Nosebleeds, sometimes coughing, may appear. During the first week, body temperature becomes permanent, a feeling of malaise, weight loss, abdominal pain and diarrhea increase. A sick child becomes inhibited, he develops delirium. The child looks seriously ill, he is disoriented and indifferent to others. The rash occurs within 2-3 days and is found on the skin in the abdomen and lower chest in the form of spots with a diameter of 1-6 mm. The total number of rashes is small (10-30). Every element of the rash exists.

1-5 days, usually 3-4 days. After the disappearance of the rash, subtle skin pigmentation remains. Symptoms of damage to the digestive system at the height of the disease are maximum. The lips of patients are dry, often covered with crusts. The tongue is thickened, covered with a grayish-brownish coating, the edges and the tip of its bright red color with imprints of teeth ("typhoid" tongue). The abdomen is swollen. Manifestations of the disease decrease during

2-4 weeks if complications do not join. Headache ceases, sleep normalizes, appetite improves, tongue moistens, plaque disappears from it. The disturbed functions of the body are restored, and it is released from typhoid pathogens.

Malaise and lethargy can persist for another 1-2 months.

In young children, moderate and severe forms of the disease predominate. Moreover, the younger the child, the more severe the disease. The rapid onset of the disease, damage to the central nervous system with symptoms of meningitis and meningoencephalitis, the rapid development of intoxication are characteristic.
Most often there is lethargy, sleep disturbance, rarely anxiety, irritability, convulsions, delirium. Dry mucous membranes, lining of the tongue, abundant liquid stools of green color up to 10-15 times a day are noted. Some children experience vomiting. Bloating, enlarged liver and spleen are also characteristic. Specific complications rarely develop.

Diagnostics. It is based mainly on the basis of clinical data and laboratory studies of urine, feces, bile. Vidal's reaction is positive from the 2nd week, the diagnostic titer is 1/200 (the titer must be evaluated in dynamics).

Complications Complications of typhoid fever can be conditionally divided into specific, associated with the pathogenic effect of the pathogen and its toxin, as well as non-specific, caused by concomitant microflora.

Of the specific complications, intestinal bleeding, intestinal perforation, peritonitis, and toxic shock are of the greatest importance. Perforation occurs from the 11th day of illness, more often - at the 3rd week. Signs of intestinal perforation are abdominal pain, vomiting, bloating, palpitations, lack of gas, increased breathing, and fever. The first symptoms of intestinal bleeding are a decrease in body temperature and clarification of consciousness. Then the child turns pale, facial features are sharpened, cold sweat appears on the forehead, dizziness and thirst appear, the pulse quickens, blood pressure drops. Non-specific complications include pneumonia, meningitis, etc.

Treatment. The course and outcome of typhoid fever depends on proper care, diet and the timely appointment of antibacterial agents. Treatment is carried out in an infectious inpatient setting. Treatment should be comprehensive, that is, prescribe a protective regime and a balanced diet, use etiotropic and symptomatic agents. It is important for a sick child to ensure peace, a comfortable bed, good hygiene conditions. Equally important is the care of the oral cavity and skin. Bed rest should be observed until the 6-7th day of normal temperature. From 7-8 days it is allowed to sit, and from 10-11 days of normal temperature in the absence of contraindications it is allowed to walk. With the development of complications, strict bed rest is indicated. The diet should be mechanically and chemically sparing in relation to the intestines, which helps to reduce fermentation processes. Exclude foods and dishes that enhance the processes of decay and fermentation in the intestine. In the presence of fetid stool, protein food is limited, with a sharp flatulence - carbohydrate, with diarrhea, milk is excluded. However, the diet should be quite high in calories. Diet No. 4 meets these requirements. With recovery, the diet is gradually expanding. Infants are given expressed breast milk or adapted non-lactose mixtures (on the basis of soybean - “Nutrisoy”, “Alsoy”, “Frisosa”, on the basis of milk - “Isomil”). Vitamin therapy is mandatory (BP B2, PP, P, C in therapeutic doses).

Etiotropic therapy is prescribed to all patients, regardless of the form and severity of typhoid fever. The choice of drugs is carried out taking into account the sensitivity of typhoid salmonella to antibiotics. Treatment with cephalosporins and fluoroquinols is indicated. The course of antibiotic therapy lasts until the 10th day of normal body temperature. Detoxification therapy and restoration of water-electrolyte balance are also carried out. Enterosorbents (smecta, enterodesis, polyphepan, coal sorbents) are also used. All patients are prescribed antioxidants (tocopherol, ascorutin).

Herbal medicine is prescribed during the recovery period in the form of decoctions of herbs (chamomile, St. John's wort, cinquefoil), oak bark, pomegranate, etc. - as anti-inflammatory and astringent agents. A course of 1 month is recommended (1 tsp or 1 dess. L. 5-6 times a day). Every 10 days the grass needs to be changed.

The recovery of recovered children is carried out after a full clinical recovery, normalization of laboratory parameters, after 3-fold negative cultures of feces and urine and a single culture of bile.

Prevention Vaccination has been developed and is being applied (strictly according to epidemic indications).

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Typhoid fever

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