《传染病学教学课件》10、typhoid伤寒.pptx

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1、Typhoid FeverDept.Infectious Disease2nd Affiliated HospitalCMU DefinitionvTyphoid fever is an acute infectious disease of digestive tract caused by typhoid bacillus.vLesion lymphatics in the terminal ileumvPathological feature proliferation of large mononuclear macrophage cells DefinitionvClinical f

2、eature continued fever relative slow pulse toxic symptoms rose rash splenomegaly and hepatomegaly leukopenia vComplication hemorrhage&perforation EtiologyEtiology EtiologyvPathogen:Typhoid bacillus genus salmonella group DvPathogenicity:endotoxinvResistance:Stable in environment,sensitive to heat,ac

3、id,common disinfectants EtiologyvAntigenicity:O antigen:lipopolysaccharide group-specialH antigen:protein,strain-specialVi antigen:polysaccharide EtiologyEpidemiologyvSource of infection Patient,Carrier,shed bacteria in feces 1.The best known carrier was Typhoid Mary.Mary Mallon was a cook in Oyster

4、 Bay,New York in 1906 who is known to have infected 53 people,5 of whom died.2.Later returned with false name but detained and quarantined after another typhoid outbreak.3.She died of pneumonia after 26 years in quarantine.EpidemiologyvSource of infection Patient,Carrier,shed bacteria in fecesvRoute

5、 of transmission Fecal-oral route:contaminated food or watercontagious spread spread by insectvSusceptibility vEpidemic features sporadic cases high incidence in fall&summer Pathogenesis Bacillus Stomach killed by gastric acid Small intestine penetrate mucosa Regional lymphatics incubation period Bl

6、ood stream -first bacteremia MPS in liver,spleen,bone marrow Blood stream -second bacteremia endotoxin liver spleen regional lymphotics clinical symptoms swelling inflammation Pathology Proliferation of large mononuclear cell 1st week 2nd 3rd week 4th week proliferation necrosis heal edema ulceratio

7、n no scarPathologyPathologyPathologyTyphoid cellPathology Clinical manifestationIncubation period:7-23 day(average 10 to 14 days)Typical typhoid fever:Initial periodFastigiumDefervescenceConvalescenceClinical manifestation2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 322 4 6 8 10 12 14 16 18 20 22 24 26

8、28 30 32 initialinitialincubationincubationBLOOD CULTUREBLOOD CULTURESTOOL STOOL&URINE CULTUREURINE CULTUREWIDAL TESTWIDAL TEST90%POS90%POS20%POS20%POS80%POS80%POS50%POS50%POS70-90%POS70-90%POSfastigiumfastigiumremissionremissionrecoveryrecovery day of diseasepathologypathologyENDOTOXEMIADISSEMINATE

9、DSEPTICEMIAnecrosisnecrosis ulceration PerforationhemorrhageTissue Tissue repair&Clinical recoveryClinical recoveryClinical and pathological correlations of typhoid feverClinical and pathological correlations of typhoid fever.P P T T180 180 41410 0160 160 4040140 140 3939120 120 3838100 100 373780 8

10、0 3636Clinical manifestation Initial periodonset:insidious,gradualfever:T stepwise fashion risingnon-special symptoms:Clinical manifestation Fastigiumsustained fevertoxic symptoms:NS apathy,tinnitus,delirium,lethargy,coma DS anorexia,abdominal pain,diarrhea,constipation CS relative slow pulse,bradyc

11、ardia,myocarditisClinical manifestationClinical manifestation Fastigiumrose rash:erythematous macules or papules occur on 613 days upper abdomenhepatomegaly and splenomegalyClinical manifestationClinical manifestation Devervescence ConvalescenceClinical manifestationvClinical type:Mild typecommon ty

12、peprolonged type,ambulatory typefulminate type Clinical manifestation Relapse:It occur 13week after T has reached normal.The illness follows a similar pattern to the primary attach.Blood culture positive.Recurrence:It occur 34 after the illness.T begin to fall,then rise again.Blood culture positive.

13、-+-+-+-+-O1/80 O 1/160 O 1/160 O 1/640O1/80 O 1/160 O 1/160 O 1/640O1/80 O 1/160 O 1/160 O 1/640H1/160 H 1/160 H 1/320 H 1/640H1/160 H 1/160 H 1/320 H 1/640H1/160 H 1/160 H 1/320 H 1/640Blood cultureBlood cultureStool cultureStool cultureUrine cultureUrine cultureWidals testWidals testRelapse after

14、treated with chloramphenicolRelapse after treated with chloramphenicolChlora.Chlora.2.02.0 1.0 1.0 g/d g/dDaysDays 2.02.0 1.0 1.0 g/d g/dadmissionadmissionrelapserelapseComplicationsvIntestinal hemorrhagevIntestinal perforationvToxic hepatitis and myocarditisvPneumonia Laboratory FindingsvBlood pict

15、ure:leukopenia vBacteria culture:blood bone morrow urine and stoolLaboratory FindingsvWidal test:agglutination of serum reaction 5 Ag:“O”“H”,“HABC”titer:O=1:80 H=1:160 results analysis:DiagnosisvEpidemiological datavClinical manifestationvLaboratory findingsvDefinitive diagnosis:bacteria culture pos

16、itiveDifferential DiagnosisvTyphusvrickettsisesvmalariavdisseminated TB TreatmentvGeneral therapyvEtiologic therapyquinolone:first choicecephalosporins:2nd and 3rd generationchloromycetinPreventionvControl of source of infection:isolationvInterruption of route of transmissionvProtection of susceptible population:Vaccinated with vaccine