Enteric fever - Revision history

Aidan: added doses

2024-05-13T14:59:22Z

added doses

@@ Line 48: / Line 48: @@
 **Can take 4 to 6 days to defervesce, even with treatment
 *Monitor for relapse 2 to 3 weeks after treatment ends
 [[Category:Gram-negative bacilli]]
 [[Category:Returned travellers]]

Aidan: /* Diagnosis */

2024-05-13T14:19:14Z

Diagnosis

← Older revision		Revision as of 14:19, 13 May 2024
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	==Diagnosis==		==Diagnosis==

	*Blood cultures (large volume, like x4), stool cultures, bone marrow		*Blood cultures (large volume, like x4), stool cultures, bone marrow biopsy (most sensitive)
	*Biopsy (most sensitive)

	==Management==		==Management==

Aidan at 13:57, 27 January 2022

2022-01-27T13:57:17Z

← Older revision		Revision as of 13:57, 27 January 2022
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	===Microbiology===		===Microbiology===

	*Caused by ''[[Salmonella enterica]]'' ~~subsp.~~ ''~~typii~~'' and ~~''paratyphii''~~		*Caused by ''[[Salmonella enterica]]'' subspecies ''enterica'' serotypes Typhi and Paratyphi
	*Virulence is related to Vi antigen and invasin protein		*Virulence is related to Vi antigen and invasin protein

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	===Pathophysiology===		===Pathophysiology===

	*Induction of pH-shock proteins and other adaptions allow ingested bacteria to pass through the ~~stomch~~ and into the small intestine		*Induction of pH-shock proteins and other adaptions allow ingested bacteria to pass through the stomach and into the small intestine
	*There, they penetrate the intestinal mucosa followed by mononuclear cells, which transport them to ~~lypmh~~ nodes		*There, they penetrate the intestinal mucosa followed by mononuclear cells, which transport them to lymph nodes
	*They multiple within the reticuloendothelial system during the incubation period		*They multiple within the reticuloendothelial system during the incubation period
	*After a threshold is reached, they disseminate to blood		*After a threshold is reached, they disseminate to blood
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	**[[Myelitis]], [[psychosis]], [[ataxia]], [[parkinsonism]]		**[[Myelitis]], [[psychosis]], [[ataxia]], [[parkinsonism]]
	**[[Meningoencephalopathy]]		**[[Meningoencephalopathy]]
	**[[~~abscess~~]] or [[empyema]]		**[[Abscess]] or [[empyema]]
	**[[Endocarditis]], [[myocarditis]], and [[pericarditis]]		**[[Endocarditis]], [[myocarditis]], and [[pericarditis]]
	**[[Pneumonia]]		**[[Pneumonia]]
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	*Treatment with third-generation cephalosporins like [[Is treated by::ceftriaxone]], stepped down to oral when improving and susceptibility data are available		*Treatment with third-generation cephalosporins like [[Is treated by::ceftriaxone]], stepped down to oral when improving and susceptibility data are available
	**Alternatives are [[Is treated by::azithromycin]], followed by [[ampicillin]], [[TMP-SMX]], [[chloramphenicol]]		**Alternatives are [[Is treated by::azithromycin]], followed by [[ampicillin]], [[TMP-SMX]], [[chloramphenicol]]
	**Avoid fluoroquinolones due to high resistance rate		**Avoid [[fluoroquinolones]] due to high resistance rate
	*Duration 10 to 14 days		*Duration 10 to 14 days
	**Can take 4 to 6 days to defervesce, even with treatment		**Can take 4 to 6 days to defervesce, even with treatment

Aidan at 11:27, 23 August 2020

2020-08-23T11:27:48Z

← Older revision		Revision as of 11:27, 23 August 2020
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	===Epidemiology===		===Epidemiology===

	*Fecal-oral transmission acquired from ~~contraminated~~ food, milk, or water		*Fecal-oral transmission acquired from contaminated food, milk, or water
	*Less than 5% of infected people become chronic carriers, with bacteria remaining in the gallbladder despite adequate antibiotic treatment		*Less than 5% of infected people become chronic carriers, with bacteria remaining in the gallbladder despite adequate antibiotic treatment

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	*Most commonly presents as [[fever in the returned traveller]]		*Most commonly presents as [[fever in the returned traveller]]
	*Incubation period [[Usual incubation period::5 to 21 days]]		*Incubation period [[Usual incubation period::5 to 21 days]]
			*Symptoms progress over weeks
	*~~Prominent~~ ~~symptoms include high~~ [[Causes::fever]], [[Causes::~~headache~~]], [[Causes::~~diarrhea]] or [[Causes::constipation~~]], [[Causes::relative bradycardia]], [[Causes::~~splenomegaly]], and [[Causes::leukopenia~~]]		**First week: [[Causes::fever]], [[Causes::chills]], [[Causes::bacteremia]], [[Causes::relative bradycardia]], [[Causes::headache]]
	*If ~~untreated~~ ~~for~~ ~~several weeks~~, a blanchable [[Causes::papular rash]] ("rose spots") may appear		**Second week: [[Causes::abdominal pain]], and a blanchable [[Causes::papular rash]] ("rose spots") may appear
			**Third week: can progress to gastrointestinal perforation, hepatosplenomegaly, GI bleed, secondary bacteremia
			*[[Causes::Constipation]] is more common in adults, while [[Causes::diarrhea]] is more common in children and people with [[HIV]]
			*CBC shows [[Causes::leukopenia]] and [[Causes::anemia]]
	*Extraintestinal manifestations are myriad		*Extraintestinal manifestations are myriad
	**[[~~Meningoencephalopathy~~]], [[~~abscess~~]] or [[~~empyema~~]], ~~and others~~		**[[Myelitis]], [[psychosis]], [[ataxia]], [[parkinsonism]]
			**[[Meningoencephalopathy]]
			**[[abscess]] or [[empyema]]
	**[[Endocarditis]], [[myocarditis]], and [[pericarditis]]		**[[Endocarditis]], [[myocarditis]], and [[pericarditis]]
	**[[Pneumonia]]		**[[Pneumonia]]
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	==Management==		==Management==

	*Treatment with third-generation cephalosporins like [[Is treated by::ceftriaxone]]		*Treatment with third-generation cephalosporins like [[Is treated by::ceftriaxone]], stepped down to oral when improving and susceptibility data are available
			**Alternatives are [[Is treated by::azithromycin]], followed by [[ampicillin]], [[TMP-SMX]], [[chloramphenicol]]
	*Avoid fluoroquinolones due to high resistance rate		**Avoid fluoroquinolones due to high resistance rate
			*Duration 10 to 14 days
			**Can take 4 to 6 days to defervesce, even with treatment
			*Monitor for relapse 2 to 3 weeks after treatment ends

	[[Category:Gram-negative bacilli]]		[[Category:Gram-negative bacilli]]

Aidan: /* Clinical Manifestations */

2020-08-05T13:38:07Z

Clinical Manifestations

← Older revision		Revision as of 13:38, 5 August 2020
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	*Most commonly presents as [[fever in the returned traveller]]		*Most commonly presents as [[fever in the returned traveller]]
	*Incubation period 5 to 21 days		*Incubation period [[Usual incubation period::5 to 21 days]]
	*Prominent symptoms include high [[Causes::fever]], [[Causes::headache]], [[Causes::diarrhea]] or [[Causes::constipation]], [[Causes::relative bradycardia]], [[Causes::splenomegaly]], and [[Causes::leukopenia]]		*Prominent symptoms include high [[Causes::fever]], [[Causes::headache]], [[Causes::diarrhea]] or [[Causes::constipation]], [[Causes::relative bradycardia]], [[Causes::splenomegaly]], and [[Causes::leukopenia]]
	*If untreated for several weeks, a blanchable [[Causes::papular rash]] ("rose spots") may appear		*If untreated for several weeks, a blanchable [[Causes::papular rash]] ("rose spots") may appear

Aidan: /* Clinical Manifestations */

2020-08-03T11:54:23Z

Clinical Manifestations

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-== Background ==
+==Background==
-=== Microbiology ===
+===Microbiology===
-=== Pathophysiology ===
+===Epidemiology===
 [[Category:Gram-negative bacilli]]

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-14T18:48:03Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 18:48, 14 July 2020
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	* After a threshold is reached, they disseminate to blood		* After a threshold is reached, they disseminate to blood

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==
	* Most commonly presents as fever in a returned traveller		* Most commonly presents as fever in a returned traveller
	* Incubation period 5 to 21 days		* Incubation period 5 to 21 days

Aidan: /* Clinical Presentation */ added rose spots

2020-01-30T02:28:51Z

Clinical Presentation: added rose spots

← Older revision		Revision as of 02:28, 30 January 2020
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	* Incubation period 5 to 21 days		* Incubation period 5 to 21 days
	* Prominent symptoms include high fever, headache, diarrhea or constipation, [[relative bradycardia]], splenomegaly, and leukopenia		* Prominent symptoms include high fever, headache, diarrhea or constipation, [[relative bradycardia]], splenomegaly, and leukopenia
			* If untreated for several weeks, a blanchable papular rash ("rose spots") may appear
	* Extraintestinal manifestations are myriad		* Extraintestinal manifestations are myriad
	** Meningoencephalopathy, abscess or empyema, and others		** Meningoencephalopathy, abscess or empyema, and others

Aidan: Major revision

2019-11-11T02:17:34Z

Major revision

@@ Line 1: / Line 1: @@
-== Microbiology ==
+== Background ==
-== Diagnosis ==
+=== Pathophysiology ===
 * Blood cultures (large volume, like x4), stool cultures, bone marrow
 * Biopsy (most sensitive)
 == Management ==
 [[Category:Gram-negative bacilli]]

Aidan at 15:07, 17 August 2019

2019-08-17T15:07:10Z

← Older revision		Revision as of 15:07, 17 August 2019
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	= Microbiology =		== Microbiology ==

	* ''Salmonella enterica'' subsp. ''typii'' and ''paratyphii''		* Caused by ''Salmonella enterica'' subsp. ''typii'' and ''paratyphii''

	= Diagnosis =		== Diagnosis ==

	* Blood cultures (large volume, like x4), stool cultures, bone marrow		* Blood cultures (large volume, like x4), stool cultures, bone marrow
	* Biopsy (most sensitive)		* Biopsy (most sensitive)

	= Management =		== Management ==

	* Treatment with 3rd gen cephalosporins		* Treatment with 3rd gen cephalosporins