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Typhoid fever and paratyphoid fever are acute infectious diseases characterized by bacteremia, fever, intoxication, damage to the lymphatic apparatus of the small intestine, rose-like skin rashes, and enlargement of the liver and spleen.

Clinical diagnosis

The incubation period is from 1 to 3 weeks (an average of 2 weeks). The onset is often gradual. Weakness, fatigue, adynamia. Headache. Fever. Increased intoxication. Sleep disturbance, anorexia. Constipation, flatulence. In the initial period, symptoms are detected: lethargy, bradycardia, dicrotism of the pulse, muffled heart sounds, dry rales in the lungs; the tongue is covered with a grayish-brown bloom and thickened, from the edges and tip of the tongue is clean, catarrhal tonsillitis, enlarged liver and spleen. By the beginning of the 2nd week, the symptoms reach their maximum development: intoxication intensifies (impaired consciousness, delirium),

on the skin of the upper abdomen and lower chest there are elements of a rose-papular rash. Bradycardia, dicrotism of the pulse, blood pressure decreases, heart sounds are muffled. The tongue is dry, covered with a dense dirty brown or brown coating. Pronounced flatulence, often constipation, less often diarrhea. Rumbling and soreness in the right iliac region. In the blood - leukopenia, in the urine - protein. Complications: bleeding, perforation With paratyphoid A in the initial period, there are: fever, facial flushing, conjunctivitis, scleritis, catarrhal symptoms, herpes. Exanthema is polymorphic and appears earlier.

With paratyphoid B, a shortening of the period of the disease is noted, in the initial period, toxicosis and gastrointestinal disturbances are more pronounced, typhoid-like and septic forms are possible.

With paratyphoid C, typhoid-like, septic and gastrointestinal forms are found.

<Laboratory diagnosis

1. Bacteriological method0. From the first days of the disease at the height of the fever (during relapse), 5-10 ml of blood is sown in bile (selenite) broth (50-100 ml) in order to isolate blood culture. To isolate the pathogen, you can examine bowel movements, urine, scraping with roseol, and bone marrow punctate. The material is inoculated onto enrichment media or directly onto dense differential diagnostic media. Sowing blood, urine, feces, scraping with roseol can be repeated every 5-7 days. Sputum, pus, abdominal exudate, cerebrospinal fluid (according to special indications) can be subjected to bacteriological research in order to isolate the causative agent of typhoid fever and paratyphoid.

2. The serological method. From the 5-7th day of the disease with an interval of 5-7 days, a blood test is performed to detect antibodies and increase their titer in RA and RPHA separately with O-, H- and Vi-diagnostics.

3. To identify typhoid parathyroid carriage

bacteriological examination of bile and bowel movements (after giving a salt laxative). An indirect indication of the carriage of bacteria may be the detection of Vi antibodies.

Activities for patients and contacts

Hospitalization. Required Leaving the patient at home is allowed with the permission of the epidemiologist.

Isolation contact. Not carried out. Medical is being established

observation within 21 days from the moment of hospitalization of the patient (daily thermometry, a single bacteriological study of feces and a blood test in RPGA). Three phasing is carried out. When the pathogen is excreted from the bowel movements, a second study of bowel movements, as well as urine and bile, is carried out to determine the nature of carriage. With a positive result of RPHA (titer higher than 1:40), a single bacteriological examination of feces, urine and

Workers of food enterprises and persons equated with them, under

the positive result of bacteriological and serological studies are considered as chronic carriers and are not allowed to work. Their further observation and examination is carried out in the same way as convalescents (see below).

Statement conditions. Clinical recovery and a threefold result of a bacteriological examination of feces and urine (on the 5th, 10th and 15th day of normal temperature) and a single bacteriological examination of bile (for 12-14 days of normal temperature). Persons who have not received antibiotics are prescribed no earlier than the 14th day of normal temperature.

Admission to the team. Reconvalescents of typhoid fever and paratyphoid fever (except for workers of food enterprises and persons equivalent to them) are admitted to the team without additional examination.

Reconvalescents - workers of food enterprises and persons equated with them, are not allowed to work in their specialty for a month, by the end of which they excreted bowel movements and urine five times. If these people continue to isolate the pathogen, they are transferred to another job. 3 months after clinical recovery, they examine the bowel movements and urine five times with an interval of 1-2 days and once bile. If the result of the bacteriological examination is negative (a month after recovery), these persons are allowed to work in the specialty with a monthly bacteriological examination of bowel movements and urine in

the next two months and once a study of bile and staging of RPHA with cysteine ​​- by the end of the 3rd month. A single selection of the pathogen after 3 months after recovery leads to the removal of these persons from work with a change in profession.

Pupils of schools and boarding schools are admitted to the team, and in case of identification of carriage, they are suspended from duty on the catering and canteen.

Preschoolers-carriers of bacteria in the team are not allowed and sent to the hospital for examination for aftercare.

Clinical examination: All patients with typhoid fever and paratyphoid fever (except for workers of food enterprises and persons equated to them) are observed for 3 months. In the first 2 months, a medical examination and thermometry are carried out weekly, in the 3rd month - once every 2 weeks. A bowel examination of feces and urine is carried out monthly, a study of bile - after 3 months at the same time as RPGA with cysteine. With a negative result, they are deregistered, with a positive result, after-care, removal from duty on the catering and canteen.

Workers of food enterprises and persons equated with them are examined quarterly (bowel movements and urine - once) for 2 years, and then 2 times a year - until the end of their work. At the end of the 2nd year, they are given RPGA with cysteine ​​and, with a positive result, a five-fold bacteriological examination of bowel movements and urine and a single bile are performed

Specific prophylaxis

Immunization against this infection is regarded only as an additional tool in the system of a complex of antiepidemic measures. Vaccinations in modern conditions of a relatively low incidence of typhoid fever cannot have a significant impact on the course of the epidemic process.

Vaccinations, both routinely and according to epidemiological indications, are carried out taking into account the level of communal improvement of the populated areas.

Nonspecific Prevention

General sanitary measures (improving the quality of water supply, sanitation of populated areas, sewage, fighting flies, etc.).
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  1. Typhoid fever, paratyphoid A and B
    Training target: using diagnostic algorithms, be able to establish a diagnosis of typhoid fever, determine the clinical form, severity, complications and prescribe adequate treatment. Assignment for independent study of the topic. Using a textbook and lecture material to acquire the necessary basic knowledge, learn the following sections for practical training: 1) etiology;
    Typhoid fever and paratyphoid fever are called typhoid paratyphoid diseases. Typhoparathyphoid diseases are bacterial diseases, usually of an anthroponous nature, caused by bacteria of the genus Salmonella with a fecal-oral transmission mechanism, with a pronounced cyclicity, fever, bacteremia, symptoms of general intoxication and specific damage to the lymphatic apparatus of the small intestine.
  3. Intestinal infections (typhoid fever, paratyphoid A and B, dysentery, cholera) and their prevention.
    Acute intestinal infections include dysentery, typhoid fever, paratyphoid A and B, cholera infectious hepatitis, etc. These diseases are characterized by the same location (intestines), the same transmission route (fecal-oral), similar symptoms (disorders of the intestinal tract). Diseases are caused by pathogenic bacteria that are transmitted from a sick person to a healthy person.
  4. Pathogenesis of typhoid fever and paratyphoid
    In practice, the pathogenesis of typhoid and paratyphoid is identical. The causative agent enters through the mouth. Phases of pathogenesis: • the introduction phase includes the ingestion of a microbe in the mouth, where it is already possible to enter the lymphatic formations (because salmonella are tropic to the lymphatic system). There may be catarrhal inflammation in the tonsillar tissue, and then, at the height of the disease, there may be ulcerative necrotic
  5. Typhoid fever.
    Typhoid fever is an acute intestinal infectious disease caused by S.typhi abdominalis. The causative agent is the main representative of a large genus (2500 serotypes) of salmonella - flagellate gram-negative microbes that cause a disease called salmonellosis. Typhoid fever is the most dangerous form of salmonellosis, therefore it is isolated in an independent form. This is anthroponosis, the source is
  6. Typhoid fever
    Typhoid fever is an acute infectious disease caused by typhoid bacilli. Characteristic features are a predominant lesion of the lymphatic apparatus of the small intestine, high fever, severe intoxication and bacteremia. Epidemiology. Mostly people under the age of 20 get sick. The transmission of the pathogen is carried out by contact-household, water, food, and
  7. 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.
  8. Typhoid fever
    See the article FEVER, with the addition that the significance of typhoid is much more serious than that of ordinary fever. A patient with typhoid fever experiences very strong anger, which plunges him into a state of prostration and complete indifference to those around him. He should pacify his pride as soon as possible and forgive the person who caused this anger. (See the stages of forgiveness at the end of this
  9. Typhoid fever.
    The causative agent is Salmonella typhi. The transmission path is feck-op. The source of infection is a patient, a carrier of bacteria. Pathogenesis. In the small intestine, salmonella infects Peyer's patches and solitary follicles, distinguishes 4 stages, each of which lasts about a week: 1) brain-like swelling of lymphatic tissue, 2) necrotic lymphatic tissue, 3) rejection of necrotic ulcers, 4) stage of clean ulcers, 5) convalescence . Ulcers
  10. Typhoid fever
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  11. Typhoid fever
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  14. paratyphoid A and B (clinic, treatment)
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