Enteric fever: Difference between revisions
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===Epidemiology=== |
===Epidemiology=== |
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| − | *Fecal-oral transmission acquired from |
+ | *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]] |
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*Incubation period [[Usual incubation period::5 to 21 days]] |
*Incubation period [[Usual incubation period::5 to 21 days]] |
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| + | *Symptoms progress over weeks |
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| − | * |
+ | **First week: [[Causes::fever]], [[Causes::chills]], [[Causes::bacteremia]], [[Causes::relative bradycardia]], [[Causes::headache]] |
| − | * |
+ | **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 |
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| + | *[[Causes::Constipation]] is more common in adults, while [[Causes::diarrhea]] is more common in children and people with [[HIV]] |
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| + | *CBC shows [[Causes::leukopenia]] and [[Causes::anemia]] |
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*Extraintestinal manifestations are myriad |
*Extraintestinal manifestations are myriad |
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| − | **[[ |
+ | **[[Myelitis]], [[psychosis]], [[ataxia]], [[parkinsonism]] |
| + | **[[Meningoencephalopathy]] |
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| + | **[[abscess]] or [[empyema]] |
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**[[Endocarditis]], [[myocarditis]], and [[pericarditis]] |
**[[Endocarditis]], [[myocarditis]], and [[pericarditis]] |
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**[[Pneumonia]] |
**[[Pneumonia]] |
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==Management== |
==Management== |
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| − | *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]] |
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| − | *Avoid fluoroquinolones due to high resistance rate |
+ | **Avoid fluoroquinolones due to high resistance rate |
| + | *Duration 10 to 14 days |
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| + | **Can take 4 to 6 days to defervesce, even with treatment |
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| + | *Monitor for relapse 2 to 3 weeks after treatment ends |
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[[Category:Gram-negative bacilli]] |
[[Category:Gram-negative bacilli]] |
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Revision as of 07:27, 23 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 contaminated 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
- Symptoms progress over weeks
- First week: fever, chills, bacteremia, relative bradycardia, headache
- Second week: abdominal pain, and a blanchable papular rash ("rose spots") may appear
- Third week: can progress to gastrointestinal perforation, hepatosplenomegaly, GI bleed, secondary bacteremia
- Constipation is more common in adults, while diarrhea is more common in children and people with HIV
- CBC shows leukopenia and anemia
- Extraintestinal manifestations are myriad
Diagnosis
- Blood cultures (large volume, like x4), stool cultures, bone marrow
- Biopsy (most sensitive)
Management
- Treatment with third-generation cephalosporins like ceftriaxone, stepped down to oral when improving and susceptibility data are available
- Alternatives are azithromycin, followed by ampicillin, TMP-SMX, chloramphenicol
- 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
