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ENTERIC FEVER

Enteric fever, caused by Salmonella typhi and Salmonella paratyphi, is acquired through contaminated food and water, leading to symptoms ranging from mild fever to severe illness. Diagnosis involves isolating bacilli from blood, feces, or urine, and serological tests like the Widal test to detect antibodies. Treatment includes antibiotics such as chloramphenicol and fluoroquinolones, with preventive measures including vaccination and control of carriers.

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3 views3 pages

ENTERIC FEVER

Enteric fever, caused by Salmonella typhi and Salmonella paratyphi, is acquired through contaminated food and water, leading to symptoms ranging from mild fever to severe illness. Diagnosis involves isolating bacilli from blood, feces, or urine, and serological tests like the Widal test to detect antibodies. Treatment includes antibiotics such as chloramphenicol and fluoroquinolones, with preventive measures including vaccination and control of carriers.

Uploaded by

tmsiva6098
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© © All Rights Reserved
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Q.

Pathogenesis and lab diagnosis of Enteric fever

 Causative agents: Salmonella typhi-causing typhoid fever


Salmonella paratyphi A, B and C- Paratyphoid fever
 Enteric fever includes both typhoid and paratyphoid fever
PATHOGENESIS
 Infection is acquired through ingestion of contaminated food and water
 Incubation period:7-14 days
 On reaching the small intestine bacilli attach to epithelial cells of intestinal villi and penetrate to lamina
propria and sub mucosa
 They are then phagocytosed by neutrophils and macrophages
 These bacteria resist intracellular killing and multiply within these cells
 Enter the mesenteric lymph nodes, multiply there and via the thoracic duct, enter the blood stream
 Transient bacteraemia follows and internal organs like liver, gall bladder, spleen, bone marrow, lungs,
lymphnodes and kidneys are infected
 Massive bacteraemia occurs from these sites of multiplication and clinical disease sets in
 Bacteria multiply abundantly in the gall bladder as bile is a good culture medium for bacteria
 Bacteria are discharged continuously in to the intestine involving Peyer’s patches and lymphoid follicles of
the ileum
 These become inflamed, necrosed and slough off, leaving behind the typhoid ulcers-may lead to two
major complications-intestinal perforation and haemorrhage

CLINICAL FEATURES

 Mild pyrexia to fatal fulminating disease


 Headache, anorexia and congestion of mucous membranes
 Hepatosplenomegaly, step-ladder pyrexia with relative bradycardia and leucopenia
 Rose-spots may appear during the second or third week
 Paratyphoid fever resembles typhoid fever but is milder

LABORATORY DIAGNOSIS

1.Isolation of bacilli

2.Demonstraton of antibodies

3.Demonstration of antigen

4.Other tests

1.Isolation of bacilli

 By culture of specimens like blood, faeces, urine, aspirated duodenal fluid


 Selection of relevant specimen is very important and depends upon duration of illness

Duration if disease Specimen examination % of positivity


1st week Blood culture 90
2nd week Blood culture 75
Faeces culture 50
Widal test Low titre
3rd week Widal test 80-100
Blood culture 60
Faeces culture 80
i)Blood culture:

 10 ml of blood
 Glucose broth and taurocholate broth
 5ml to 50ml culture media
 Incubated at 37 °C
 Subculture on to - Mac conkeys agar,XLD,DCA
 On Mac conkeys agar/DCA -Pale non lactose fermenting colonies
XLD – black centered colonies
 Gram staining from these colonies show gram negative bacilli
 Motility test- motile bacilli
 Species of salmonella can be differentiated by biochemical reactions
 Slide agglutination with O and H antisera confirms the species

ii)Demonstration of antibodies

Widal test

 Agglutination test for detection of agglutinins(H and O)


 Antigens used in the test are H and O antigens of S.typhi and H antigens of S.paratyphi A and S.paratyphi B
 Salmonella antibodies start appearing in the serum at the end of first week and rise during the third week
 Two specimens of sera at an interval of 7 to 10 days are preferred to demonstrate a rising antibody titre
 Antibody titre depends on the stage of the disease
 Demonstration of a four-fold or greater rise in titre of both H and O antibodies at an interval of 7-10 days
is diagnostic
 Significant titre: O titre of 1:100 or more and H titre of 1:200 or more

Other serological tests

 ELISA
 Indirect haemagglutination test
 CIEP

iii)Demonstration of circulating antigen

 Antigens are present in blood and urine


 Antigen can be detected by Counterimmunoelectrophoresis(CIEP) and ELISA

iv)Other tests

 Total leucocyte count - leucopenia


 Diazo test in urine

TREATMENT

 Chloramphenicol
 Fluoroquinolones
 Third generation cephalosporins

PROPHYLAXIS

 General measures
 Control of carriers
 Vaccination:
i)TAB vaccine-Heat killed whole cell vaccine
Dose:0.5ml at an interval of 4-6 weeks followed by booster every three years ,given
subcutaneously
ii)Live oral Typhoid vaccine(TY 21 a)
Three doses given on alternate day
iii)Purified Vi polysaccharide vaccine
Contains purified Vi antigen
Single dose IM

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