TYPHOID FEVER

Bruce TIF - infectious disease from the group of intestinal infections, characterized by ulcerative lesions of the lymphatic apparatus of the small intestine, cyclic flow, bacteremia, symptoms of intoxication, rash on the skin.

The causative agent is Salmonella typhi, a gram-negative mobile rod-shaped bacterium with a large number of flagella. In the environment (water, soil), typhoid bacteria can persist for several months. In some products, for example milk, cottage cheese, minced meat, microbes are able to multiply. They are well tolerated by low temperatures, but quickly die by boiling and under the influence of disinfectants.

The source of the infectious agent is a sick person and a carrier. Excretion of the pathogen from the patient begins in the last days of the incubation period and occurs throughout the disease, and also often during the recovery period. In a number of cases, the excretory excretion continues for 3 months after the illness (acute carrier), and sometimes all life (chronic carrier). Chronic carriers are especially epidemiologically dangerous, therefore they are not allowed to work at food industry enterprises, public catering, in children's institutions. The causative agent enters the environment with feces and urine. Infection of a person occurs with the use of water and food contaminated with feces containing the causative agents of typhoid fever, as well as through contaminated hands. The transmission of pathogens involved flies.

The highest incidence is in the summer and autumn months; But can be observed throughout the year.

Clinical picture. The incubation period lasts from 3 to 25 days, more often 10-14 days. The disease usually begins gradually, although often there is an acute onset. With gradual development, the body temperature slowly rises, which reaches high figures by 4-7 days, weakness, malaise, headache , insomnia, and appetite decrease. The temperature rests on high figures 2 - 3 weeks; Its decrease occurs slowly, with large fluctuations between the morning and evening temperatures. Since the first days of illness, paleness and dryness of the skin have been noted. On the 8th-9th day of the disease on the skin of the chest and abdomen, there is often a roseolous rash - red specks with a diameter of 2 - 3 mm, disappearing when pressed. The rash is usually uneventful, it lasts 3 to 5 days, in severe cases it can be hemorrhagic. The appearance of new elements of the rash is possible during the entire febrile period and even at normal body temperature. The tongue is thickened, with the prints of the teeth, it is coated with a white coating, the edges and tip are clean. Due to the cut of the intestine, the abdomen is swollen, rumbling is noted in the right iliac region, and there is a tendency to constipation. By the end of the first week of the illness, enlarged spleen and liver are usually palpated. From the first days of the disease there may be a cough , dry, and sometimes wet wheezing , is heard in the lungs. At the height of the disease, the pulse rate lags behind the temperature: there is a relative bradycardia (for example, at t 39 - 40 ° C, the pulse is 80-90 beats per minute). Occasionally, dyskotia of the pulse (a two-wave pulse) is detected. Heart sounds are deaf, blood pressure is lower. At the height of the disease, all the symptoms increase, the sick are inhibited, and delusions are possible.

With the drop in temperature, the general condition of the patient usually improves. Sometimes, against the background of a beginning recovery (a decrease in temperature, a reduction in the headache, improvement in appetite and sleep), the temperature rises again, the state of health worsens, the headache , insomnia, and roseola appear. This is an exacerbation of the disease, which must be distinguished from its relapses. Relapses characterized by recurrence of all symptoms of typhoid fever occur after several days or weeks, during which the normal temperature persists. They are usually lighter and shorter. Signs of a possible relapse may be subfebrile temperature, tachycardia , absence of eosinophils in the blood (aneosinophilia), enlarged spleen. Relapses occur more often when a violation of the regime, mental trauma, inaccuracies in the diet, early cancellation of antibiotics.

Typhoid fever can occur abortively (a typical beginning, but with a rapid drop in temperature and the disappearance of other symptoms) and is erased (low intensity symptoms of intoxication, short-term flow).

The most formidable complications are intestinal bleeding and perforation of the intestine , which are usually observed at the 2nd -3rd week of the disease. With bleeding, the patient pales, facial features sharpen, blood pressure falls, tachycardia arises , feces acquire tarry appearance (melena). When perforating the walls of the intestine, patients complain of pain in the right iliac region. Quite quickly there is a local tension in the muscles of the abdomen, then a symptom of irritation of the peritoneum, there are signs of intoxication, indicating a developing peritonitis. Complications such as pneumonia , pressure ulcers, parotitis , thrombophlebitis , otitis , cystitis , cholecystitis , myocarditis , meningitis , etc. can also be observed.

The diagnosis is established based on the clinical picture of the disease, the epidemiological history (contact with patients or bacterial carriers, the use of non-contaminated water) and the results of laboratory studies. In the blood there are leukopenia with a stab-shift, neutropenia, relative lymphocytosis, aneosinophilia.

The earliest and most accurate confirmation of the diagnosis is the excretion of pathogens from blood (haemoculture). To do this, from the ulnar vein take 5-10 ml of blood and sow it on 50-100 ml of bile broth or other medium containing bile, and sent to the laboratory. The answer is received in 4 to 5 days. Be sure to conduct bacteriological studies of feces and urine, and in convalescents of duodenal contents. Serological tests of blood serum are auxiliary diagnostic methods. More often the reaction of indirect hemagglutination (RIGA) with erythrocyte diagnosticums O, H and Vi, which happens to be positive, starting from the 4th-5th day of the disease. The diagnostic titer is 1: 160 and above.

Treatment. Hospitalization is compulsory. One of the main conditions for the patient's recovery is good care. During the first 6 to 7 days after the establishment of normal temperature, the patient must comply with strict bed rest, then he is allowed to sit in bed and only from 10 -12th day - to walk. Assign a strict diet. The patient gets easily assimilated, saturated with vitamins, high-calorie food (broth, meatballs, cottage cheese, kefir, liquid porridges, except millet, juices, baked apples, etc.).

Medication includes antibacterial drugs: levomitsetin , ampicillin , biseptol . To prevent recurrence and bacterial transport in combination with antibiotics, vaccine therapy can be carried out. For the purpose of detoxification, various liquids are injected intravenously: polyionic solutions, hemodez, reopolyglucin, etc. Cardiovascular and hypnotics are used for indications, it is advisable to use routine, ascorbic acid, and also vitamins of group B.

People discharging typhoid fever are discharged from the hospital after a complete clinical recovery, but not earlier than the 23rd day after the establishment of normal temperature (after antibiotic treatment).

The prognosis for uncomplicated typhoid is favorable. In the case of complications, especially with perforation of the gut and the occurrence of peritonitis, the prognosis may be unfavorable.

Prevention. The basis for the prevention of typhoid fever is sanitation and preventive measures: the improvement of settlements, the supply of benign water to the population, the creation of a rational system for the removal of sewage and garbage from the territory of settlements, the observance of established rules for water use, production, transportation and sale of food products, flies control and hygiene education (Compliance with personal hygiene, washing vegetables, fruits and berries with disinfected water, etc.). Preventive measures include medical supervision of workers in the food industry and public catering, as well as equated with them (employees of waterworks, utilities, medical and preventive institutions, etc.). Individuals entering the work for these enterprises (institutions) are subjected to a single bacteriological study of stool, and also serum of blood is examined with the help of RNGA. With a positive result of a bacteriological study, hospitalization is shown to ascertain the nature of the carrier. With a positive result of serological reactions, a fivefold bacteriological study of feces and urine is carried out and, in the case of a negative result, a further study of bile is performed.

Recovered patients are discharged from the hospital with a triple negative result of bacteriological examination of feces and urine and a single negative result of seeding of duodenal contents. All those who have recovered after discharge from the hospital are subject to follow-up for 3 months, during which a single bacteriological study of feces and urine is performed monthly. At the 4th month, a bacteriological study of duodenal contents is carried out and the RNGA is placed. For 2 months, the patient was having a thermometry - once a week for 1 month and then at least once every 2 weeks. In case of fever or deterioration of the general condition (sleep disturbance, weakness, headache), a general blood test and a bacteriological study of feces, urine, blood to identify typhoid paratyphoid bacteria are performed. In case of negative results in all studies, convalescent can be removed from dispensary observation.

Reconvalvesent after the transferred typhoid from the number of workers of food enterprises and persons equal to them, are not allowed to work in their specialty for 1 month after discharge from the hospital. During this time, the convalescents of this group produce a fivefold bacteriological study of feces and urine. If the result is negative, these persons are allowed to work, but in the next 2 months they are examined monthly (feces and urine). By the end of the third month, single bile and serum were examined with the help of RNGA. If negative results are obtained, these individuals are examined for a period of 2 years quarterly (feces and urine) once, and then, twice a year, feces and urine are examined twice during their entire work life. With a positive result of one of the studies, these individuals are not allowed to work and sent to the hospital to determine the nature of the carrier and treatment.

Patients who communicate with the patient are monitored for 21 days, they undergo a single bacteriological study of feces and urine (for workers in food enterprises and persons equated to them - twice) and a blood serum study with the help of RNGA. When isolating the pathogen from the feces, and in the case of a positive result of the serological reaction, hospitalization is necessary to determine the nature of the carriage and treatment.

In the outbreak, the current and final disinfection is carried out. To all persons who were in contact with the patient, prescribe a typhoid bacteriophage (3 times 50 ml per reception). For immunization according to epidemiological indications, a chemical sorbed liquid vaccine containing the antigenic component of the causative agent of typhoid fever is used. The vaccine is administered subcutaneously, once; Single dose for children under 14 years - 0.6 ml: from 15 years - 1 ml.