Enteric fever: Difference between revisions
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*Most commonly presents as [[fever in the returned traveller]] |
*Most commonly presents as [[fever in the returned traveller]] |
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*Incubation period 5 to 21 days |
*Incubation period [[Usual incubation period::5 to 21 days]] |
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*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]] |
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*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 |
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Revision as of 13:38, 5 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
