Enteric fever: Difference between revisions

Revision as of 11:54, 3 August 2020

Background

Microbiology

Caused by Salmonella enterica subsp. typii and paratyphii
Virulence is related to Vi antigen and invasin protein

Epidemiology

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

Pathophysiology

Induction of pH-shock proteins and other adaptions allow ingested bacteria to pass through the stomch and into the small intestine
There, they penetrate the intestinal mucosa followed by mononuclear cells, which transport them to lypmh nodes
They multiple within the reticuloendothelial system during the incubation period
After a threshold is reached, they disseminate to blood

Clinical Manifestations

Most commonly presents as fever in the returned traveller
Incubation period 5 to 21 days
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
- Meningoencephalopathy, abscess or empyema, and others
- Endocarditis, myocarditis, and pericarditis
- Pneumonia
- Hepatitis, cholestasis, liver abscess
- Osteomyelitis, rarely

Diagnosis

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

Management

Treatment with third-generation cephalosporins like ceftriaxone
Avoid fluoroquinolones due to high resistance rate

@@ Line 1: / Line 1: @@
-== Background ==
+==Background==
-=== Microbiology ===
+===Microbiology===
-* Caused by ''[[Salmonella enterica]]'' subsp. ''typii'' and ''paratyphii''
-* Virulence is related to Vi antigen and invasin protein
+*Caused by ''[[Salmonella enterica]]'' subsp. ''typii'' and ''paratyphii''
-=== Epidemiology ===
+*Virulence is related to Vi antigen and invasin protein
-* Fecal-oral transmission acquired from contraminated food, milk, or water
-* Less than 5% of infected people become chronic carriers, with bacteria remaining in the gallbladder despite adequate antibiotic treatment
-=== Pathophysiology ===
+===Epidemiology===
-* Induction of pH-shock proteins and other adaptions allow ingested bacteria to pass through the stomch and into the small intestine
-* There, they penetrate the intestinal mucosa followed by mononuclear cells, which transport them to lypmh nodes
-* They multiple within the reticuloendothelial system during the incubation period
-* After a threshold is reached, they disseminate to blood
+*Fecal-oral transmission acquired from contraminated food, milk, or water
-== Clinical Manifestations ==
+*Less than 5% of infected people become chronic carriers, with bacteria remaining in the gallbladder despite adequate antibiotic treatment
-* Most commonly presents as fever in a returned traveller
-* Incubation period 5 to 21 days
-* 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
-** Meningoencephalopathy, abscess or empyema, and others
-** Endocarditis, myocarditis, and pericarditis
-** Pneumonia
-** Hepatitis, cholestasis, hepatic abscesses
-** Osteomyelitis, rarely
+===Pathophysiology===
-== Diagnosis ==
-* Blood cultures (large volume, like x4), stool cultures, bone marrow
-* Biopsy (most sensitive)
+*Induction of pH-shock proteins and other adaptions allow ingested bacteria to pass through the stomch and into the small intestine
-== Management ==
+*There, they penetrate the intestinal mucosa followed by mononuclear cells, which transport them to lypmh nodes
-* Treatment with third-generation cephalosporins like [[Is treated by::ceftriaxone]]
+*They multiple within the reticuloendothelial system during the incubation period
-* Avoid fluoroquinolones due to high resistance rate
+*After a threshold is reached, they disseminate to blood
+==Clinical Manifestations==
+*Most commonly presents as [[fever in the returned traveller]]
+*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]]
+*If untreated for several weeks, a blanchable [[Causes::papular rash]] ("rose spots") may appear
+*Extraintestinal manifestations are myriad
+**[[Meningoencephalopathy]], [[abscess]] or [[empyema]], and others
+**[[Endocarditis]], [[myocarditis]], and [[pericarditis]]
+**[[Pneumonia]]
+**[[Hepatitis]], [[cholestasis]], [[liver abscess]]
+**[[Osteomyelitis]], rarely
+==Diagnosis==
+*Blood cultures (large volume, like x4), stool cultures, bone marrow
+*Biopsy (most sensitive)
+==Management==
+*Treatment with third-generation cephalosporins like [[Is treated by::ceftriaxone]]
+*Avoid fluoroquinolones due to high resistance rate
 [[Category:Gram-negative bacilli]]