傷寒TypoidFeverTyphoidFever傷寒TypoidFever

DefinitionTyphoidfeverisanacuteinfectiousdiseaseofdigestivetractcausedbytyphoidbacillus.Placeoflesson

lymphaticsintheterminalileumPathologicalfeatureproliferationoflargemononuclearcellsderivedfromMPS傷寒TypoidFever

DefinitionClinicalfeature

sustainedfeverrelativeslowpulsetoxicsymptomsarose-colorrashsplenomegalyandhepatomegalyleukopeniaComplication

hemorrhage&perforation

傷寒TypoidFever

EtiologyCausativeorganism:TyphoidbacillusgenussalmonellagroupDPathogenicity:

endotoxinResistance:Stableinenvironment,sensitivetoheat,acid,commondisinfectants傷寒TypoidFever

EtiologyAntigenicity:Oantigen:lipopolysaccharidegroup-specialHantigen:protein,strain-specialViantigen:polysaccharide傷寒TypoidFeverEpidemiologySourceofinfectionPatient,Carrier,shedbacteriainfecesRouteoftransmissionFecal-oralroute:contaminatedfoodorwatercontagiousspreadspreadbyinsectSusceptibilityEpidemicfeaturessporadiccaseshighincidenceinfall&summer

傷寒TypoidFeverPathogenesis

BacillusStomachkilledbygastricacidincubationSmallintestinepenetratemucosaperiodRegionallymphaticsBloodstream-firstbacteremiainitialMPSinliver,spleen,bonemarrowBloodstream-secondbacteremiaendotoxinliverspleenregionallymphoticsClinicalsymptomsabscesinflammation傷寒TypoidFever

PathologyProliferationoflargemononuclearcell1stweek2nd3rdweek4thweekproliferationnecrosishealedemaulcerationnoscar傷寒TypoidFever

ClinicalmanifestationIncubationperiod:

7-23day(average10to14days)Typicaltyphoidfever:InitialperiodFastigiumDefervescenceConvalescence傷寒TypoidFeverClinicalmanifestationInitialperiodonset:insidious,gradualfever:Tstepwisefashionrisingnon-specialsymptoms:傷寒TypoidFeverClinicalmanifestationFastigiumsustainedfevertoxicsymptoms:

NSapathy,tinnitus,delirium,lethargy,comaDSanorexia,abdominalPain,diarrheaConstipationCSrelativeslowpulse,bradycardia,myocarditis傷寒TypoidFeverClinicalmanifestationFastigiumrose-coloredrash:

erythematousmaculesorpapulesoccuron6~13days

upperabdomenhepatomegalyandsplenomegaly傷寒TypoidFeverClinicalmanifestationDevervescenceConvalescence傷寒TypoidFeverClinicalmanifestationClinicaltype:Mildtypecommontypeprolongedtype,ambulatorytypefulminatetype傷寒TypoidFeverClinicalmanifestationRelapse:Itoccur1~3weekafterThasreachednormal.Theillnessfollowsasimilarpatterntotheprimaryattach.Bloodculturepositive.Recurrence:Itoccur3~4aftertheillness.Tbegintofall,thenriseagain.Bloodculturepositive.傷寒TypoidFeverComplicationsIntestinalhemorrhageIntestinalperforationToxichepatitisandmyocarditisPneumonia傷寒TypoidFeverLaboratoryFindingsBloodpicture:leukopeniaBacteriaculture:

bloodbonemorrowurineandstool傷寒TypoidFeverLaboratoryFindingsWidaltest:

agglutinationofserumreaction5Ag:“O”“H”,“HABC”titer:O>=1:80H>=1:160resultsanalysis:傷寒TypoidFeverDiagnosisEpidemiologicaldataClinicalmanifestationLaboratoryfindingsDefinitivediagnosis:bacteriaculturepositive傷寒TypoidFeverDifferentialDiagnosisTyphusrickettsisesmalariadisseminatedTB傷寒TypoidFeverTreatmentGeneraltherapyEtiologictherapyguinolone:firstchoicecephalosporins:2ndand3rdgenerationchloromycetin傷寒TypoidFeverPreventionControlofsourceofinfection:isolationInterruptionofrouteoftransmissionProt