ENTERIC FEVER

                                                    ENTERIC FEVER

EPIDEMIOLOGY:-


It is an endemic disease caused by salmonella enterica.Transmitted by ingestion of contaminated food water or milk.Natural reservoir of the microorganism is humans.It transmits over congenitally and by intrapartum means.

Convalescent carriers-excrete salmonella for 3 months after the illness.Period of communicability is as long as bacteria is present in the exctreta.The disease spreads rapidly in hot summer months,over crowding,breakdown in safe water supply and sewage disposal.

PATHOGENESIS:-

Risk increases with increase in inoculum size,stomatch acidity,possession of Vi antigen.The microorganism invade peyers patches,then get transported to intestinal lymph nodes,multiply inside monocytes and gets carries to mesenteric lymph nodes.Macrophages then engulf bacteria and gets carried away alng with it to blood stream through thoracic duct which eventually causes primary bacteremia.Results in onset of fever.The microorganism spread to liver,spleen and bone moarrow causing more complications.It multiplies in liver and spleen and release antigens causing secondary bacteremia.

CLINICAL MANIFESTATIONS:-

Incubation period is 7-14days.Its less common under 2 years.It has got a gradual onset.Fever is of step ladder pattern and it is continuous generally.Patient suffers rapid increase in fver,headache and vomiting.Constipation,diarrhea and abdominal pain may also occur.Tongue will get a white coat at the center and clear at margins.Patient may have bradycardia.Typhoid rash appears on 6th day.Appears in crops called as rose spots for a few hours and fade on pressure.On second and 3rd week abdomen gets distended with a tympanic resonance.Splenomegaly of about 1-2 cm.The patient will be in a typhoid state which is characterized by dull sensorum,apathy,stupor,muttering delirium,pick at clothes.For school aged children and adolescents,initial symptoms are fever,malaise,anorexia,myalgia,headache and abdominal pain develop over 2-3days.Dirrhoea have a pea soup consisitency.Constipation becomes a prominent symptom later.Cough and epistaxis are also symptomatic.

In 2nd week of illness major symptoms are-high fever,fatigue,cough,abdominal symptoms and severe lethargy.PHYSICAL FINDINGS-a relative bradycardia disproportionate to fever.In 50% subjects,macular or maculopapular rash measuring 1-5mm appears.Rose spots appear on 7th-10th day.The lesions are slightly raised and blanch on pressure.10-15 lesions appear on the lower chest and abdomen and lats for 2-3 days.They lave a brown discolouration.

IN INFANTS-this disease is not so common.Mild fever and malaise with diarrhoea accompaniying are the symptoms.

All fever more than 7 days,low heart rate,blood tinged fecal matter all points to this disease.

THERAPY DEPENDS UPON-age,health sattus,serotype,and complications.Mortality if untreated is 10%.The disease recurs in 10-20% subjects.Typhoid is treated by using antibilocs,analgesics.