5. S. typhi, a major human pathogen for thousands of years , thriving in conditions of poor sanitation , crowding , and social chaos
6. 430–426 B.C. Killed 1/3 of the population of Athens , including their leader Pericles . The power shifted from Athens to Sparta . 2006 study detected DNA sequences similar salmonella
7. Antonius Musa A Roman physician who achieved fame by treating the emperor Augustus with cold baths when he contracted typhoid
13. Infects roughly 21.6 million people each year * International Estimate Ramsden AE, Mota LJ, Münter S, Shorte SL, Holden DW. The SPI-2 type III secretion system restricts motility of Salmonella-containing vacuoles. Cell
14. Kills 200,000 people each year * International Estimate Ramsden AE, Mota LJ, Münter S, Shorte SL, Holden DW. The SPI-2 type III secretion system restricts motility of Salmonella-containing vacuoles. Cell
15. 62% of these occurring in Asia and 35% in Africa * International Estimate * Taylor TE, Strickland GT. Malaria. In: Strickland GT, ed. Hunter’s Tropical Medicine and Emerging Infectious Diseases. 8th ed. Philadelphia: WB Saunders, 2000:614-43.
16. Highest in Pakistan & India in Asian countries (451.7 per 100,000) * WHO Estimate * Bull World Health Organ vol.86 no.4 Genebra Apr. 2008
23. S. typhi are able to survive a stomach pH as low as 1.5 . Antacids , (H2 blockers), PPI’s, gastrectomy, facilitate S typhi infection TYPHOID FEVER RISK FACTORS
24. Contaminated food, House hold with Cases, Inadequate hand washing, , drinking unpurified water, and living without a toilet Environmental/behavioral risk factors TYPHOID FEVER RISK FACTORS
27. Diffuse abdominal pain , Inflamed Peyer patches narrow the lumen-- Constipation . Dry cough, dull frontal headache , delirium, increasingly Stupor & malaise FIRST WEEK OTHER SYMPTOMS
28. Rose spots , blanching, truncal, maculopapules usually 1-4 cm wide, < 5 in number; these generally resolve within 2-5 days ( bacterial emboli to the dermis ) FIRST WEEK OTHER SYMPTOMS
29. Distended abdomen, Soft splenomegaly , Relative bradycardia & dicrotic pulse (double beat, the second beat weaker than the first) SECOND WEEK
30. Patient may descend into the typhoid state- --apathy, confusion, and even psychosis THIRD WEEK TYPHOID STATE
31. Necrotic Peyer patches, bowel perforation, Peritonitis, intestinal hemorrhage may cause death THIRD WEEK Week of complications
32. Fever, mental state, and abdominal distension slowly improve over a few days, complications may still occur in surviving untreated individuals FOURTH WEEK WEEK OF CONVALESCENCE
35. Bilateral Salmonella typhi breast abscess unmarried 35-year-old female without any predisposing conditions Singh S, Pandya Y, Rathod J, Trivedi S. Bilateral breast abscess: A rare complication of enteric fever. Indian J Med Microbiol [serial online] 2009 [cited 2009 Oct 16];27:69-70. Available from: http://www.ijmm.org/text.asp?2009/27/1/69/45176
42. 2 or 3 weeks hx of disease, with suddenly worsening of pain & general conditions , Tenderness starts in his right lower quadrant, spreads and eventually becomes generalized, Guarding , (seldom the board-like rigidity) Erect film, shows gas Under diaphragm (50% positive) lateral decubitus film, shows gas under his abdominal wall The bradycardia and leucopenia of typhoid may occasionally mask the tachycardia and leucocytosis of peritonitis PRESENTATIN PERFORATION
44. If peritonitis seems to be localized , signs confined to only part abdomen, general condition is good , patient not deteriorating , consider non-operative treatment . If signs of generalized peritonitis, do a laparotomy CONSERVATIVE SURGICAL VS
45. “ Suck and drip” Resuscitation, antibiotics, pass a NG-tube, Monitor abdominal tenderness, pulse, temperature, white blood count. If any of these rise, suspect that peritonitis is extending, so take an erect X-ray film of his abdomen CONSERVATIVE MANAGEMENT
47. Do not forget to cover anaerobes and gram negative bacteria along with salmonella
48. Operate as early as possible , Do as much as necessory & as little as possible SURGICAL MANAGEMENT PREPARATION Adequately resuscitate, Maintain good urine output, pass nasogastric tube down, Start chemotherapy.
49. *Agbakwuru EA, Adesunkanmi AR, Fadiora SO, Olayinka OS, Aderonmu AO, Ogundoyin OO et al A review of typhoid perforation in a rural African hospital. West African Journal of Medicine 2003; 22(1):22-25. (13 kb) Abstract only Surgery Steps
57. Intestinal bleeding is often marked by a sudden drop in blood pressure and shock, followed by the appearance of blood in stool Hemorrhage presentation
58. replace the blood loses. Bleeding usually stops spontaneously Only operate if bleeding is persistent, or alarmingly INTESTINAL HEMORRHAGE
61. Occurs in 1-2% of cases *According to Indian study 8% More common in children Antibiotic resistance & virulence of bacteria *M.L. Kulkarni, SJ. Rego, Department of Pediatrics, J.J.M. Medical College, Davangere 577 004. Acute Acalculous Cholecystitis TYPHOID
62. *Thickened gall bladder wall, sonographic Murphy's sign, pericholicystic collection in the absence of gall stones *Subha Rao SD, LewinS, Shetty B, et al. Acute acalculous cholecystitis in typhoid fever. Indian Pediatr 1992, 29: 1431-1435. Acute Acalculous Cholecystitis TYPHOID
63. Unlike other AACs, antibiotic therapy is the recommended treatment for Typhoid AAC Acute Acalculous Cholecystitis TYPHOID
64. Chronic Cholecystitis (Carriers) TYPHOID Excretes bacteria in stools for more > 1 year1-4% of non-treated infected patients become chronic carriers Patients with cholelithiasis, biliary anomalies, females, Salmonella can be cultured from stools, duodenal aspirate, gall stones
65. Mary Mallon (September 23, 1869 – November 11, 1938) Forcibly quarantined twice, she infected 47 people , three of whom died . She died in quarantine.
69. Typhoid Enteric Perforation: Prognostic Factors an Experience with 76 Patients J Ayub Med Coll AbottabadJan - Mar 2000;12(1):49-52.Department of Surgery, Khyber Teaching hospital, Peshawar
75. Good food handling & water sewage treatment can eliminate typhoid Prompt anntibiotic therapy can save many lives—take it a serious job Severe vomiting, diarrhoea & abdominal distension--- complicated, admit them & give IV antibiotics and support Prognosis of complications depends on the time-lapse b/w onset & treatment TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications TYPHOID Surgical Complications take home message killer salmonella formidable