### Date : 2024-06-27 17:32 ### Topic : Typhoid Fever #medicine #internalmedicine #infec ---- ### Typhoid Fever (장티푸스) Overview **Typhoid fever** is a systemic infection caused by the bacterium *Salmonella enterica* serotype Typhi. It is characterized by prolonged fever, abdominal pain, and a range of other symptoms. The disease is primarily transmitted through ingestion of contaminated food or water and is more prevalent in areas with poor sanitation. ### Etiology **Causative Agent:** - **Bacterium:** *Salmonella enterica* serotype Typhi. **Transmission:** - **Fecal-Oral Route:** Ingestion of food or water contaminated with the feces or urine of infected individuals. - **Chronic Carriers:** Some individuals may become chronic carriers, shedding the bacteria intermittently and serving as sources of infection. ### Pathophysiology 1. **Ingestion and Entry:** - The bacteria are ingested and survive the acidic environment of the stomach. - They then invade the small intestine's mucosal lining and enter the bloodstream. 2. **Systemic Spread:** - The bacteria are transported by white blood cells to various organs, including the liver, spleen, bone marrow, and gallbladder. - They multiply within these organs and re-enter the bloodstream, leading to a systemic infection. 3. **Immune Response:** - The body's immune response to the infection causes inflammation and various symptoms associated with typhoid fever. ### Clinical Features **1. Incubation Period:** - Typically 6-30 days after exposure. **2. Symptoms:** - **Fever:** Sustained high fever, often peaking in the afternoon. - **Headache:** Persistent and severe. - **Gastrointestinal Symptoms:** Abdominal pain, diarrhea or constipation, nausea, and vomiting. - **Rose Spots:** Small, rose-colored spots on the abdomen and chest. - **Hepatosplenomegaly:** Enlarged liver and spleen. - **Malaise:** General feeling of unwellness and fatigue. - **Anorexia:** Loss of appetite. **3. Complications (if untreated):** - **Intestinal Perforation:** Leading to peritonitis. - **Sepsis:** Widespread infection causing multiple organ failure. - **Encephalopathy:** Altered mental status and confusion. - **Relapse:** Symptoms can recur if not adequately treated. ### Diagnosis **1. Clinical Evaluation:** - Detailed history of symptoms and potential exposure to contaminated food or water. - Physical examination focusing on fever pattern, abdominal tenderness, and rose spots. **2. Laboratory Tests:** - **Blood Culture:** The gold standard for diagnosis, especially in the first week of illness. - **Stool and Urine Cultures:** Can help in later stages of the disease. - **Widal Test:** Serological test detecting antibodies against *Salmonella* antigens, though it has limitations in sensitivity and specificity. - **Complete Blood Count (CBC):** May show anemia, leukopenia, and thrombocytopenia. - **Liver Function Tests:** Elevated liver enzymes in some cases. ### Example Case Study **Patient Profile:** - **Name:** Jee Hoon Ju - **Age:** 32 - **Occupation:** Restaurant Worker **Medical History:** - Recent travel to a region with poor sanitation. - Complaints of high fever, headache, and abdominal pain for the past week. **Clinical Evaluation:** - **Symptoms:** High fever, abdominal tenderness, and malaise. - **Physical Examination:** Rose spots on the abdomen, hepatosplenomegaly. **Laboratory Tests:** - Blood culture positive for *Salmonella enterica* serotype Typhi. - CBC shows leukopenia and mild anemia. - Liver function tests mildly elevated. **Diagnosis:** Based on clinical presentation and laboratory findings, Jee Hoon Ju is diagnosed with typhoid fever. ### Management **1. Antibiotic Therapy:** - **First-Line Antibiotics:** - **Ciprofloxacin:** Preferred in non-resistant cases. - **Azithromycin:** An alternative in areas with fluoroquinolone resistance. - **Ceftriaxone:** For severe cases or when oral administration is not feasible. - **Alternative Antibiotics:** Based on local resistance patterns, other antibiotics like ampicillin, amoxicillin, or trimethoprim-sulfamethoxazole may be used. **2. Supportive Care:** - **Hydration:** Ensuring adequate fluid intake to prevent dehydration. - **Nutritional Support:** Small, frequent meals to maintain nutritional status. - **Antipyretics:** Paracetamol to manage fever and discomfort. **3. Monitoring and Follow-Up:** - Regular monitoring of vital signs, fluid balance, and clinical symptoms. - Follow-up cultures to confirm eradication of the bacteria. **4. Preventive Measures:** - **Vaccination:** Available vaccines for individuals traveling to endemic areas or at high risk. - **Improving Sanitation:** Ensuring access to clean water and proper sewage disposal. - **Personal Hygiene:** Encouraging handwashing and safe food practices. ### Prognosis - **Good with Treatment:** Most patients recover fully with appropriate antibiotic therapy. - **Complications:** Risk of severe complications if untreated or if there is a delay in treatment. ### Conclusion Typhoid fever is a serious systemic infection caused by *Salmonella enterica* serotype Typhi, characterized by high fever, abdominal pain, and other systemic symptoms. Prompt diagnosis and treatment with appropriate antibiotics are crucial to prevent complications and ensure recovery. Preventive measures, including vaccination and improved sanitation, play a key role in reducing the incidence of typhoid fever. Understanding the etiology, pathophysiology, clinical features, and management strategies is essential for effectively treating and preventing this condition.