Typhoid fever disease symptoms of agitation. Typhoid fever - symptoms and treatment. Diagnosis of typhoid fever. External signs

Typhoid fever - This infectious disease human bacterial nature, which affects the intestines and lymphatic system, characterized by prolonged fever, intoxication, damage to the intestinal lymphoid apparatus with the formation of ulcers in the small intestine. Symptoms develop gradually over more than three weeks: first, fever, chills and headache. Left untreated, typhoid fever can result in life-threatening intestinal perforation and bleeding.

Some people carry the disease without having symptoms when typhoid bacteria enters the bile or gallstones. From there, bacteria can periodically migrate into the intestines and be excreted in feces, thus contaminating water, soil or plants that have been fed with human waste. Typhoid fever responds well to antibiotic treatment. With early treatment severe symptoms unlikely, although approximately one in five patients experiences a relapse of the disease.

Etiology. The causative agent is the typhoid bacterium S.typhi, belonging to the family. Enterobacteriaceae, genus Salmonella, according to the Kaufman-Uyt scheme - to serogroup D.

These are gram-negative rods, motile due to the presence of flagella, do not form spores, and are aerobes.

Morphologically, S. typhi is not different from other Salmonella species. Differences were established by enzymatic activity (biochemical properties) and serological characteristics ( antigenic structure). S.typhi contains a somatic antigen - a heat-stable O-antigen, which includes a Vi-antigen (virulence antigen), and a flagellar (heat-labile) - H-antigen. Depending on their sensitivity to phages, pathogens are divided into 96 phage products (phage types); in Russia and the CIS, an abbreviated phage typing scheme is used, including 45 phage products.

S.typhi is a highly virulent bacteria and does not produce exotoxin. The mechanism of pathogenesis is associated with heat-stable endotoxin released during autolysis of the bacterial cell.

The virulence and pathogenicity of the causative agent of typhoid fever are not constant values. During the infectious process, with long-term persistence of the pathogen in the body, the microbe undergoes significant changes, which leads to the appearance of various variants, in particular to Z-transformation. Factors contributing to the formation of Z-forms include antibacterial therapy. The microbe isolated at the height of the disease is more virulent than during its decline. In conditions of high epidemiological morbidity, the continuous passage of microbes from one organism to another leads to an increase in the virulence and pathogenicity of Salmonella.

The bacteria are resistant to high and low temperatures and can withstand heating up to 60-70 °C for 20-30 minutes. They persist at the bottom of reservoirs for several months, in running water for several days, and in stagnant water for up to 1-1.5 years. Favorable environments for the development of S.typhi are food products (milk, sour cream, cottage cheese, jelly). At the same time, microorganisms are destroyed by exposure to ordinary disinfectant solutions phenol, Lysol, bleach and chloramine after a few minutes. The presence of active chlorine in water at a dose of 0.5-1.0 mg/l ensures reliable water disinfection against typhoid salmonella.

Causes

Typhoid fever is caused by the bacterium Salmonella typhi, which invades the wall of the small intestine.

Typhoid fever is spread through water and food contaminated by the feces of an infected person.

Almost 5 percent of recovered people become chronic carriers of the infection; they carry bacteria and spread disease, but they themselves show no signs of it.

Flies can spread bacteria and cause epidemics; it is usually seen in areas with poor sanitation.

Epidemiology. Typhoid fever is an anthroponosis.

According to WHO, there is not a single country free from typhoid infection. To date, deaths from this disease have not been ruled out. In this regard, typhoid fever is an urgent problem for practical and theoretical medicine.

In recent years, the incidence of typhoid fever in the Russian Federation has remained at a relatively low level. So, in 2003-2004. it did not exceed 0.1–0.13 per 100,000 population. However, in 2005, an increase in incidence was registered to 0.14 per 100 thousand population. The occurrence of typhoid fever is facilitated by the formation of chronic bacterial carriage as a reservoir of infection.

The source of infection is the patient or the bacteria excretor. The greatest danger is posed by patients in the 2-3rd week of the disease, since at this time massive excretion of the pathogen occurs in feces. In addition, an important role in the spread of typhoid fever is played by patients with mild and atypical forms of typhoid fever, in whom the disease remains unrecognized and their timely isolation is not carried out.

The pathogen is transmitted through household contact, water, and food. In addition, a significant role belongs to the “fly” factor.

Contact and household transmission is the main route among young children. In this case, isolated cases or family foci of infection are recorded.

The waterway is typical for rural areas.

Water outbreaks are easier than food outbreaks due to the relatively small dose of the pathogen, and are accompanied by a high level of morbidity. At the same time, the incidence curve has a steep rise and a rapid decline.

Foodborne outbreaks often occur after consuming contaminated milk and dairy products. In this case, the disease is characterized by a shortened incubation period, a more severe course, and possible deaths.

There is universal susceptibility to typhoid fever. Children get sick much less frequently than adults (16-27.5% of the total incidence). The age group most often affected is from 7 to 14 years. Contagiousness index 0.4.

Typhoid fever is characterized by a summer-autumn seasonality.

In the past, before the use of antibiotics, the mortality rate for typhoid fever exceeded 20%. Currently, subject to timely diagnosis and prescription of antibacterial therapy, the value of this indicator is less than 1%.

After past illness Most children are freed from the pathogen 2-3 weeks after body temperature normalizes. Convalescents develop persistent, usually lifelong, immunity. At the same time, in approximately 2-10% of those who have recovered from the disease, typhoid salmonella continues to be detected for many months in feces, bile, and urine. Among the reasons contributing to the formation of long-term or chronic carriage, one should indicate inadequate antibacterial therapy, the presence of concomitant diseases of the hepatobiliary system, kidneys, gastrointestinal tract, and immunodeficiency states. A number of authors consider typhoid carriage as a chronic infectious process.

Pathogenesis. The typhoid bacillus reaches the lower part of the small intestine through the mouth, bypassing the stomach and duodenum, where its primary colonization occurs. Invading the intestinal lymphoid formations - solitary follicles and Peyer's patches, and then into the mesenteric and retroperitoneal lymph nodes, the bacteria multiply, which corresponds to the incubation period. Then the pathogen breaks into the circulatory system - bacteremia and endotoxemia develop. In this case, the initial symptoms of the disease appear: fever, general infectious syndrome. As a result of hematogenous introduction of bacteria into various organs Secondary foci of inflammation and the formation of typhoid granulomas arise. Subsequently, secondary bacteremia develops. With bile, salmonella again enter the intestine, penetrating into sensitized lymphatic formations. At the same time, hyperergic inflammation develops in the latter with characteristic phases of morphological changes and dysfunction of the gastrointestinal tract.

Endotoxin released during the death of microorganisms has an effect on the central nervous system and the cardiovascular system, which may be accompanied by the development of typhoid status and hemodynamic disturbances, the manifestations of which are blood flow to the internal organs, a drop in blood pressure, relative bradycardia, gross metabolic disorders, and hepatosplenomegaly.

The onset of the infectious process is accompanied by the activation of the body's defense systems, the ultimate goal of which is the elimination of the pathogen and the restoration of disturbed homeostasis. In this process, an important role belongs to mucous-tissue barriers, the bactericidal properties of blood, the phagocytic activity of macrophages, and strengthening the function of the excretory systems (hepatobiliary, urinary and intestinal). Lysis of S.typhi, release of specific antigens, and their contact with immunocompetent cells leads to the launch of a cascade of reactions that implement the immune response. At the same time, the strength of the immune response is genetically determined and determined by the characteristics of the phenotype according to the HLA system.

The transferred disease leaves a fairly stable and long-lasting immunity. Recurrence of typhoid fever is rare.

At the same time, in 3-5% of convalescents, the formation of long-term bacterial carriage is possible, the pathogenesis of which has not been fully studied.

Chronic bacterial carriage is based on the intracellular persistence of the pathogen in the cells of the mononuclear phagocytic system, which is due to its genetically determined inferiority.

The process occurs throughout life in the form of two alternating stages - latency (in this case the pathogen is not released into the external environment) and release of the pathogen from the body.

Symptoms

Constant fever and chills. The temperature rises in the morning.

Headache.

Abdominal pain.

General poor health.

Muscle pain.

Nausea and vomiting.

Constipation or diarrhea.

Loss of appetite and weight.

A pale, reddish rash on the skin of the shoulders, chest and back that lasts three to four days.

Nosebleeds.

Personality changes, delusions; coma.

Convulsions in children.

Pathomorphology. In the first week of typhoid fever, focal inflammatory changes, usually of a productive nature, occur primarily in the lymphoreticular formations of the ileum. Granulomas are formed, consisting of large cells with massive light cytoplasm - the stage of medullary swelling.

At the 2nd week of the disease, the granulomas become necrotic.

At the 3rd week, necrotic areas are rejected, ulcers form, reaching the muscle layer and serous membrane. During this period, specific complications of typhoid fever - intestinal perforation and intestinal bleeding - develop most often.

In the 4th week, the period of clean ulcers begins.

At 5-6 weeks, ulcers begin to heal, without leading to scarring or stenosis.

The indicated stages of morphological changes in the intestine are to a certain extent arbitrary, both in nature and in terms of timing of occurrence.

Due to functional immaturity immune system In young children, pathological anatomical disorders are limited to the stage of cerebral swelling, so specific complications of typhoid fever do not occur in patients of this age group.

Classification

Typhoid fever is classified as follows:

1. By type:

Typical;

Atypical (erased and subclinical forms, occurring with predominant damage to individual organs - pneumotyphoid, nephrotyphoid, colotyphoid, meningotyphoid, cholangotyphoid).

2. According to the form of gravity:

Medium-heavy;

Heavy.

3. According to the nature of the flow:

Smooth;

Non-smooth (exacerbations, relapses, complications, formation of chronic carriage).

Examples of diagnosis:

1. Typhoid fever, typical, moderate form, acute, smooth course.

2. Typhoid fever, typical severe form, protracted, recurrent, unsmooth course.

Complications: intestinal bleeding, normochromic anemia.

Clinic

The incubation period for typhoid fever can range from 3 to 50 days. The average duration is most often 10-14 days.

In most children, the onset of the disease is acute. In this case, it is possible to distinguish periods of increase clinical symptoms(5-7 days), peak (7-14 days), decline (14-21 days) and convalescence (after 21 days of illness).

The disease begins with persistent headache, insomnia, increasing body temperature, and increasing intoxication. Then comes the oppression mental activity, and in severe forms - typhoid status. The latter is manifested by stunned patients, delirium, hallucinations, and loss of consciousness. Currently, typhoid status is rarely observed, which is apparently due to the early prescription of antibiotics and detoxification therapy.

One of the main symptoms of typhoid fever is fever. The average duration of the febrile period for typhoid fever in modern conditions is 13-15 days. In the acute period, the body temperature of most patients rises to 39-40 °C. In severe forms of typhoid fever, the fever is constant. It should be noted that the smaller the daily temperature range, the more severe the disease.

In mild and moderate forms, remitting or intermittent fever is often observed.

In the dynamics of typhoid fever, there are several types of temperature curve: Botkin, Wunderlich, Kildyushevsky. However, in modern conditions, fever of the wrong or remitting type predominates, which makes it difficult clinical diagnostics infections.

Changes in the digestive organs are characterized by dry, cracked (fuliginous) lips, an enlarged tongue coated with a thick brown (or dirty gray) coating, sometimes Duguay's sore throat, flatulence, hepatosplenomegaly, constipation, occasionally diarrhea (the appearance of "pea puree"), increased mesenteric lymph nodes (Padalka's symptom).

At the height of the disease, the cardiovascular system may experience relative bradycardia, pulse dilation, decreased blood pressure, muffled or deaf heart sounds.

On the 6-9th day of illness, a roseola rash appears on the skin of the abdomen, lateral surfaces of the chest and back in the form of pinkish small spots (2-3 mm in diameter). It is extremely rare that exanthema occurs on the face. When pressed, roseola disappears, but after a few seconds they appear again. Since the elements are not abundant, they are detected only upon careful examination. 3-4 days after the disappearance of the first roseolas, new elements may appear - the “spilling phenomenon”.

Kidney damage in most patients is limited to transient febrile albuminuria, but acute renal failure can also develop.

Reproductive system It is rarely affected, although orchitis and epididymitis may occur.

The period of resolution of the disease is characterized by a decrease in body temperature. At modern trend the temperature is often reduced by a short lysis without an amphibolic stage. Headache disappears, sleep normalizes, appetite improves, tongue cleanses and moisturizes, diuresis increases. At the same time, weakness, irritability, mental lability, and emaciation can persist for a long time. Low-grade fever is possible as a result of vegetative-endocrine disorders. An exacerbation of typhoid fever is characterized by a new increase in body temperature, deterioration of general condition, increased headache, painful insomnia, and the appearance of roseola exanthema.

Sometimes late complications develop: thrombophlebitis, cholecystitis.

It should be remembered that the clinical picture of typhoid fever is characterized by a certain polymorphism, in which symptoms indicating damage to certain internal organs can be recorded with different frequency.

With typhoid fever, characteristic changes are observed in the peripheral blood. So, in the first 2-3 days, the leukocyte count may be normal or increased. At the height of clinical manifestations, leukopenia, neutropenia with a shift in the leukocyte formula to the left, and accelerated ESR develop. A characteristic feature is aneosinophilia.

Features of typhoid fever in young children are an acute onset of the disease, a shorter febrile period, frequent occurrence of diarrhea syndrome, severe forms of the disease, and the threat of death. Catarrhal phenomena, meningeal and encephalitic syndromes are possible. Nonspecific complications develop quickly. At the same time, exanthema, relative bradycardia and dicrotia of the pulse, Duguay's angina, leukopenia, intestinal bleeding and perforation are rare.

The disease in vaccinated people is characterized by more light current, frequent development of abortive forms, shortening of the febrile period, rare occurrence of exanthema, complications and relapses, absence of deaths.

In the erased form of typhoid fever, the main symptoms of the disease are barely detectable, there is no significant intoxication, the body temperature rises to low-grade levels, and sometimes short-term liquefaction of stools is observed.

Diagnosis is possible only on the basis of bacteriological and serological studies, as well as with the development of specific complications.

The subclinical form has no manifest manifestations and is usually detected in lesions after additional examinations.

Atypical forms of typhoid fever include:

Feverless variant of the course;

Pneumotyphoid;

Nephrotyphoid;

Meningotif;

Encephalotif;

Colotif;

Typhoid gastroenteritis;

Holangotif;

Hyperpyretic;

Hemorrhagic.

With the listed types of disease, lesions of individual organs come to the fore in the clinical picture. In addition, the development of “typhoid sepsis” is possible, occurring without intestinal changes. Currently, these forms of infection are rare. Among atypical forms The most severe are hyperpyretic and hemorrhagic. With the latter, along with roseola exanthema, abundant hemorrhagic elements appear on the skin and mucous membranes.

The criteria for the form of severity can be used:

Nature and duration of fever;

The severity and duration of intoxication symptoms: the degree of damage to the central nervous system (headache, insomnia, lethargy, typhoid status), the degree of damage to the cardiovascular system (tachy- or bradycardia, decreased blood pressure, collapse);

Presence of signs of DIC syndrome;

The presence of specific and nonspecific complications.

The course of the disease is said to be unsmooth in the event of an exacerbation, relapse or complication. An exacerbation is understood as a new outbreak of an infectious process during the period of early convalescence. At the same time, as the disease subsides, until body temperature normalizes, fever and intoxication increase again, fresh roseola appears, and the liver and spleen enlarge. Exacerbations can be single or repeated.

Relapse is a return of the disease that occurs after body temperature normalizes and symptoms of intoxication disappear. Before the use of antibiotics, relapses more often occurred in the first two weeks of apyrexia, which determined the timing of discharge of patients from the hospital. It was noted that the more severe the typhoid fever, the higher the likelihood of relapse. In addition, antibacterial therapy started late or carried out in a short course also contributes to the reactivation of the infection.

Complications

Complications of typhoid fever can be both specific and nonspecific. The latter include pneumonia, mumps, abscesses, otitis, pyelitis, stomatitis, thrombophlebitis, neuritis, plexitis.

Intestinal bleeding can occur in 0.7-0.9% of patients with typhoid fever and, as a rule, develops at the end of the 2-3rd week. The formation of this complication is facilitated by late antibiotic therapy. Depending on the depth of damage to the intestinal wall, the number of bleeding ulcers, the caliber of ulcerated vessels, the level of blood pressure, and the state of blood coagulation, intestinal bleeding can be profuse or small (capillary bleeding). Bleeding occurs suddenly.

At heavy bleeding The deterioration of the patient’s condition coincides with the appearance of the following symptoms:

Decreased body temperature;

Increasing weakness, dizziness;

Pale skin, cold extremities;

Falling blood pressure, tachycardia;

Confusion, collapse;

The appearance in the stool of an admixture of blood, both altered (melena) and scarlet.

For light bleeding general state the patient may not change significantly and this complication is diagnosed either by the presence of tarry stools, or as a result of stool examination for occult blood and progressive anemia.

An equally serious complication is intestinal perforation, which occurs in 0.1-0.5% of patients with typhoid fever. Perforation usually occurs in the terminal ileum, rarely in the colon. Perforations can be single or multiple, their sizes range from barely noticeable to 1.5 cm.

When the intestine is perforated, patients experience:

Acute abdominal pain;

Defense of the anterior muscles abdominal wall, symptoms of peritoneal irritation;

Decreased body temperature, pale skin;

Cold sweat;

Shortness of breath of a mixed nature;

Small and rapid pulse.

In the future, in the absence of surgical assistance:

Facial features become sharper;

Intoxication increases;

Body temperature rises;

Hiccups and vomiting appear;

Liver dullness disappears;

Flatulence increases.

List of some diseases to be excluded for the fever syndrome

Infectious diseases	Non-communicable diseases
Typhoid fever	Acute leukemia
Paratyphoid A and B	lupus erythematosus
Typhus and Brill's disease	Acute pneumonia
Infectious mononucleosis	Rheumatism (exacerbation)
Typhoid-like form of salmonellosis	Acute pancreatitis
Adenovirus infection	Acute pyelonephritis
Miliary tuberculosis
Yersiniosis	Lymphogranulomatosis
Leptospirosis
Generalized form of tularemia
Crimean hemorrhagic fever
Acute brucellosis
HIV infection
Tuberculosis

Leukocytosis in a general blood test can develop several hours after the onset of perforation.

Diagnostics

Laboratory tests are required to make a diagnosis.

Differential diagnosis

By the “fever” syndrome, typhoid fever should be distinguished from a number of infectious and non-infectious diseases.

In most patients, paratyphoid A and B are practically impossible to distinguish clinically from typhoid fever. In this regard, the final diagnosis is established after receiving the results of bacteriological and serological studies.

Typhus differs from typhoid fever by the presence of:

Facial hyperemia;

Scleral vascular injections;

. "chalk" tongue;

Early enlargement of the spleen;

Early appearance of roseola-petechial rash with a favorite localization (flexor surfaces of the arms, abdomen, chest).

In the first days of the disease there is a need to carry out differential diagnosis between influenza and typhoid fever according to the “fever” and “intoxication” syndromes. It should be remembered that influenza is characterized by:

Increase in incidence during the cold season;

Violent sudden onset of the disease;

Short-term (3-4 days) increase in body temperature with an uncomplicated course;

Catarrhal syndrome.

In addition, with influenza there is no hepatosplenomegaly or roseola exanthema.

The clinical picture of acute brucellosis is characterized by severe sweating, polyadenitis, muscle and joint pain, neuralgia, and high, but relatively easily tolerated by patients, fever. Later, bursitis, fibrositis, and arthritis appear. An analysis of the epidemiological history is important, since brucellosis is most often occupational disease. The final diagnosis is established in the presence of positive reactions of Wright, Hadelson, and Burnet skin allergy test.

Infectious mononucleosis differs from typhoid fever:

1) availability:

. “lace” cheesy plaque on the tonsils;

Enlarged posterior cervical lymph nodes;

Changes in the hemogram - leukocytosis, lymphocytosis, atypical mononuclear cells;

positive reaction Paul-Bunnell, or detection of specific antibodies to EBV;

2) absence:

Dyspeptic syndrome;

Flatulence;

Roseola rash;

Brown plaque on the tongue.

Unlike typhoid fever, pseudotuberculosis can reveal:

Early (on the 1st-4th day of illness) scarlet-like, less often maculopapular, rashes on the skin;

Thickening of the rash in the form of a “hood”, “gloves” and “socks”;

Peeling of the skin;

Jaundice.

Help to distinguish leptospirosis from typhoid fever:

Characteristic epidemic history;

Stormy, sudden onset of the disease;

Complaints of pain in the calf muscles, aggravated by walking;

The characteristic appearance of the patient (hyperemia and puffiness of the face, scleritis);

Polymorphic exanthema (in severe patients - hemorrhagic), appearing on the 3-6th day of illness;

Arthritis symptoms;

Jaundice;

Meningeal signs;

Kidney damage (oligo- or anuria, positive Pasternatsky’s sign, changes in the general urine test in the form of proteinuria, leukocyturia, microhematurgia).

Laboratory diagnostics

The diagnosis of typhoid fever is based on data from bacteriological and serological studies. The material for bacteriological studies is blood, roseola contents, bone marrow punctate, bile, urine and feces.

The earliest method of bacteriological diagnosis is blood testing (hemoculture). Blood is taken on any day of illness when body temperature rises. The probability of isolating a blood culture depends on the timing of blood culture: the earlier, the greater the probability.

The likelihood of pathogen release is increased by subcutaneous administration (in the absence of contraindications) of a 0.1% solution of adrenaline in an age-appropriate dosage, which stimulates contraction of the spleen and promotes the release of pathogens into the bloodstream. In the early stages, blood is taken before the start of chemotherapy, at least 10 ml, in later stages - 15-20 ml. Sowing is done at the patient's bedside on a nutrient medium in a strict ratio of 1:10 (to avoid the bactericidal effect of blood on the pathogen).

If direct culture at the patient’s bedside is not possible, the blood is sterilely mixed with 40% sodium citrate in the following ratio:

9 parts of blood and 1 part of sodium citrate - and sent to the laboratory for further research.

The preliminary result is obtained in 2-3 days, the final result in 5-10 days. Increasing the frequency of inoculation (3 days in a row) increases the likelihood of isolating a blood culture.

When a rash appears on the skin, the contents of roseola can be inoculated. To do this, the skin over them is treated with 70° alcohol and scarified, then a drop of yolk or simple broth is added, sucked off, and transferred into bottles with 50 ml of broth. This method is not early, since roseola appears on the 8-10th day.

With bone marrow culture (myeloculture), positive results can be obtained both in the presence of body temperature and in normal temperature response.

Sowing of feces (coproculture) is usually carried out on the 8th-10th and subsequent days. To increase the likelihood of excreting coproculture, it is advisable to give a mineral laxative. Positive results are obtained in the 2-3rd, less often - in the 1st week of the disease.

Urine culture (urine culture) in an amount of 20-30 ml is performed directly on nutrient media, starting from the 2nd week of the disease.

Sowing of bile (biculture) of all 3 portions (A, B, C) in the amount of 1-

2 ml is produced on enrichment media from the 8-10th day of the disease. The probability of its isolation is 15 times higher than coproculture.

Serological methods are used at the end of the 1st week of the disease, during the period of appearance of specific antibodies.

The Widal reaction allows you to detect specific antibodies - agglutinins. Placed with O- and H-antigens. Antibodies to O-antigens appear on the 4th-5th day, and their level decreases during the period of convalescence. Antibodies to the H-antigen appear on the 8th-10th day and persist for 2-3 months after recovery. The result in the titer is considered positive

1:200 as it increases over the course of the disease. RIGA is more sensitive and specific, it is placed with O-, H- and Vi-antigens. The diagnostic titer with O- and H-antigen is 1: 160-320, with Vi-antigen - 1: 40-1: 80 and above.

Express diagnostic methods RIF, RSF, ELISA are used less frequently.

ELISA allows for separate determination of specific antibodies belonging to immunoglobulins of classes M and G. Detection of Ig class M indicates an acute disease, Ig class G indicates the vaccine nature of antibodies or a previous infection.

For the rapid diagnosis of typhoid fever and bacterial carriage, the following reactions are used;

Immunofluorescence analysis;

Phage titer increase reaction (RPT);

Antibody neutralization reaction (RNA);

Enzyme-linked immunosorbent method (ELISA);

Immunoradiometric analysis (IRA).

These methods are specific, sensitive and allow you to detect the presence of typhoid bacteria in the blood, urine, feces, and bile within a few hours.

Treatment

Do not take aspirin or other over-the-counter pain medications for typhoid fever unless prescribed by your doctor. These medications may lower blood pressure; aspirin may also promote gastrointestinal bleeding.

The antibiotic chloramphenicol is most often prescribed to treat typhoid fever in developing countries. Other antibiotics, such as ciprofloxacin or trimethoprimsulfamethoxazole, may also be effective.

Antidiarrhea medications may be needed to reduce diarrhea and cramping.

Blood transfusions may be necessary if there is bleeding in the intestine.

The corticosteroid dexamethasonone may be used in severe cases where the central nervous system is affected to relieve delirium, seizures, or prevent a stroke.

Urgent surgery may be necessary in case of intestinal perforation.

Several months of antibiotic treatment can eliminate bacteria from chronic carriers of the disease; sometimes necessary surgical removal gallbladder (cholecystectomy).

Treatment of typhoid fever in children is carried out only in a hospital and involves the appointment of strict bed rest, which should be observed until the 6th day of normal body temperature. Then the child is allowed to sit in bed, and from the 10th day of normal temperature - to walk.

The diet of patients should be mechanically and chemically gentle, help reduce fermentation and putrefactive processes and at the same time be sufficiently high in calories. Fractional feedings are used in small portions, every 3-4 hours. During the day, the patient should receive fluid in a volume corresponding to physiological need taking into account current pathological losses. During the period of convalescence, the diet expands and the volume of food gradually increases. Avoid foods that cause increased peristalsis and gas formation (brown bread, peas, beans, cabbage dishes). The diet includes boiled lean meat and lean varieties of boiled fish, egg dishes, white bread, fermented milk products, chopped vegetables and fruits.

As an etiotropic agent, ampicillin is prescribed intramuscularly or orally in combination with chemotherapy drugs that act on gram-negative flora. In addition to ampicillin, you can use chloramphenicol, amoxiclav, amoxicillin, unasin, rifampicin. Antibiotics are used throughout the febrile period and for another 7-10 days after normal body temperature has been established. Antibacterial therapy does not prevent relapses and the formation of chronic bacterial carriage. The use of antibiotics in combination with immunomodulatory agents promotes more effective elimination of bacteria from the body. Antifungal agents are prescribed according to indications.

Pathogenetic therapy involves the administration of fluid orally or parenterally according to general principles (depending on the form of severity), symptomatic agents, a complex of vitamins, protease inhibitors, etc.

Medical tactics with the development of a specific complication in a patient with typhoid fever depends on its nature. So, if there is intestinal bleeding, the patient should not be fed for 24 hours; after 10-12 hours, you can give him iced tea. After 24 hours, you can give a small amount of jelly, then over the course of 3-4 days the diet is gradually expanded and by the end of the week it is transferred to the usual table for typhoid patients. In case of prolonged and massive bleeding, catheterization of the central vein is advisable; subcutaneous administration of atropine for profuse bleeding reduces intestinal motility and improves thrombus formation. In addition, thromboerythrocyte mass, cryoplasma, fibrinogen, Vicasol, calcium preparations, rutin, ascorbic acid, and fibrinolysis inhibitors are used.

If symptoms of perforation of the intestinal wall appear, an urgent transfer of the patient to surgery department for suturing the perforated hole.

Convalescents of typhoid fever are discharged from the hospital after complete clinical recovery, but not earlier than the 14th day from the moment of normalization of body temperature (after treatment with antibiotics - no earlier than the 21st day) and receiving a double negative bacteriological examination of feces and urine, started on the day the antibiotic was discontinued and carried out at intervals of 5 days. Older children undergo a single duodenal intubation.

Persons who have had typhoid fever are subject to dispensary observation. In this case, no later than the 10th day after discharge from the hospital, fivefold bacteriological examination feces and urine with an interval of 1-2 days. Subsequently, for two years, three examinations of feces and urine are carried out 4 times a year. If the results are negative, children are subject to deregistration.

Diet must be mechanically and chemically gentle. A strict diet should be followed until the 12-15th day from the moment the temperature normalizes, then gradually move on to prescribing a general diet for convalescents (diet No. 15). During a febrile period, you can give following products: semi-stale white bread (150-200 g for an adult), white crackers (75 g per day), butter (30-40 g), yogurt, kefir, acidophilus (up to 500 ml of one of these dairy products per day) , sour cream (100 g per day), soft-boiled eggs or the yolks of two raw eggs; It is allowed to consume 25-30 g of granular or pressed black or red (chum) caviar. At lunch, the patient can be given 200 g of lean beef or chicken broth, or noodle soup with meatballs, slimy oatmeal soup, or semolina soup. As a second course, they serve steamed cutlets with the addition of 10-15 g of butter, boiled fish, well-cooked semi-liquid buckwheat porridge, and boiled vermicelli. We also recommend pureed fresh apples, mousses, jelly with blackcurrant or orange juice, and natural fruit, berry or vegetable juices. For drinking, you can give rosehip infusion, sweet tea, and a small amount of coffee.

Prevention

Wash your hands often with soap and warm water, especially after using the toilet or before handling food. Infected people should use a separate toilet and wash their hands or wear gloves before preparing food.

Get a typhoid vaccine (although it is only partially effective) before traveling to high-risk areas.

When traveling abroad or in areas with poor sanitation, drink only bottled water or other bottled drinks and eat only well-cooked foods and fruits that you can peel yourself. Do not use food grade ice.

Contact your doctor if you have persistent fever and chills along with other signs of typhoid fever.

It is necessary to maintain good sanitary conditions in populated areas, ensure proper water supply and sewerage, and carry out sanitary education work aimed at developing hygiene skills among the population. Healthy people who have had close contact with patients with typhoid fever should be under medical supervision for 25 days with mandatory daily temperature measurements and a single culture of stool and urine for typhoid bacteria. If they show even minor signs of the disease, hospitalization in the infectious diseases department of the hospital is necessary. Chronic bacteria carriers are subject to systematic monitoring.

Nonspecific prevention . After isolating the patient at the source of infection, final and ongoing disinfection is carried out. Persons who have had contact with a patient with typhoid fever are subject to medical observation for 21 days and a bacteriological examination is carried out once every 10 days (feces, urine). When the pathogen is isolated from feces, hospitalization is required to determine the nature of carriage and treatment.

Contacts are prescribed typhoid bacteriophage 50 ml at an interval of 5 days three times.

Children up to school age Those living in the outbreak and attending children's institutions are excluded from visiting preschool children's institutions until they receive a single negative test result for bacterial carriage.

The basis for the prevention of typhoid fever is sanitary and preventive measures: improvement of populated areas, supply of good quality water to the population, creation of a rational system for removing sewage and waste from the territory of populated areas, compliance with established rules for water use, production, transportation and sales food products, control of flies and sanitary educational work among the population.

Of auxiliary importance is preventive immunization, which is carried out for the population living in areas where the incidence rate exceeds 25 cases per 100 thousand.

Specific prevention . Vaccinations are carried out according to epidemiological indications from the age of 3-7 years, depending on the type of vaccine in areas unfavorable for this infection, and to persons at risk (population living in areas with a high incidence of typhoid fever, in chronic water epidemics of typhoid fever, persons , engaged in the maintenance of sewerage structures, equipment, networks; traveling to hyper-epidemic regions and countries for typhoid fever, as well as contingents in outbreaks according to epidemiological indications).

Characteristics of drugs. The following typhoid vaccines are registered in Russia:

Dry alcoholic typhoid vaccine, Russia.

VIANVAC - liquid vipolysaccharide vaccine (Russia).

Typhim Vi is a polysaccharide Vi vaccine produced by Aventis Pasteur (France).

Dry alcohol typhoid vaccine - ethyl alcohol-inactivated and lyophilized microbial cells of S. typhi strain 4446. Does not contain a preservative. One ampoule contains 5 billion microbial cells. The drug is intended for the prevention of typhoid fever in adults. Release form: ampoules, in a package of 5 ampoules with vaccine and solvent. Store at 2-8 °C for 3 years.

Vaccination is carried out 2 times: 0.5 ml, after 25-35 days - 1.0 ml, revaccination after 2 years at a dose of 1.0 ml. Injected subcutaneously into the subscapular region.

VIANVAC is a purified solution of capsular vi-polysaccharide: a colorless, transparent, slightly opalescent liquid with a phenol odor. It is used from the age of 3 once s/c into the outer surface of the upper third of the shoulder. A single dose for all ages is 0.5 ml (25 mcg). Revaccination - every 3 years. The introduction of the vaccine leads to a rapid and intense growth of specific antibodies, providing immunity to infection in 1-2 weeks, which lasts for 2 years. Release form: ampoules of 1 dose - 0.5 ml (25 mcg of Viantigen) and five doses - 2.5 ml of 5 or 10 ampoules in a pack or blister pack. Store for 2 years at 2-8 °C.

Typhim Vi is similar in composition to VIANVAK and contains 25 mcg of Vi antigen in 1 dose (0.5 ml). Administered once subcutaneously or intramuscularly, immunity develops after 2-3 weeks and persists for at least 3 years. Revaccination - once with the same dose. Used from 5 years of age, vaccinations for children 2-5 years old are carried out after consultation with a doctor. Available in a syringe of 1 dose and in bottles of 20 doses. Store for 3 years at 2-8 °C.

Adverse reactions and complications. The typhoid vaccine is alcohol-based, dry, reactogenic, a temperature of more than 38.6 °C is allowed, an infiltrate of more than 50 mm in no more than 7% of vaccinated people. The general reaction appears after 5-6 hours, its duration is usually up to 48 hours, local - up to 3-4 days. In extremely rare cases, shock develops.

Adverse reactions to the VIANVAC and Typhim Vi vaccines are rare and mild: low-grade fever in 1-5% within 24-48 hours, headache.

Contraindications. There are a wide range of contraindications to the use of alcohol-based whole-cell vaccine - both acute and chronic conditions. VIANVAC is administered no earlier than 1 month after recovery from acute or remission of chronic diseases; it is contraindicated in pregnant women. Typhim Vi is not administered in case of hypersensitivity to the components of the vaccine or in pregnant women.

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The origin of the name is typhoid fever; its roots go back to ancient times; this disease was known hundreds of years before our era. The term “typhoid” used to cover all diseases that were accompanied by clouding of consciousness or dizziness. A little later, this infection was classified as a “dangerous” disease, which was due to the peculiarities of its manifestation, since the symptoms resemble a combination of several diseases at the same time. But today the situation has changed dramatically for the better, although this infection still cannot be called mild or harmless.

What is typhoid fever and for what reasons does it occur? How does the disease manifest itself today and how often does it occur in modern world? What is the causative agent of this infection and the route of transmission? What are the phases of the disease and what are the symptoms at different stages of its development? How is typhoid fever tolerated and are there possible complications after it? How is this disease treated and what preventive measures should be followed? Below you will find answers to all these questions.

What is typhoid fever

Despite the fact that this infection has existed since the appearance of life on the planet, scientists have constantly learned something new about it.

1. Typhoid fever is an anthroponotic infection, that is, its source is a sick person who is contagious at almost any stage of the disease.
2. A person is contagious for a long time, starting from the end of the first week after infection, and the period of bacterial excretion of the pathogen itself lasts about three months.
3. Most often, adolescents and adults from 15 to 45 years old suffer from typhoid fever, and they are infected mainly by water. Infants can encounter the pathogen contained in mother's milk.
4. Mortality from the disease has always been high. What is the current mortality rate from typhoid fever? - it does not exceed 1% of all those who have recovered from the disease and is more often associated with complications.
5. Past infection provides 100% immune protection only for a few years. After this time, with a sharp decrease in immunity, you can become infected again.
6. The number of cases is decreasing from year to year; if in 2000 the total number of patients with typhoid fever worldwide was within several million, today in individual countries there are no more than several hundred. In Russia, the number of cases per year does not exceed hundreds of people.

Now typhoid fever is not as terrible as its many complications.

The causative agent of typhoid fever

There are a number of features that can help you learn more about the bacterium.

1. The causative agent of typhoid fever is very mobile. It does not form spores or capsules, but can be transformed into L-forms - this is a temporary cell-free state of the bacterium, which makes it resistant in the human body, including to many drugs.
2. The stick itself is unstable to the action of antiseptics and dies upon contact with alcohol and ordinary chlorine-containing solutions.
3. Bacteria persist for a long time external environment- they can stay in water for up to several months, and they multiply quickly in milk, sour cream and jelly.
4. A feature of the causative agent of typhoid fever is the ability to multiply in the cells of the lymphatic system, causing their death.
5. The typhoid bacillus tolerates low temperatures well, but when boiled it quickly dies.

Bacteria have flagella, so they are well mobile, but they grow better on media containing bile. This explains damage to the biliary tract and bacterial carriage, when a person, years after suffering from the disease, discovers typhoid fever pathogens in the gallbladder or digestive system.

Causes and routes of transmission of typhoid fever

The main mechanism of transmission is fecal-oral, that is, through the oral cavity. But there are several ways of transmitting typhoid fever, among which are the most important and acceptable.

The source of infection for typhoid fever is only humans. It doesn’t matter if this is a patient in the acute phase of the disease, a bacteria carrier, or someone who has worsened chronic infection. All of them are in the category of especially dangerous diseases. Susceptibility to the disease is high, so people become infected very quickly.

Pathogenesis of typhoid fever

How a bacterium behaves in the human body depends on the characteristics of its structure. The infectious agent has three important antigens or proteins, which are the cause of the destructive effect in the human body. Even when the bacteria dies, a toxin is released that continues to act.

The entry point for typhoid fever is oral cavity. But the pathogen easily passes through all the body’s defense systems on its way to the intestines. Of course, a small part of the bacteria dies, but this does not make a person feel better.

The pathogen stops in the initial part of the intestine, attaches itself to its cells and penetrates into the deeper layers of the lymphatic system. There are multiple formations in the intestines - follicles or clusters lymphoid tissue. It makes up a significant part of human immunity, which is often forgotten.

The first blow falls on the immune system, because having penetrated the lymph nodes, the typhoid bacillus begins to multiply intensively and causes local inflammation. The lymph nodes are the first to be affected by typhoid fever. At this time there are still no specific manifestations of the disease.

The pathogen then enters the bloodstream, which is associated with a violation barrier systems. The conditional second phase of the disease begins - bacteremia. The human body begins to fight, so some of the bacteria die. During their death, endotoxin is released, which contributes to further inflammation. Endotoxin is neurotropic, that is, the nervous system is also involved in the inflammatory process.

Later, typhoid bacteria infect the internal organs and it is at this time that, in order to get rid of the pathogen, the body tries to bring it out with all available methods: with bile into the intestinal lumen, with urine and feces.

Classification of typhoid fever

The severity of the infection can be mild, medium degree severity and severity, which is determined by the manifestations of the disease. According to its course, typhoid fever is classified into typical and atypical.

Typical infection occurs cyclically and includes 4 main phases of the development of typhoid fever:

• initial phase;
• peak period;
• resolution of the disease;
• recovery phase.

An atypical course of typhoid fever is rare and has a relatively benign course. This is an abortive and erased form of the disease.

The disease is also divided into complicated and uncomplicated.

Symptoms at different periods of the disease

Each period of development of typhoid fever occurs with certain symptoms and has its own characteristics.

First phase of typhoid fever

The incubation period is the most dangerous in terms of the spread of infection. Indeed, at the moment the pathogen appears in the blood and penetrates all internal organs, a person is already infectious to others.

The duration of the incubation period for typhoid fever is from 9 to 14 days. But it can vary within other limits - from a week to 25 days.

The initial period of the disease lasts a long time. At this time the person is disturbed following symptoms.

After approximately 7 days, the first period of initial manifestations of typhoid fever ends and the time of increasing symptoms and the height of the disease begins.

Second phase of typhoid fever

The disease does not occur in waves, but rather with an increase in the main manifestations. During the height of the disease, the symptoms intensify and new ones appear, because the causative agent of typhoid fever is in the blood, and the toxin released as a result of its partial destruction affects more and more new systems. Changes accompany the initial clinical manifestations nervous system. This period lasts about two weeks.

What signs of typhoid fever can be noted at this stage?

This period is the most dangerous due to numerous severe symptoms and complications of typhoid fever. In the best case, it goes away in 9–10 days.

Periods of resolution and recovery

The next stage of typhoid fever is the resolution of the disease, which lasts about a week. General health much better, but gradually.

1. The temperature drops, but in a special way, the difference between morning and evening sometimes fluctuates within 2.5 ºC.
2. Sleep is normalized.
3. The effect of the toxin is reduced, so headaches during typhoid fever also gradually subside.
4. Appetite improves and kidney function is restored.

The recovery period is the most anticipated after all manifestations of typhoid fever. But this is a long stage in the development of the disease. For at least two weeks, a person is still worried about some weakness, only gradually the body gets rid of the pathogen, and the functions of all organs are completely restored. The maximum time the body adapts is about a month.

Despite timely and correctly selected treatment, 3–5% of patients may experience a relapse of the disease. In the third week after the peak phase of typhoid fever subsides, the temperature begins to slowly rise, but recovery does not occur. At the same time, the person’s liver and spleen are still enlarged and inflamed, the rash appears earlier, and repeated typhoid fever is much easier. Another feature is its short course.

Typhoid fever in children follows the same scenario as in adults, with the same clinical manifestations. But mostly school-age children get sick. At an early age in children, the disease occurs atypically with an acute onset.

Complications of typhoid fever

The desired outcome of any infectious disease is complete recovery. But in the case of typhoid fever, this option is not always available. The disease is dangerous due to its numerous and severe complications. As for this disease, they occur not only after the disease itself subsides, but also during the active manifestation of one of the periods.

Complications of typhoid fever are possible as follows.

1. Sometimes during the development of the disease itself, inflammation of one or another organ predominates - the membranes of the brain, lungs, cecum (they are called meningotif, pneumotyphoid, and so on, based on the presence of inflammation in a particular system).
2. The second group of complications are the nonspecific consequences of typhoid fever, which develop due to the weakness of the immune system after an infection: bronchitis and pneumonia, meningitis, thrombophlebitis, inflammation of the kidney tissue.
3. Specific complications of typhoid fever are more severe processes, one of them is intestinal bleeding, which occurs in 2% of cases and more often appears in the third week, can be local or diffuse (in all parts), occurs due to the weakness of the vascular walls in the affected areas, and also due to a decrease in blood clotting and a tendency to thrombosis. Minor bleeding will have virtually no effect on a person’s condition, but severe bleeding can cause shock.
4. Perforated peritonitis is an undesirable complication of typhoid fever, when, due to the weakness of the intestinal wall, its membrane breaks through and the entire contents enter the abdominal cavity. This is facilitated by sudden movements, increased peristalsis and flatulence. Peritonitis develops in 1.5% of cases and approximately in the second week after the onset of the disease.
5. During the height of typhoid fever, no more than 1% of diseases are complicated by infectious-toxic shock, which occurs due to the presence of a large number of bacteria and their toxins in the human body; with its development, a sharp decrease in temperature occurs, blood pressure drops, sweating increases, and the amount of urine excreted decreases.

Diagnostics

Diagnosis of typhoid fever does not always begin from the moment the tests are taken. The area where the infection occurs and the manifestation of the disease plays a major role in making a diagnosis. Until the pathogen is identified, typical clinical manifestations of typhoid fever can help doctors. The problem is that in recent years the disease does not always occur with the classic picture, and in the case of vaccination, symptoms are rare.

Then blood tests are the basis of diagnosis. How is a typhoid fever test taken? The study can be carried out from the first day of illness and throughout the febrile period. For bacteriological culture on media, blood is taken from the antecubital vein in sterile conditions from 5 to 15 ml. Then, in the next few minutes, it is inoculated into vials with 50–100 ml of bile broth. The result is assessed several hours or days after taking. But such a study has its drawbacks:

• if you take blood for typhoid fever and do not maintain its concentration with the medium at 1:10, then the blood cells will inactivate or defeat the microorganism and the analysis will be meaningless;
• in the case when a person has been vaccinated against an infection, the cells of the causative agent of typhoid fever remain in the blood - there will be false positive test;
• Bacteria can also be detected in all those who have recovered or are carriers of the bacteria.

To finally determine the diagnosis, they carry out serological studies for typhoid fever. This is a determination of the titer of antibodies to a pathogen in human blood. They mainly make RA and RPGA. A titer of 1:200 is considered positive.

For the Vidal reaction to typhoid fever, the first study is carried out 5–7 days from the onset of the disease. Then the same is done at 3-4 weeks. The titer increases 2, 3 and higher times (1:400, 1:800). Such research is gradually losing its significance, as other methods help to quickly determine the diagnosis.

The pathogen can also be detected in urine, feces, sweat and rashes.

Treatment of typhoid fever

Regardless of the severity of typhoid fever, it should be treated only in a hospital setting. Patients not only feel unwell, they are carriers of infection, so they are isolated as much as possible from others.

What treatment principles should be followed?

1. According to clinical guidelines For typhoid fever, patients need a special diet - as gentle as possible during the febrile period with a gradual expansion at the time of recovery. A person needs to be provided with peace and good hygienic conditions.
2. To relieve symptoms of intoxication and support the body, plasma-substituting solutions, glucose and Ringer's solution are used.
3. The main treatment for typhoid fever is long-term administration of antibiotics, and in the case of bacterial carriage, antibacterial drugs are prescribed for a period of several months.
4. In case of severe infection, hormonal drugs are prescribed.

Prevention of typhoid fever

For the purpose of general prevention of typhoid fever, compliance with sanitary and hygienic standards when collecting water from open sources for use in everyday life is monitored. Public catering establishments are monitored and Food Industry for their compliance with the sanitary regime.

Personal prevention includes avoiding swimming in unfamiliar bodies of water, maintaining hygiene, washing raw vegetables and fruits, and heat treatment of meat and milk.

In areas of infection, disinfection is carried out, as well as isolation of sick people.

Vaccination is also used for prevention purposes. First of all, vaccinations are given in those areas where outbreaks of typhoid fever are often recorded. In other countries - according to epidemic indications.

What is special about typhoid fever? - its long course and varied manifestations. Numerous symptoms affecting not only the intestines, but also the immune system and nervous system are characteristic of this infection. Therefore, there is no need to try to treat typhoid fever on your own; the best help is to consult a doctor in a timely manner.

Content

A healthy digestive tract is the dream of every person. However, even banal symptoms (tendency to constipation, frequent bowel movements) should alert you. There is a bacterium, the presence of which in the body leads to serious violations, and when improper treatment complications can be devastating.

What is typhoid fever?

An acute infectious disease, typhoid fever, is caused by salmonella. The pathogen affects the lymphatic structure of the intestine, causing fever, intoxication, elevated body temperature, general malaise, severe lethargy, a characteristic skin rash, and impaired consciousness. Today, the infection has been practically destroyed; many countries, at a high level of development of hygiene and medicine, have managed to reduce its development to a minimum. Unsanitary conditions often create an environment for bacteria to grow.

Examination of many patients showed that infection is a big problem. The disease is characterized by the following ways of spread:

• Transmission occurs more often during the hot season.
• Adults and children have equal 100% susceptibility to the bacterium.
• Carriers are dangerous for healthy people: Although symptoms do not appear, transmission of the pathogen is possible.
• Even isolated cases can lead to the development of an epidemic.
• The route of infection can be oral or fecal, through the secretions of a carrier or a patient in environment.

Typhoid fever - classification

The classification of typhoid fever is also varied. The basis is the distinction between variants of the disease: typical and atypical. The second type of disease is divided into abortive, erased (any symptom is absent), or asymptomatic, and other types and forms of the disease. Using specific diagnostics, you can determine the type of the disease, which will help you quickly select therapy for the carrier. bacterial infection.

The causative agent of typhoid fever

The bacteria salmonella typhi is the causative agent of typhoid fever. The microorganism looks like a gram-positive rod with many small flagella. It is difficult for the surrounding world to fight it due to the possibility of its long stay in the environment (up to two months) and its presence in food products (dairy products, meat and minced meat). The study has proven that the stick is resistant to a decrease in temperature, but an increase or exposure chemical substances have a negative effect on her.

The epidemiology is as follows: the source and carrier of this type of salmonella is only humans. If incubation maturation has passed, bacteria begin to be released into the environment surrounding the sick person. The process lasts throughout clinical manifestations until complete recovery. Salmonella typhi and its etiology, as well as the signs of the disease it causes, have not been known to scientists for so long. It does not form spores, but it contains endotoxin that affects the human body.

Mechanism of transmission of typhoid fever

Anthroponotic typhoid fever is transmitted in a simple way - fecal-oral, its pathogenesis is very simple. The source of infection can be water, food, and household items that previously came into contact with feces and contained a lot of salmonella. Community spread most often occurs through open water or other waterways. Dairy products and meat are at particular risk.

Transmission occurs both from animal to person and vice versa, but the first will simply be a carrier. Contact or household cases of infection are rare; this happens only in the erased form, when the patient may not be aware of the presence of the pathogen. This developmental mechanism is a vicious circle; to stop it, therapeutic intervention is necessary. Pathogens can constantly appear and spread throughout the body from the lymph nodes, passing into the blood. The spleen and liver are affected, causing harm to the entire body.

Typhoid fever - incubation period

The incubation period of typhoid fever varies, the approximate period is from several days to four weeks. Previously, doctors believed that the disease progresses slowly and progressively, but observation has proven that the acute period is the beginning of the development of bacteria. Once the infection enters the bloodstream, it ends incubation period, and the first indicative symptoms appear.

Typhoid fever - symptoms

Symptoms of typhoid fever can be extremely pronounced or, conversely, almost invisible. More often, the clinical picture of the disease is very diverse and can be characterized at the very beginning by symptoms like a cold or intestinal poisoning. It all depends on the severity and form of the disease. On average, symptoms are as follows:

• fever;
• rash;
• intestinal bleeding;
• The patient's internal organs are affected.

Severe course leads to many unpleasant symptoms. This:

1. headache;
2. hypotension;
3. delirium, confusion;
4. bradycardia;
5. with the accumulation of endotoxins – infectious-toxic shock;
6. patients are inhibited due to neurotoxic effect on the nervous system;
7. the stomach is swollen;
8. in advanced cases or severe forms – hallucinations.

A tongue with teeth marks, which has a brownish coating, is a typical indicator of intestinal disorders. Fever- the first permanent symptom indicating the presence of Salmonella waste products in the blood. Those who are ill are often lethargic and negative towards their surroundings. They also study the dullness of heart sounds, which indicates the third stage of the disease, when myocarditis develops.

The rash is the same characteristic manifestation like the temperature. It occurs in the second week of the disease. The changes protrude slightly above the surface of the skin, covering small areas of the skin of the back, sternum and abdomen. The face is often not affected. Pale pink round rashes with clear boundaries - roseola - persist for about 4 days and then disappear without a trace. Elements of the rash may appear periodically.

Diagnostics

A blood test for typhoid fever is taken in the early stages of the disease, and it is isolated by culture on nutrient media. In 3-4 days you can receive an answer. Serological analysis is auxiliary, and it should be done using RNG. For rent on laboratory analysis urine and feces, as well as intestinal contents and duodenum after probing.

Treatment of typhoid fever

Treatment of typhoid fever should be carried out in a hospital, where the correct and necessary care. The infectious type of the disease is very contagious, so the person must be isolated from others. Doctors prescribe antibiotics when severe poisoning Toxins are prescribed a specific course of treatment, mixtures for intravenous administration. The patient is discharged on the 20th day after normalization of body temperature, when the bacterial culture test is negative.

Diet

The standard diet for typhoid fever should be high in calories, easily absorbed by the body and healthy. It is recommended to steam everything, the maximum variety of cereals, light soups and drinking in large quantities. In order for the body to recover faster, you should eat small portions at least five times a day: this way the intestines will not be empty or overexerted. Balanced fractional nutrition is one of the stages of rapid recovery; the body should not starve.

Complications of typhoid fever

Health workers are against self-medication, because this leads to a number of problems. The consequences of typhoid fever can be very severe: bleeding in the intestines, complications such as peritonitis, sagging of the intestinal wall. In most cases, the prognosis is favorable, and there is every chance of a full recovery. Possible nonspecific complications:

• pneumonia;
• cholecystitis;
• blockage of blood vessels by blood clots.

Prevention

Prevention of typhoid fever includes the prevention of morbidity, transmission of the pathogen must be blocked, and typhoid status is declared in outbreak areas. When traveling to high-risk countries, you should be vaccinated and adhere to all personal hygiene rules. At the first suspicion or appearance of symptoms, seek help at the hospital.

Video: typhoid fever - what is it

Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on the individual characteristics of a particular patient.

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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 specific antigen virulence, i.e. 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, and also due to the ability of the pathogen long time persist (be present) in the body, new drugs are created resistant strains; 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 when high temperatures(boiling, autoclaving, etc.) 60˚ C – 30 minutes, when boiling, 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 sections digestive tract, bypassing all protective mechanisms, the pathogen reaches the small intestine and invades 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 it breaks into the bloodstream and bacteremia occurs (Salmonella typhi 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, if diagnosis and treatment are not timely, that the connective tissue framework of the intestine is practically destroyed, resulting in a high risk perforated ulcers and peritonitis.

Due to the affinity for nervous tissue, symptoms are not limited to damage to the nervous system of the intestine; lesions occur on the side peripheral nerves 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. Because excretory function the above organs are 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 formation 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, they take different materials for research and is 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), take the following materials for research using the following methods:
- Bacteriological method with blood/urine/feces culture on nutrient media; How it will be 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).

Partially the patient is transferred to parenteral (via intravenous administration) 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);
Employee survey food enterprises(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.

Typhoid fever is an acute anthroponotic infectious disease caused by Salmonella typhi. The disease is widespread throughout the world, but typhoid outbreaks are most often observed in countries with hot climates and poor sanitation conditions (absence or poor quality of centralized water supply and sanitation).

At the moment, there are about 16 million cases of typhoid fever every year in the world. Of these, more than 600 thousand cases of the disease are fatal.

In countries with developed economies and high standards of living, the disease occurs rarely and, as a rule, in the form of isolated outbreaks. On the territory of the Russian Federation, typhoid salmonella are most often found in Dagestan and Chechnya.

Typhoid fever is an anthroponotic disease, manifested by the development of severe febrile syndrome, general intoxication symptoms, hepatolienal syndrome, as well as specific roseola rashes and changes in the intestines ( ulcerative lesions lymphoid structures in the small intestine).

In terms of etiology, epidemiological features, developmental pathogenesis and clinical symptoms, the disease is very similar to the paratyphoid group. Typhoid fever and paratyphoid types A, B and C form a class of typhoid paratyphoid pathologies. For a long time, paratyphoid fever was even described as a mild form of typhoid fever with a blurred clinical picture.

For reference. It was found that paratyphoid fever is caused by an independent species of Salmonella, which, unlike typhoid, affects the lymphatic structures of the large intestine and less often leads to the development of severe destructive lesions in the intestine.

According to the ICD10 classification, typhus and paratyphoid fevers are classified as A01. Typhoid fever code according to ICD10 is A01.0.

Typhoid fever is the causative agent

The cause of typhoid fever is typhoid salmonella, which belongs to the genus Salmonella and is part of the family of intestinal enterobacteriaceae.

Typhoid Salmonella are able to survive at low temperatures, but they are highly sensitive to heat. A temperature of 60 degrees kills salmonella in half an hour, and when boiled, typhoid salmonella die in a few seconds.

Attention. The most favorable environment for the proliferation of salmonella is food. In milk, sour cream, cottage cheese, minced meat, etc. The infectious agent can not only persist for a long time, but also actively reproduce.

How can you get typhoid fever?

Typhoid fever is a typical intestinal and anthroponotic infection (that is, only humans can be the source and natural reservoir of the causative agent of typhoid fever).

Both patients with typhoid fever and healthy bacteria carriers pose an epidemiological danger.

The disease is characterized by a pronounced summer-autumn seasonality. Typhoid fever is most often reported in patients between fifteen and forty-five years of age.

Attention. The greatest danger is posed by healthy bacteria carriers or persons carrying typhoid fever in an erased form. Such patients do not know that they are sick and can cause massive outbreaks of typhoid fever, especially if they work with food (food department employees).

The main route of transmission of typhoid fever is fecal-oral. In children's groups, contact and household mechanisms of salmonella transmission can also occur (shared toys).

Patients or carriers excrete Salmonella in feces and urine (in small quantities). Bacteria begin to be actively released into the environment from the seventh day of illness.

Important. Most often, infection with typhoid fever occurs through consumption of water contaminated with salmonella (the pathogen can remain active for a long time in fresh water), milk, sour cream, cottage cheese, ice cream, minced meat (not fully processed). heat treatment) etc.

Humans have a high level of susceptibility to typhoid Salmonella.

After an infection, stable immunity is formed. In isolated cases, repeated typhoid fever is recorded.

Forms of the disease

Based on the nature of the clinical picture, the disease is divided into:

• typically;
• atypical (erased, abortive, outpatient, also includes rare forms - pneumotyphoid, meningotyphoid, nephrotyphoid, colotyphoid, typhoid gastroenteritis).

The pathology can be acute and occur with exacerbations and periods of relapse.

The severity of the infection may be mild, moderate, or severe. Depending on the presence of complications, the disease can be uncomplicated or complicated. Complications of infection may include:

• specific (the occurrence of intestinal perforation with profuse bleeding, shock, etc.);
• nonspecific (the occurrence of pneumonia, parotitis, cholecystitis, thrombophlebitis, orchitis, etc.)

Pathogenesis of the development of typhoid fever

Typhoid fever is an infection with a specific cyclicity and the development of specific pathophysiological changes. Since salmonella enters the body through the mouth, the mucous membranes of the digestive tract serve as the entry point for infection. However, due to the bactericidal effect of gastric juice, if salmonella enters in small quantities, the pathogen can die without leading to the development of the disease.

If salmonella enters the small intestine, it begins to actively multiply and fixate in the lymphoid structures of the small intestine and accumulate in the lymph nodes of the abdominal cavity. The entry of Salmonella into the lymphoid formations of the intestine is accompanied by the development of lymphangitis, mesadenitis, inflammation in the small and sometimes large intestine.

For reference. Damage to the intestinal lymphoid system occurs even before the end of the incubation period of typhoid fever. Subsequently, the pathogen breaks through into the blood, accompanied by the development of severe bacteremia.

Due to the phagocytic activity of leukocyte cells, part of the pathogen dies, releasing endotoxins and causing severe intoxication. At this stage, vivid clinical symptoms of typhoid fever develop: fever, adynamia, drowsiness, lethargy, pallor and cyanosis of the skin, bradycardia, constipation appear, due to paresis of the intestinal muscles, etc.

This period of illness can last from five to seven days. At the same time, part of the pathogen continues to actively multiply in the lymph nodes of the abdominal cavity, maintaining the constant flow of salmonella into the bloodstream and the development of severe inflammation of the lymphoid intestinal formations of the “brain-like swelling” type.

Against the background of ongoing bacteremia, internal organs (tissue of the liver, kidneys, spleen, bone marrow) are affected. This process is characterized by the appearance of specific inflammatory granulomas in them, as well as the development of neurotoxicosis and hepatosplenomegaly (enlargement of the liver and spleen).

Also, the body begins to actively synthesize antibodies to salmonella and the patient develops sensitization, manifested by the appearance of a specific rash. Typhoid fever rashes are foci of hyperergic inflammation in places of greatest accumulation of pathogens in the skin vessels.

Attention! At this stage, the patient is maximally contagious, as he excretes a huge amount of typhoid Salmonella in his feces and urine.

With repeated penetration of bacteria into the intestines, an anaphylactic reaction develops with necrosis of lymphatic tissue.

The severity of bacteremia decreases only in the 3rd week of the disease. In this case, inflammation in the organs persists, and the process of rejection of areas of necrosis in the intestines begins, with the formation of deep ulcers. At this stage of the disease, there is a high risk of developing severe complications: perforation of intestinal ulcers, bleeding and peritonitis.

By the end of the fourth week, the intensity of bacterial circulation in the blood reaches a minimum, body temperature normalizes and the severity of intoxication syndrome decreases.

However, in some cases, typhoid Salmonella can persist in monocytes, leading to distant relapses or exacerbation of the disease. It is also possible that secondary bacterial foci (pyelitis, cholecystitis, etc.) may occur due to the penetration of bacteria into the biliary and urinary systems.

Symptoms of typhoid fever

The incubation period for typhoid salmonella ranges from three days to twenty-one days (in most cases from nine to fourteen days). In the period of initial manifestations, the patient experiences general intoxication symptoms: nausea, loss of appetite, weakness, irritability, headaches. In some cases, the disease may begin acutely, with a sharp increase in temperature and severe intoxication.

With a gradual onset, the fever progresses slowly. The maximum increase in temperature (up to forty degrees) is observed on the fifth to seventh day of the disease. In patients with acute onset, severe intoxication and high fever may be observed already on the second day of the disease.

For reference. Patients with typhoid fever are sharply inhibited, adynamic, and indifferent to what is happening. When you try to talk to them, they give monosyllabic answers after a long pause or do not answer at all. The skin is pale and slightly cyanotic. In some cases, mild facial redness and swelling may occur.

Damage to the cardiovascular system is accompanied by a decrease in blood pressure and a slowdown in heart rate (bradyarrhythmia).

Patients are often bothered by coughing and nasal congestion. When auscultating the lungs, you can hear a lot of scattered dry rales.

Tongue for typhoid fever

Characterized by thickening of the tongue, the appearance of clear teeth marks and a grayish coating on it. At the same time, there is no plaque on the tip and edges of the tongue and their bright red color attracts attention.

There is moderate hyperemia in the pharynx, the tonsils are enlarged.

On palpation of the abdomen, severe bloating and the appearance of a rough, sonorous rumbling in the iliac region are noted. Palpation of the abdomen is sharply painful.

Patients are worried severe pain in the abdomen (manifestation of ileitis and mesadenitis), constipation, nausea, vomiting, severe weakness. Oliguria (decreased urination volume) gradually develops.

For reference. During the height of the disease, patients are in a state of severe stupor. They do not recognize loved ones and hospital staff, delusions and hallucinations, severe daytime drowsiness and night insomnia, incoherent speech, etc. are noted.

In some cases, small ulcers may appear on the palatine arches (signs of Duguay's angina). By the tenth day of illness, most patients develop reddish-pinkish rashes of a roseolous nature, covering the abdomen, lower chest and, sometimes, limbs.

Important. The rash is strictly monomorphic, that is, it can only be roseola. The number of rashes varies from six to eight (rarely more). The rashes stand out sharply against the background of pale skin. In severe cases of the disease, the rash may be hemorrhagic in nature.

Roseola typhoid rash

The rash lasts from three to five days, after its disappearance there remains a slight pigmentation of the skin. In the future, it is possible to add new elements. In most patients, the skin of the feet and palms acquires a pronounced yellowish coloration (jaundice associated with endogenous carotene hyperchromia of the skin, due to a violation of the conversion of carotene to vitamin A).

In isolated cases, symptoms of heart failure may appear.

At the height of the disease, the tongue may become covered with bleeding ulcers and cracks, and the lips may be dry and crusty. The stool takes on a greenish color. Despite constipation (stool retention is caused by intestinal paresis), the stool is liquid.

The appearance of rapid heartbeat (tachycardia) is characteristic of complications (intestinal bleeding, collapse, perforation of ulcers).

Symptoms of cholecystitis, pyelitis, pyelonephritis, thrombophlebitis, cystitis, mastitis may appear; epididymitis and orchitis may occur in men.

Important. The most severe complications of the peak period are perforation of typhoid ulcerative lesions of the intestine with the development of profuse bleeding, peritonitis, sepsis and shock conditions.

The occurrence of exacerbations and relapses of infection

During the period of decreasing intensity clinical symptoms(until the fever disappears), exacerbations may develop. In this case, the patient’s symptoms of fever begin to increase again, roseola rashes, lethargy, etc. appear. In most cases, exacerbation of typhoid fever occurs sporadically.

Multiple exacerbations are extremely rare and are observed with improperly prescribed treatment or in patients with immunodeficiency conditions.

Relapse of the disease is diagnosed when symptoms of the disease appear against the background of normal temperature and the complete disappearance of manifestations of intoxication. Relapses of the disease may be associated with the use of chloramphenicol, which acts on the pathogen bacteriostatically (suppresses growth and reproduction), and not bactericidal (kills the pathogen).

For reference. Relapses can last from a day to ten to fourteen days and are much milder than the disease itself.

Diagnosis of typhoid fever

Blood for typhoid fever to isolate blood cultures of typhoid salmonella can be tested from the fifth to seventh day of the disease. Also, analysis for typhoid fever can be carried out using the Widal reaction, detection of specific typhoid antibodies using the RNGA method, as well as detection of immunoglobulins M using ELISA.

Examination of feces and blood using PCR can detect deoxyribonucleic acid of typhoid Salmonella.

From the 2nd week of the disease, RNGA and the Widal reaction are performed, as well as the isolation of typhoid Salmonella cultures from bile, urine and feces.

Treatment of typhoid fever

All therapy for typhoid fever is carried out exclusively in infectious diseases hospitals. Treatment is comprehensive and includes etiotropic (typhoid vaccine) and antibacterial therapy.

For the treatment of typhoid fever, preference is given to ceftriaxone, cefixime, ciprofloxacin, ofloxacin, and pefloxacin. Antibacterial therapy is carried out for a long time (up to ten days after stabilization of the patient’s temperature).

For mild forms of the disease, azithromycin can be used.

IN mandatory detoxification therapy is carried out with solutions of Ringer, reamberin, rheopolyglucin, etc.

Symptomatic therapy is aimed at maintaining blood pressure, relieving hypothermia, and preventing and treating complications.

For reference. The duration of treatment for typhoid fever is at least twenty-five days (for mild forms of infection). All this time, patients must remain in the hospital. In severe cases of the disease, the duration of treatment can be more than forty-five days.

Typhoid fever - vaccination

Vaccination against typhoid Salmonella is carried out with the Tifivak vaccine. Patients aged fifteen to fifty-five years are vaccinated according to epidemiological indications (with constant contact with bacteria carriers, the need to travel to areas with a high risk of disease, etc.). A month later, a second vaccination is carried out, and after two years it is necessary to perform a revaccination.

For patients over three years of age, the Vianvac vaccine can be used (re-vaccination is indicated after three years).