TYPHOIDOPTOM FASLU MUHAMMED

The course of un-treated typhoid fever is divided into 4 individual stages.

Each stage lasting approximately 1 week, in the first week there is a slowly rising temperature with relative brady cardia, malaise, headache ,cough and bleeding nose (epistaxis) abdominal pain is also possible.

There is leucopenia a decrease in the no. of circulating WBC with eosinophenia and relative lymphocytosis.

A positive reaction and blood cultures are positive for salmonella typhi or paratyphi.

The clasic widal test is negative in the first week

In the second week of the infection, the patient have high fever(40°c) and brady cardia classically with a dicrotic pulse wave.

Delirium is frequently calm but sometimes agitated. This delirium gives to typhoid the nick name of “ nervous fever”

Rose spots appears on the lower chest and abdomen.

Bronchitis in lung Diarrhea can occur in this stage 6 to 8 stools in a

day, green with a characteristic smell, comparable to pea soup

Constipation is also frequent

The spleen and liver are enlarged (hepato- spleeno megaly) and tender

There is elevation of liver transaminase The major symptom of this fever is that the

fever usually rises in the after noon up to the 1st and 2nd weeks.

In the 3rd week no. of complications can occurs

1. intestinal hemorrhage due to bleeding in congested payer’s patches.

2. Intestinal perforations in the distal ileum3. Encephalitis4. Neuro psychiatric symptoms5. Metastatic abcesses, cholecystitis,

endocardytis

The fever is still very high and oscillates very little over 24 hrs

By the end of 3rd week the fever has started reducing this carries into the 4th and final week.

TRANSMISSION It may spread through poor hygiene habits

and public sanitation conditions and sometimes also by flying insevts feeding on feces.

A person may become an asymptomatic carrier of typhoid fever, suffering no symptoms, but capable of infecting others

DIAGNOSIS Blood, bone marrow or stool cultures and

with widal test (demonstration of salmonella antibodies against antigen O- somatic and H- flagellar)

Therapeutic trial with chloramphenicol Stool culture

PREVENTION Typhoid vaccine : oral Ty- 21- a vaccine and

infectable typhoid polysaccharide vaccine Both are between 50% to 80% protective and

are recommended for travelers to areas where typhoid is endemic.

MEDICAL TREATMENT Oral rehydration therapy Antibiotics such as ampicillin,

chloramphenecol, trimetho prim- sulfa methoxazole, amoxicillin, ciprofloxacin.

SURGICAL TREATMENT In cases of intestinal perforation whole

cystectomy