Typhoid-paratyphoid diseases

Typhoid-paratyphoid diseases (typhoid fever, paratyphoid A and B) are a group of acute infectious diseases with a fecal-oral transmission mechanism caused by salmonella and similar in clinical manifestations. Characterized by fever, general intoxication, bacteremia, enlargement of the liver and spleen, enteritis and a peculiar lesion of the lymphatic apparatus of the intestine. Relate to intestinal anthroponosis. The main source of infection in recent years are the chronic bacterial carriers of Salmonella (see also Salmonella).

Etiology, pathogenesis. The causative agents of the disease are several species of salmonella - Salmonella typhi, S. Paratyphi A, S. schottmulleri. Pathogens are sensitive to levomycetin and ampicillin. The infecting dose ranges from 10 million to 1 billion microbial cells. The introduction of the pathogen occurs in the small intestine, where a specific enteritis develops. Lymphatic formations of the small intestine and mesenteric lymph nodes are affected. Since the first days of the disease, it is possible to isolate pathogens from the blood. During the breakdown of Salmonella, endotoxin is released, which causes symptoms of general intoxication and plays an important role in the genesis of ulcers of the small intestine, leukopenia and can cause the development of an infectious-toxic shock.

Symptoms, course. The incubation period lasts from 1 to 3 weeks. With a typical course, the disease begins gradually. Fatigue, headache, symptoms of intoxication grow, body temperature rises every day, reaching the highest figures by the 7th-9th day of the disease. The chair is usually detained, there is flatulence. When paratyphoid in the initial period of the disease there may be symptoms of acute gastroenteritis. When paratyphoid A there are symptoms of catarrh of the respiratory tract. In the midst of the heat, there is a retardation of the patients, a headache, a decrease in appetite, a mild cough. The examination reveals a typical typhoid fever. It is a single roseola with a diameter of 3-6 mm, towering above the level of the skin with clear boundaries. After 3 - 5 days, the roseola disappears without a trace. Occasionally, new elements of the rash appear. Relative bradycardia is noted; Can be heart rate, blood pressure lowered, heart sounds muffled. Rare dry rales are heard over the lungs. The tongue is dry, covered with a dense brownish coating. The edges and tip of the tongue are free from plaque, with prints of teeth. The abdomen is swollen, rough rumbling in the caecum and soreness in the right ileal region are noted. The liver and spleen are enlarged. At the height of the disease, the number of leukocytes in peripheral blood, especially neutrophils and eosinophils, decreases. ESR normal or moderately elevated (up to 20 mm / h). In the urine there are traces of protein.

The most formidable complications are perforation of intestinal ulcers and intestinal bleeding. Possible pneumonia, infectious psychosis, acute cholecystitis, less often other complications. Perforation of the intestine occurs in 0.5-8% of patients usually in the period from the 11th to the 25th day of the disease. In recent years, intestinal perforation often occurs against the background of normal temperature and well-being of the patient, often with the expansion of the motor regime. It begins suddenly with acute pain in the abdomen, muscle tension, irritation symptoms of the peritoneum. There is a free gas in the abdominal cavity, a decrease in the dimensions of the hepatic dullness. These initial manifestations of perforation may decrease, which causes difficulties in early diagnosis, and further (if surgery is not performed in the first 6 hours), a pattern of diffuse peritonitis, vomiting, increased body temperature, increased body temperature, tachycardia, irritation of the peritoneum, fluid in the abdominal Cavity, leukocytosis. Intestinal bleeding is possible and the same terms as the perforation of the intestinal ulcer. It is determined by the appearance of an admixture of altered blood in feces or by the symptoms of an acutely developing internal bleeding. With the early cancellation of antibiotics, the relapse rate reached 20-30%. Relapses sometimes occur 1-2 weeks after the normalization of body temperature. Chronic bacteriocarrier development occurs in 3-5% of patients who have recovered.

Clinical diagnosis in the initial period of typhoid paratyphoid diseases presents difficulties, especially in the lungs and atypical cases. During this period, the evidence is the isolation or detection of pathogens in the blood (cultures for bile broth, detection with the help of immunofluorescent method). With a typical clinical picture, diagnosis is not difficult. In later periods of the disease, stool and stool can be used (Vidal's reaction, RNGA).

Treatment. Assign levomitsetin 0.5-0.75 g 4 times a day until the 10th-12th day of normal temperature. In the absence of effect, the presence of contraindications (psoriasis, eczema, fungal infections), intolerance of the drug prescribed ampicillin inside 1 g 4-6 times a day to 10-12th day of normal temperature. In severe forms, antibiotic therapy is combined with a short course (5-7 days) of glucocorticoids (prednisolone 30-40 mg / day). Pathogenetic therapy (vitamins, oxygen therapy, vaccine therapy) is used. Bed rest until the 7th-10th day of normal temperature. At intestinal bleeding, the patient needs absolute rest, a cold on the abdomen, vikasol (1 ml of a 1% solution), aminocaproic acid (200 ml of a 5% solution). With perforation of the intestine - an urgent surgical intervention. Treatment of chronic bacteriocarrier is not developed.

The prognosis with modern methods of treatment is favorable. In severe forms and the presence of complications (especially intestinal perforation), the forecast is worse. Workability is restored after 1,5-2 months from the onset of the disease.

Prevention. Sanitary supervision of food and water supply. Reconvalvesent is prescribed after a triple negative bacteriological study of feces and urine and a single examination of bile (portions B and C). Those who have been ill stay on the account of a sanitary-epidemiological station for 2 years (workers of food enterprises - 6 years). Isolation of patients ceases from the 21st day of normal body temperature. The indications are specific immunization. The focal point is the final disinfection.