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Typhoid fever


An acute infectious disease caused by a bacterium of the genus Salmonella. The causative agent can persist in soil and water for up to 1-5 months. Dies when heated and exposed to conventional disinfectants.
The only source of infection is a sick person and a carrier carrier. Typhoid bacilli are carried directly by dirty hands, flies, sewage. Outbreaks associated with the use of infected foods (milk, cold meat dishes, etc.) are dangerous.
Symptoms and course:
The incubation period lasts from 1 to 3 weeks. In typical cases, the disease begins gradually. Patients note weakness, fatigue, moderate headache. In the following days, these phenomena intensify, body temperature begins to rise to 39-40 ° C, appetite decreases or disappears, sleep is disturbed (drowsiness during the day and sleeplessness at night). There is a delay in stool, flatulence. By 7-9 days of illness on the skin of the upper sections the abdomen and lower chest, usually on the anterolateral surface, a characteristic rash appears, which is small red spots with clear edges, 23 mm in diameter, rising above the skin level (roseola). They are characterized by a peculiar retardation of patients, pallor of the face, decreased heart rate and decreased blood pressure. Scattered dry hrins are heard over the lungs - a manifestation of specific bronchitis. The tongue is dry, cracked, covered with a dirty brown or brown coating, the edges and tip of the tongue are free of plaque, with teeth imprints. There is a rough rumbling of the cecum and pain in the right iliac region, the liver and spleen are enlarged upon palpation. The number of leukocytes in peripheral blood is reduced, especially neutrophils and eosinophils.
ESR remains normal or rises to 15-20 mm / h. By week 4, the condition of the patients gradually improves, body temperature decreases, headache disappears, appetite appears. Terrible complications of typhoid fever are intestinal perforation and intestinal bleeding.
In recognizing the disease, timely identification of the main symptoms is of great importance: high body temperature lasting more than a week, headache, adynamia - decreased motor activity, loss of strength, sleep disturbances, appetite, characteristic rash, sensitivity to palpation in the right ileal abdomen, liver enlargement and the spleen. From laboratory tests, the bacteriological (immunofluorescence method) blood culture on Rappoport's medium or bile broth is used to clarify the diagnosis; serological studies - the reaction of Vidal and others.
Treatment:
The main antimicrobial drug is chloramphenicol. Assign 0.50.75 g, 4 times a day for 10-12 days to normal temperature. A 5% glucose solution, an isotonic sodium chloride solution (500-1000 mg) is injected intravenously. In severe cases, corticosteroids (predisolone at a dose of 30-40 ml per day). Patients must comply with strict bed rest for a minimum of 7-10 days.
Prevention:
Sanitary supervision of food enterprises, water supply, sewage. Early detection of patients and their isolation. Disinfection of premises, linen, dishes that are boiled after use, the fight against flies. Dispensary observation for cases of typhoid fever. Specific vaccine vaccination (TAVTe).