Enteric feve

ميسره احمد عثمان كتب:Enteric fever
Last reviewed: May 19, 2013.

Typhoid fever is an infection that causes diarrhea and a rash. It is most commonly due to a type of bacterium called Salmonella typhi (S. typhi).
Causes, incidence, and risk factors

S. typhi is spread through contaminated food, drink, or water. If you eat or drink something that is contaminated with the bacteria, the bacteria enter your body. They travel into your intestines, and then into your blood. The bacteria travel through the blood to your lymph nodes, gallbladder, liver, spleen, and other parts of the body.

Some persons become carriers of S. typhi and continue to release the bacteria in their stools for years, spreading the disease.

Typhoid fever is common in developing countries. Fewer than 400 cases are reported in the U.S. each year. Most cases in the U.S. are brought in from other countries where typhoid fever is common.

Symptoms

Early symptoms include fever, general ill-feeling, and abdominal pain. High fever (103°F, or 39.5°C) or higher and severe diarrhea occur as the disease gets worse.

Some people with typhoid fever develop a rash called "rose spots," which are small red spots on the abdomen and chest.

Other symptoms that occur include:

Abdominal tenderness
Agitation
Bloody stools
Chills
Confusion
Difficulty paying attention (attention deficit)
Delirium
Fluctuating mood
Hallucinations
Nosebleeds
Severe fatigue
Slow, sluggish, lethargic feeling
Weakness
Signs and tests

A complete blood count (CBC) will show a high number of white blood cells.

A blood culture during the first week of the fever can show S. typhi bacteria.

Other tests that can help diagnose this condition include:

ELISA urine test to look for the bacteria that cause Typhoid fever
Fluorescent antibody study to look for substances that are specific to Typhoid bacteria
Platelet count (platelet count may be low)
Stool culture
Treatment

Fluids and electrolytes may be given by IV (into a vein). Or you may be asked to drink uncontaminated water with electrolyte packets.

Antibiotics are given to kill the bacteria. There are increasing rates of antibiotic resistance throughout the world, so your health care provider will check current recommendations before choosing an antibiotic.

Outlook (Prognosis)

Symptoms usually improve in 2 to 4 weeks with treatment. The outcome is likely to be good with early treatment, but becomes poor if complications develop.

Symptoms may return if the treatment has not completely cured the infection.

Possible Complications

Intestinal hemorrhage (severe GI bleeding)
Intestinal perforation
Kidney failure
Peritonitis
When to Contact a Medical Professional

Call your health care provider if:

You have had any known exposure to typhoid fever
You have been in an endemic area and you develop symptoms of typhoid fever
You have had typhoid fever and the symptoms return
You develop severe abdominal pain, decreased urine output, or other new symptoms
Prevention

A vaccine is recommended for travel outside of the U.S. to places where there is typhoid fever. The Centers for Disease Control and Prevention website has information about where typhoid fever is common. Ask your health care provider if you should bring electrolyte packets in case you get sick.

When traveling, drink only boiled or bottled water and eat well-cooked food.

Water treatment, waste disposal, and protecting the food supply from contamination are important public health measures. Carriers of typhoid must not be allowed to work as food handlers.

References

Giannella Ra. Infectious enteritis and proctocolitis and bacterial food poisoning. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 107.
Lima AAM, Guerrant RL. Inflammatory enteritides. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Elsevier Churchill Livingstone; 2009:chap 97.
Review Date: 5/19/2013.

Reviewed by: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

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