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enteric fever

Why is typhoid called enteric fever?

Why is typhoid called enteric fever?

Typhoid fever, also known as enteric fever, is a potentially fatal multisystemic illness caused primarily by Salmonella enterica serotype typhi and, to a lesser extent, S enterica serotypes paratyphi A, B, and C. The terms typhoid and enteric fever are commonly used to describe both major serotypes.

enteric fever

Enteric fever is a syndrome of fever, abdominal pain, relative slow heart rate (bradycardia), splenomegaly, and low white blood cell count (lycopene). Contamination with Salmonella typhi is a synonym for the disease although other bacteria can cause this disease, such as non-typhoid salmonella and Yersinia enterocolitica. Here we will discuss the disease caused by Salmonella typhimurium, which is considered an intracellular pathogen, and is highly endemic in third world countries, especially in India, South America, Southeast Asia and the Caribbean Islands.

Each year, approximately 16 million new cases are reported, of which, approximately 600,000 end with the patient’s death. Enteric fever has almost disappeared in industrialized countries, and appears mainly in travelers who stayed in endemic areas, and it is associated with a very small death rate.

The infection is caused by the consumption of food or drinking water contaminated with human feces. The ingested germs need to overcome the acidity of the stomach, and then invade the lymph nodes (Peyer’s patches) in the intestine, from which they spread throughout the body through the lymphatic tract or through the blood, especially in the lymphatic organs (spleen, liver and bone marrow). The low acidity in the stomach helps to infect the germ, knowing that the human body is the natural habitat of this germ.

The incubation period of the germ takes between 5-21 days, while the disease begins to develop gradually. In most cases, the temperature ranges between (100%-75%). In the first week, the patient’s temperature rises gradually (Remittent), to stabilize in the second week, and sometimes, between 39-40 degrees Celsius. This is accompanied by a relative slowing of the heartbeat, and the appearance of rashes in the lower back or on the abdomen (Rose spots), which help diagnose the disease.

The disease may be accompanied by constipation (in half of the cases) or diarrhea (in the other half) and sometimes with conjunctivitis, sore throat and cough. Complications of the disease begin to appear in the third week of the entry into force of the bacteria in the bloodstream, it is possible that these complications include pneumonia, endocarditis (endocarditis), inflammation of the bone (osteomyelitis), rheumatoid arthritis , meningitis brain (meningitis) and rupture of the intestine.

Diagnosis of enteric fever

In most cases, diagnosis is based on blood samples or a bone marrow biopsy. The growth of the germ in a sample of stool and urine is also circulating, but at a lower rate. The traditional Widal test is not considered an effective method for diagnosing enteric fever.

Enteric fever treatment

The recommended antibiotic treatment is with the use of the third generation group of cephalosporins such as: Ceftriaxone or from the group of quinolones such as Ciprofloxacin.

Conventional treatment with chloramphenicol is effective but to a lesser extent, and results in a very high percentage of deaths or recurrence of enteric fever. In some patients, the germ lives in the biliary tract, which makes these patients carriers of the disease and constitute a source of infection.

Prevention of enteric fever

Travelers to endemic areas can protect themselves from infection by observing the basic rules of caution with regard to eating and drinking, as well as by vaccination.

There are two types of vaccine (vaccination): a vaccine from a live and attenuated germ that is taken orally, and another vaccine based on the complex sugars (polysaccharides) found on the sides of the germ and is supplied through the injection. The efficacy of the vaccine is 50%-80%, and its validity extends from two to five years.

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