Typhoid fever is a very serious infectious disease that affects the stomach, intestines, spleen, liver, and blood vessels. It proceeds with severe signs of intoxication. The causative agent is the bacterium S.typhi, which is quite resistant to the environment. Penetrating into the human body, it begins to produce very strong toxic substances, which determine the onset of symptoms and the severity of the disease.
You can get infected only from a sick person or a healthy carrier of pathogens.
The causative agent of typhoid
The abdominal type is an acute infectious disease that affects the intestines and lymph nodes. It is accompanied by an increase in the spleen and liver, fever, severe intoxication, and also clouding of consciousness. Despite the fact that in recent years the incidence of the disease has decreased very much, however, the problem is still quite relevant.
The causative agent of typhoid fever is salmonella, which belongs to the family of enterobacteria. In appearance, it resembles a short stick with slightly rounded ends. Its shell is densely covered with flagella, which prevent the active movement of bacteria.
An important feature of the causative agent of typhoid fever is the possibility of producing endotoxin. In fact, it is a poison that is inside salmonella. However, if its death occurs, then toxic substances penetrate the bloodstream, provoking a very strong intoxication or poisoning of the body. It is with this that the main manifestations of the disease are associated.
Salmonella typhoid fever is characterized by the fact that it does not form capsules and spores, but at the same time it can remain in the environment for a long time. Especially often you can find such a bacterium in dairy products, salads with mayonnaise, as well as minced meat. In them, it not only persists for a long time, but also actively reproduces.
If the causative agent of typhoid enters the body with strong immunity, then its transformation occurs. Thanks to this property, the bacterium does not die. When it is excreted through the intestines and enters a sensitive organism, it again acquires its pathogenic qualities. Only disinfectant solutions or heat can finally destroy it.
Disease feature
Typhoid fever is an anthroponous disease that manifests itself in the rapid development of fever, intoxication, changes in the intestines, and various rashes. According to its epidemiological characteristics, development and symptoms, the disease is quite similar to the paratyphoid group. Typhoid fever and paratyphoid types A, B and C form a separate class of pathologies. For a long time they were considered a mild form of typhus with erased symptoms.
It was found that typhoid fever and paratyphoid are provoked by various types of salmonella, which lead to the formation of very serious intestinal lesions. Such microorganisms are resistant to low temperatures, but are characterized by high sensitivity to heat. At a temperature of 60 degrees, Salmonella dies in 30 minutes, and when boiled, a few seconds are enough for this process.
The most favorable breeding environment is considered food. Typhoid fever is an infection that affects the intestines. This disease is characterized by pronounced summer-autumn seasonality. Typhoid fever is most often diagnosed in people aged 15-45 years.
The greatest danger in terms of infection is hidden bacteria carriers, that is, those who have transferred the disease in an erased form. They do not even suspect that they are sick and can be the main cause of outbreaks of typhoid, especially if they work with food.
After the infection, a stable immunity forms. In some cases, re-infection may occur.
Classification
By the nature of the clinical picture, typhoid fever is divided into such forms as typical and atypical. The pathological condition can be acute and occur with periods of relapse and remission. The severity of the infection may be:
Typhoid fever can be complicated and uncomplicated, depending on the severity. It is very important to recognize the symptoms of infection in a timely manner, as well as conduct diagnostics and comprehensive treatment.
Causes of occurrence
The main cause of intestinal infection is the Salmonella bacterium. Transmission of typhoid fever occurs from a sick person. Penetrating into the body, Salmonella goes through several stages, which are very difficult to prevent. A high concentration of pathogens causes bacteria to quickly penetrate certain parts of the small intestine.
Active reproduction of salmonella in the intestinal mucosa provokes an inflammatory process, resulting in enteritis. Since the lymphatic system cannot retain the pathogen, this becomes the main reason that the infection enters the systemic circulation. There is a defeat of the internal organs.
Since pathogens circulate through the circulatory system, this causes poisoning of the whole organism. If complex therapy is not timely performed, then the presence of bacteria in the body will be cyclical in nature, destroying along the way the spleen, liver, and also the tissues of the lymph nodes.
The main symptoms
The latent course of typhoid fever at the initial stage greatly complicates the determination of infection at the very beginning of its development. In some cases, acute symptoms are observed from the very first days. Symptoms of typhoid fever are often increasing in nature and manifest as:
- slowly rising temperature;
- general weakness of the body;
- muscle and headache;
- nausea and vomiting
- signs of intoxication;
- loss of appetite;
- sleep disturbances.
Fever can last for 2-3 weeks. In dynamics, there is a constant change in body temperature. In addition, there may be symptoms of typhoid fever, such as dry skin and severe pallor.
Around 8-10 days, a skin rash that spreads throughout the body is added to the fever. Spots can reach significant sizes, approximately 3 mm in diameter. If you lightly press on this spot with your finger, then a pale color will appear on it. Rashes can remain on the skin for 5 days, and if the disease is severe, the rash takes on a special form with bruising.
The appearance of a reddish rash can be observed throughout the entire course of the disease, but with a lesser degree of intensity. When conducting a general examination, you can notice a thickening of the walls of the tongue, and when you click on it, a characteristic mark remains. In addition, the presence of white plaque in the basal region of the tongue is noted.
Among the main symptoms of typhoid, flatulence, weakening of the intestines, and rumbling in the stomach can be distinguished. The patient very often complains of a difficult act of defecation.
At the initial stage of the course of the disease, a cough is observed, and when listening to the lungs, dry or wet rales are heard. With exacerbation of typhoid, there may be mild bradycardia that occurs against a background of a strong increase in temperature. Against the background of general weakness, a decrease in pressure and a muffled heart rate are observed. In the most severe course, the progression of signs of the disease occurs, expressed in:
- severe intoxication;
- retardation of consciousness;
- hallucinations.
After you manage to lower the temperature, the patient's well-being immediately begins to improve. The subsequent exacerbation has much less pronounced symptoms. In this case, the temperature is not high, but the appearance of a rash may be observed throughout the body.
The erased form of the disease is characterized by the speed and shortness of all available signs. Exactly the same symptoms appear when a relapse occurs, which can happen if a person interrupts treatment on his own, violates the diet, and various psychoemotional factors affect his body.
Diagnostics
Typhoid fever is considered a rather dangerous disease, the transmission routes of which come from a sick person. Despite the fact that a dangerous disease is quite rare, it can cause difficulty in diagnosing even a qualified doctor. It is important to be able to distinguish it from other pathologies that are accompanied by severe intoxication of the body, as well as high temperature.
Similar symptoms provoke diseases such as dysentery, typhoid fever, cholera, pneumonia, and malaria. Typhoid can be distinguished from other pathologies only by characteristic symptoms. If it lasts more than 5 days, then the doctor can prescribe a number of laboratory tests that will help determine the pathogen. Among the tests for typhoid fever can be distinguished:
- general blood analysis;
- Analysis of urine;
- biochemical analysis.
A blood test determines the amount of all elements contained. In this case, there is an increase in white blood cells, lymphocytes, as well as ESR. When analyzing typhoid fever in the urine, cylinders, red blood cells, and protein are found.
In addition, bacteriological research is required . For laboratory diagnosis of typhoid fever, urine, blood, feces and bile are collected. They are sown in a nutrient medium and placed in a thermostat, where the temperature is maintained all the time at 37 degrees. If salmonella is present in the analyzes, they form colonies, which can then be examined under a microscope. To detect bacteria, you need to take blood for typhoid fever. It should be noted that pathogenic microorganisms can be in a sick person, as well as a bacterium carrier.
The earliest and most accurate diagnostic method is blood culture. Bacteria appear in the blood during the incubation period and remain until the end of the course of the disease. For the study, blood is drawn from a vein, and then it is seeded on a nutrient liquid medium. A preliminary result can be obtained after 2 days.
In addition, bacteria can be excreted from feces, since salmonella in the intestinal contents are present from 8-10 days of the course of the disease. Starting from 2 weeks, special antigens are detected in the blood. These are particles of the shell and flagella of Salmonella. They can be determined by conducting research based on the response of the immune system. The analysis is carried out by taking blood from a finger, from which serum is then isolated.
Treatment features
In the presence of the slightest suspicion of the occurrence of typhoid fever, urgent hospitalization of the patient in the infectious ward is required. It is very important to properly adjust the patient's day regimen. To prevent the development of complications, bed rest is prescribed up to 7 days of normalization of temperature. The patient is allowed to walk only after 10-12 days of normal temperature.
A strict diet is important. At the same time, food must be liquid, mashed, easily digestible and containing all the required vitamins. Typically, the patient is prescribed fermented milk products, broths, liquid cereals, chopped meat, juices.
Typhoid fever cannot be treated without antibiotics. Typhoid bacillus is very sensitive to ampicillin, as well as its derivatives, in particular, Biseptolum or Levomycetinum. In addition, there is a special vaccine. The severity of the disease is due to endotoxin, which is why infusion therapy is carried out. According to indications, cardiovascular drugs, vitamins and sleeping pills can be prescribed.
Traditional medicine products give a good result, however, they should be used in combination with medications. Also, you first need to consult a doctor.
Drug treatment
Cholera and typhoid fever have similar symptoms, which is why it is very important to diagnose in a timely manner in order to prescribe the right treatment. The patient is hospitalized in the infectious ward, where the patient will have to spend at least a month. During therapy, you must strictly observe strict bed rest. This will prevent intestinal rupture and the occurrence of internal bleeding. It is very important to try not to lift heavy objects and not even strain when visiting the toilet.
Treatment is carried out in several directions at once. Initially, salmonella must be eliminated, for which antibacterial drugs are prescribed. “Ampicillin” or “Levomycetin” is mainly used in tablet form or intramuscularly 4 times a day for a month. In severe forms of damage, a combination of antibiotics Gentamicin and Ampicillin is prescribed. In addition, the doctor can prescribe a new generation of drugs, namely, Ciprofloxacin, Azithromycin.
If antibiotics do not have the desired effect or are poorly tolerated by the body, then the doctor may prescribe antimicrobials, for example, Bactrim, Cotrimoxazole, Biseptol, Septrim. The use of this drug is shown in 2 tablets 2 times a day. The course of therapy is approximately 3-4 weeks.
Be sure to take certain measures to eliminate intoxication, and also try to prevent dehydration - drink as much fluid as possible to remove toxic substances. The amount of fluid drunk should be at least 2.5-3.0 liters per day. If this amount is not enough, then enterosorbents are additionally prescribed. These drugs help adsorb toxic substances in the intestines. To do this, appoint "Polyfelan", "Smecta", "Enterodesum."
With a moderate condition of the patient, it is necessary to cleanse the intestines and blood. For this, intravenous administration of glucose-salt solutions is indicated so that toxins are excreted much faster by the kidneys. Such drugs as “Quartasol”, “Lactasol”, “Acesol” are used. If intoxication intensifies, then “Prednisolone” is prescribed in tablet form. The course of therapy is carried out for 5 days. Oxygen therapy helps to cope with intoxication very well. For this, oxygen is introduced using catheters, or the patient is placed in a special pressure chamber. If the drugs do not help and the state of health continues to deteriorate, then the patient is given a blood transfusion.
During the course of the disease, the bone marrow does not produce the required number of white blood cells to maintain normal immunity. To enhance their production and accelerate the process of intestinal recovery, prescribe drugs such as Pentoxyl and Methyluracil. They are taken in tablet form after meals. “Ascorutin” will help improve the work of capillaries, normalize metabolism and blood circulation.
If you suspect a perforation of the intestine, the observation of a surgeon is indicated. An extract from the hospital is possible for 21 days of normalization of temperature.
Folk remedies
Some plants have sufficiently powerful bactericidal qualities, which is why in folk medicine they were previously used as a prophylactic, so as not to contract typhoid fever. Calam and garlic have proven themselves very well. The latter was consumed as food and carried with it constantly. Calamus rhizomes were cleaned, washed, and then chewed fresh.
For the treatment during the period of epidemics often used decoctions of wild rose and blackcurrant, as well as coffee with lemon. Infusions of medicinal herbs can significantly accelerate the healing of ulcers in the intestines, as well as cleanse the blood of toxic substances. To do this, 1 tbsp. l the roots of the hemorrhage pour 1 tbsp. hot water and boil for 30 minutes. Take the prepared product for 1 tbsp. l every 2-3 hours.
St. John's wort grass helps well, which must be taken in the form of a decoction or infusion throughout the day. You can prepare a healing product based on sage, centaury and chamomile. The prepared collection must be poured with hot water, insisted for 30 minutes, and then take 1 tsp.
Folk remedies can be a very good addition to the basic drug therapy prescribed by an infectious disease doctor. It is worth remembering that it is forbidden to independently carry out treatment, since this can only provoke a deterioration in well-being and lead to the development of dangerous complications.
Dieting
When typhoid fever occurs, a sparing diet is required. Food should not stay in the intestines for a long time, irritate it and provoke profuse bile secretion. Doctors recommend consuming steamed foods and then rubbed through a sieve or crushed in a blender. Food must be warm, it should be washed down with a small amount of water.
Freshly baked goods, spirits, fried and greasy dishes, sodas, fresh vegetables and fruits, seasonings, pickles and pastries are strictly prohibited.You need to consume food 5-6 times in small portions. Overeating should not be allowed, and also for a long time to experience a feeling of hunger.
After discharge from the hospital, you can begin to gradually expand the menu. Do not immediately eat fatty and smoked dishes. Over the course of 7-10 days, new foods should be gradually introduced into the diet.
Hygiene
Be sure to timely determine the presence of salmonella in the body, as well as conduct a comprehensive treatment. In addition, the transmission of the infection must be excluded. For this, the sanitary and epidemiological station carefully monitors the state of drinking water and sewage. Workers who are directly related to the cooking process should be checked for the carriage of pathogenic microorganisms.
Everyone must carefully take care of their own health, especially in countries where typhoid is widespread. It is important to observe the simplest safety rules, namely:
- consume only purchased water;
- to get ready meals that were well cooked or fried;
- Do not buy food on the streets;
- wash hands thoroughly after using the toilet and before eating;
- Do not swim in open water, where sewage from sewers can enter.
Following simple hygiene rules can protect against this serious and dangerous disease. In addition, it is important to observe the basic measures for the prevention of typhoid fever in the joint venture established by the sanitary and epidemiological station of each specific region.
Possible complications
If you do not timely carry out the treatment prescribed by the doctor, then various complications of typhoid fever can occur. The most adverse effect is fatal. It is mainly observed in debilitated patients or young children.
Another consequence is re-infection or bacterial carriage. The causative agent of the disease is very stable and often, even with antibiotic therapy, remains in the liver and bile ducts. With a decrease in immunity, the clinical picture may repeat again.
In the acute period of the course of the disease, the most dangerous complication may be intestinal bleeding or damage to the walls of the intestine with the subsequent development of peritonitis. From the nervous system, meningoencephalitis can develop. In addition, there may be damage to other organs and systems, which manifest as otitis media, myocarditis, osteomyelitis, pneumonia, cholecystitis. The consequences can occur even several months after clinical recovery. That is why patients who have been ill with this infection should be monitored for a long time.
Prophylaxis
Prevention of typhoid fever and paratyphoid fever is the main way to combat this disease. It includes a whole range of various activities, many of which are controlled by the health system. Among the main measures it is necessary to highlight:
- compliance with sanitary standards;
- health monitoring;
- vaccination.
Prevention of typhoid fever implies compliance with the rules of transporting products, monitoring the state of water, as well as personal hygiene. It is important to monitor the condition of people on whom the massive spread of infection depends. In contact with the infected person, medical supervision is required for 21 days. At the same time, urine, blood and feces should be tested for the presence of salmonella in the body.
An important preventive measure is vaccination against typhoid fever, which ensures the maintenance of good immunity for a long time. Vaccination will prevent infection when Salmonella penetrates the body. If a person is still ill, then the disease will proceed in a milder form. Recovery will occur in about 7-14 days.
Since children become infected more often, they need typhoid vaccine most of all. That is why in regions with an unfavorable epidemiological situation, people aged 5-19 years should be vaccinated. The vaccination efficacy of different manufacturers does not vary too much.
Since typhoid fever is a rather dangerous disease, it is imperative to conduct timely diagnosis and comprehensive treatment.