Enteric fever: Difference between revisions
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+ | == Background == |
| + | === Microbiology === |
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| + | * Virulence is related to Vi antigen and invasin protein |
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| + | === Epidemiology === |
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| + | * Fecal-oral transmission acquired from contraminated food, milk, or water |
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| + | * Less than 5% of infected people become chronic carriers, with bacteria remaining in the gallbladder despite adequate antibiotic treatment |
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| − | == |
+ | === Pathophysiology === |
| + | * Induction of pH-shock proteins and other adaptions allow ingested bacteria to pass through the stomch and into the small intestine |
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| + | * There, they penetrate the intestinal mucosa followed by mononuclear cells, which transport them to lypmh nodes |
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| + | * They multiple within the reticuloendothelial system during the incubation period |
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| + | * After a threshold is reached, they disseminate to blood |
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| + | == Clinical Presentation == |
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| + | * Most commonly presents as fever in a returned traveller |
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| + | * Incubation period 5 to 21 days |
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| + | * Prominent symptoms include high fever, headache, diarrhea or constipation, [[relative bradycardia]], splenomegaly, and leukopenia |
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| + | * Extraintestinal manifestations are myriad |
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| + | ** Meningoencephalopathy, abscess or empyema, and others |
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| + | ** Endocarditis, myocarditis, and pericarditis |
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| + | ** Pneumonia |
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| + | ** Hepatitis, cholestasis, hepatic abscesses |
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| + | ** Osteomyelitis, rarely |
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| + | |||
| + | == Diagnosis == |
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* Blood cultures (large volume, like x4), stool cultures, bone marrow |
* Blood cultures (large volume, like x4), stool cultures, bone marrow |
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* Biopsy (most sensitive) |
* Biopsy (most sensitive) |
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== Management == |
== Management == |
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| + | * Treatment with third-generation cephalosporins like [[Is treated by::ceftriaxone]] |
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| − | * Treatment with 3rd gen cephalosporins |
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[[Category:Gram-negative bacilli]] |
[[Category:Gram-negative bacilli]] |
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Revision as of 22:17, 10 November 2019
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 Presentation
- 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
- Extraintestinal manifestations are myriad
- Meningoencephalopathy, abscess or empyema, and others
- Endocarditis, myocarditis, and pericarditis
- Pneumonia
- Hepatitis, cholestasis, hepatic abscesses
- 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
