Typhoid fever disease. Typhoid typhoid. Treatment and Prevention of Typhoid Fever. Basic measures to prevent typhoid fever

Typhoid fever is an infectious disease that is accompanied by damage to the intestinal lymphatic system. Despite such rapid development of medicine, outbreaks of this disease are still recorded in some countries to this day.

Today, many people are interested in the question of what typhoid fever is. Everyone should know the symptoms and causes of the disease. Indeed, in the absence of proper treatment, there is a high probability of developing severe complications and sometimes death.

Brief historical information about the disease

In fact, the symptoms of typhoid fever in adults and children were first described before our era. The term “typhos” itself was introduced by Hippocrates, although at that time the name was used to refer to almost all febrile conditions. And already at the end of the 19th century, typhoid bacillus was discovered during a laboratory study of Peyer's patches of the intestine.

In 1896, M. Gruber first observed the process of agglutination of typhoid bacilli upon contact with certain serums. Subsequently, F. Vidal used this discovery to create a diagnostic procedure, which is still known today as the “Vidal reaction.”

Pathogen and its description

The causative agent of typhoid fever is the gram-negative bacillus Salmonella typhi, which belongs to the genus Salmonella, family Enterobacteriaceae. These microorganisms are usually unpretentious and affect not only humans, but also some animals.

It is worth noting that these bacteria, once released into the external environment, can retain the ability to live for quite a long time. For example, salmonella live in soil from 1 to 5 months. On food they remain pathogenic for several weeks. Heating has a detrimental effect on the microorganism, causing its death (this is why pasteurization and proper heat treatment are so important). Pathogenic microorganisms can also be destroyed using disinfectants in normal concentrations.

How is the infection transmitted?

To begin with, it is worth noting that the human body is extremely susceptible to this strain of salmonella. The route of transmission of infection in this case is fecal-oral. The main source is a sick or infected person who spreads the infection. By the way, the patient’s danger to others depends on the stage of the disease. A person becomes most contagious around the second or third week of illness, as bacteria are excreted in stool, urine, and even sweat.

Salmonella can enter the body of a healthy person in different ways. Quite often, outbreaks of the disease are associated with the spread of infection through water. This often happens in regions where there is a shortage of drinking water. In addition, you can pick up pathogenic microorganisms if you eat contaminated food (especially if we are talking about unwashed vegetables and fruits, as well as milk and meat that have not undergone appropriate heat treatment). Foodborne outbreaks are typically associated with unsanitary conditions in food production facilities or the presence of a source of infection (for example, a sick employee).

Transmission of salmonella through sharing household items is also possible. In most cases, bacteria settle on dishes, towels, bedding, toys, clothes, etc.

Pathogenesis of the disease

What is typhoid fever? Its symptoms, especially in the initial stages, are associated with intoxication of the body, which is due to the peculiarities of the life activity of salmonella. Penetrating into the body along with food or water, the pathogenic microorganism easily overcomes the protective barriers of the oral cavity and stomach. After this, the bacteria enter the lymphatic follicles of the small intestine, where they begin to multiply.

New individuals enter the bloodstream, causing the first wave of intoxication symptoms. Together with the bloodstream, Salmonella enters the tissues of other organs, including the bone marrow, spleen and liver, where characteristic typhoid granulomas are formed. Subsequently, the bacteria again penetrate the intestinal lymphatic system, but this time their active activity leads to necrosis of Peyer's patches and the formation of ulcers in the distal parts of the small intestine.

Typhoid fever: symptoms and clinical picture

The incubation period for such a disease usually lasts from 10 to 14 days, although there are cases where the first manifestations were observed three weeks after infection. In most patients, the onset of the disease is acute. The main signs of typhoid fever depend on the stage of development of the disease.

The first, or initial, stage of the disease begins with a sharp increase in body temperature, which often reaches 40 degrees. Subsequently, the main symptoms of intoxication appear. In particular, patients complain of increasing severe weakness, insomnia, dizziness, headache, and appetite disorders. Pallor of the skin may also be observed.

These are not all the disorders that accompany typhoid fever. Symptoms (you can see the photo here) include severe bloating - upon palpation, patients often complain of pain in the right iliac region. Signs of the disease include swelling of the tongue. The patient's spleen and liver are also enlarged.

The peak period of the disease occurs approximately at the beginning of the second week after infection and can last 14-20 days. Symptoms of intoxication of the body continue to increase - the temperature remains high, patients still complain of weakness and dizziness. Often a new characteristic sign appears - small roseola located on the skin of the lower chest and abdomen. As a rule, the rash consists of only 2-5 small spots, the edges of which rise above the skin. After a few days, roseola disappears, but then may appear again. Symptoms also include bradycardia, changes in pulse (a two-wave pulse is heard), and also a discrepancy between the heart rate and the patient’s body temperature.

In the absence of timely treatment, more severe disorders may develop. In particular, severe intoxication can cause disturbances of consciousness, apathy, and various movement disorders.

Subsequently, the so-called period of convalescence begins. At this time, the symptoms of typhoid fever in adults and children begin to gradually disappear. First, the body temperature normalizes, the patient begins to feel much better, as weakness, headache and drowsiness disappear. But at this stage you should also not let your guard down. Yes, the body is gradually cleared of toxins, but ulcerative processes in the intestines still remain. At this time, if treatment is stopped or care is insufficient, there is a high probability of complications such as bleeding or perforation of the intestinal wall.

Are there other forms of the disease?

Of course, not all patients experience the above-described clinical picture. After all, there is also the so-called atypical typhoid fever. Its symptoms do not appear so intensely - some of the main signs of typhus may be completely absent, which leads to difficulties during diagnosis.

Quite often in modern medicine we are faced with an abortive form of the disease, which is accompanied by a short-term increase in temperature and the rapid disappearance of signs of intoxication of the body.

What complications are possible?

It is immediately worth noting that the disease (typhoid fever) in most cases responds well to treatment. But sometimes, especially with improper treatment or its absence, complications that are dangerous to health may appear. In particular, against the background of a pronounced intoxication syndrome, infectious-toxic shock sometimes develops. This condition is accompanied by tachycardia, a noticeable decrease in body temperature, increased sweating and a sharp drop in blood pressure. This patient needs urgent medical attention.

Quite common complications also include perforation of the intestinal wall, as a result of which intestinal contents enter the abdominal cavity. Against this background, peritonitis develops, which is accompanied by an increase in temperature, severe abdominal pain, and tension in the abdominal muscles in the area of ​​the perforation of the wall.

Potentially dangerous consequences include intestinal bleeding. A small loss of blood may not be noticed, as it occurs without any symptoms. But massive bleeding is accompanied by a drop in blood pressure, increased heart rate, and a decrease in body temperature.

Basic diagnostic methods

It should be remembered that only a doctor knows what typhoid fever is, the symptoms and treatment of this disease, and the causes of its occurrence. Therefore, if you have any signs, you should immediately go to a specialist.

First, the doctor will conduct an examination and get acquainted with the patient’s complaints. Further laboratory tests are required in the future. In particular, the following are carried out: a general blood test (a slight increase in ESR is observed, as well as an increase in the number of red blood cells) and urine (samples, as a rule, contain red blood cells and an increased amount of protein).

Diagnosis of typhoid fever also includes bacteriological culture. In this case, the most reliable results are obtained by blood culture. But laboratory tests of feces and urine can not only determine the presence of infection, but also establish the fact of bacterial carriage. Such procedures help to identify the pathogen and test its sensitivity to a particular type of drug.

In some cases, an internal examination for typhoid fever is performed. In particular, duodenal intubation is quite accurate, in which the doctor carefully examines and evaluates the condition of the duodenal mucosa. In controversial cases, additional serological tests are carried out.

What treatment does modern medicine offer?

Not all people know how dangerous typhoid fever can be. Treatment in this case is mandatory. After making a diagnosis, the doctor will draw up a suitable treatment regimen. It is immediately worth noting that every patient with typhus must be hospitalized - treatment is carried out in the infectious diseases department.

Strict bed rest is extremely important for a quick recovery. For several days the patient is not even allowed to sit. And only after 10-12 days (if a person notices an improvement in well-being) do doctors allow slow walking.

As for drug treatment, it includes taking antibacterial drugs. Antibiotics such as Levomycetin, Ampicillin, Biseptol or their analogues are quite effective in this case. Sometimes patients are also vaccinated - this helps prevent the development of relapses in the future.

If necessary, symptomatic therapy is also carried out (depending on the symptoms present, patients are given sedatives or medications to normalize the functioning of the cardiovascular system). Strengthening the immune system is also of great importance - taking multivitamin complexes will have a beneficial effect on your health.

A proper diet is an integral part of treatment. Patients are offered light but high-calorie food, mainly in semi-liquid form.

As a rule, after an illness, the body forms a strong immunity to this infection - repeated infections are extremely rare.

Basic preventive measures

In areas with a high incidence of the disease, immunization of the population is often carried out. All residents (from the age of three) are vaccinated against typhoid fever. After three years, revaccination is necessary. By the way, the drug is injected into the subscapular region. The same procedure is recommended for tourists planning to travel to some countries in Africa, Latin America and Asia.

As for general prevention, it all comes down to compliance with sanitary and hygienic standards. Regular inspections of water quality, food processing plants, catering establishments, etc. are extremely important.

And do not forget that each person is obliged to take care of his own health. It is extremely important to adhere to the rules of personal hygiene, thoroughly wash food before consumption, pasteurize milk, etc. A patient infected with an infection must be hospitalized and isolated. People who have been in contact with typhoid patients should be observed by a doctor - as a preventative measure, they are given drugs with typhoid bacteriophage.

Typhoid fever is an infection that occurs in an acute form; its symptoms are not immediate, and the course of the disease is cyclical. First of all, the lymphatic system in the intestinal area is affected, then general intoxication of the body occurs, and exanthema appears. The incubation period lasts 2 weeks. The disease is diagnosed if pathogens are found in urine, blood or feces.

Therapist: Azalia Solntseva ✓ Article checked by doctor

Symptoms of typhoid fever and Filippovich's symptom

The scientifically recorded duration of the incubation period is from 3 to 50 days. However, it is most likely that the disease will manifest itself within the first 10-14 days from the moment of infection. This is exactly the amount of time it takes for the pathogen to enter the small intestine through the digestive tract and infect the lymphatic system.

The initial period of illness lasts one week. This is the time during which the typhoid pathogen spreads through the circulatory system and causes an immune response in response to the production of endotoxin.

The consequence of these processes is the appearance of the main symptoms of the disease:

• headache;
• increase in body temperature up to 39 degrees, and sometimes higher;
• inhibition of reactions;
• damage to intestinal tissue, expressed in pain in the abdominal area;
• flatulence;
• bowel disorders;
• the appearance of plaque on the tongue;
• Filippovich's symptom (yellow tint of the feet, palms, dry skin);
• muscle pain;
• seizures in young children;
• nosebleeds;
• mental disorders, the appearance of delirium.

The sign that appears one of the first and for many is the most characteristic for the diagnosis of typhoid fever is a rash on the shoulders, back and chest, which lasts up to three to four days.

Diagnosis, blood for typhoid fever

A competent diagnosis of typhoid fever consists of a comprehensive examination of the body, as well as mandatory separation from infectious diseases such as salmonellosis, paratyphoid fever, and viral exanthema.

To make a diagnosis, in addition to the clinical picture of the disease, it is necessary to conduct an analysis for typhoid fever:

1. Serological. This group of studies is designed to identify antibodies - special proteins produced by the body in response to pathogen antigens.
2. General clinical. Determine the presence of an inflammatory process in the body.
3. Bacteriological. Aimed at identifying the causative agent of the disease. Subjects of research: feces, urine, blood.

It is also necessary to use instrumental diagnostic methods:

1. Ultrasound examination of the abdominal organs.
2. X-ray examination of the chest.
3. Gastroduodenoscopy.
4. Electroencephalogram.

The integrated use of all of these methods will allow you to correctly diagnose and prescribe competent treatment.

Causes of the disease, its causative agent

The main causes of the disease - typhoid fever - are associated with the entry of Salmonella bacteria into the human body. One of the species, Salmonella typhi, is the causative agent of typhoid fever. This is a very mobile rod with a complex antigenic structure. It exhibits amazing resistance to the external environment in which it is located: bodies of water, dairy products, soil mixtures, the surface of vegetables and fruits.

Destruction of bacteria is possible. To do this, you need to use a 3% chloramine solution or ethyl alcohol. These substances destroy the pathogen; treatment of the disease will not be required in the future.

The main feature of Salmonella bacteria is the complex structure of the typhoid bacillus. The endotoxin it secretes determines the complete clinical picture of the disease.


In some cases, bacteria do not actively manifest themselves, turning into an inactive form. As they fall asleep, they continue to retain their pathogenic properties. And later, due to a decrease in the carrier’s immunity, the diseases become active.

Epidemiology, analysis for salmonellosis

The source of the disease is the person who is the carrier, as well as objects on the surface of which also contain Salmonella bacilli. Release into the external environment occurs through the spread of feces, urine, and sometimes saliva or breast milk.

A person becomes contagious at the end of the incubation period, that is, approximately 10 days after infection. Sometimes the release of bacteria can be very long, but most often it stops at the height of the disease or closer to recovery.

A person can exclusively be a carrier of the bacterium without having any symptoms. At the same time, the danger of transmitting salmonella to other people is very high.

Women are carriers about 10 times more often than men. Children are practically not dangerous in terms of transmitting bacteria.

There is a category of places in which the spread of typhoid fever is more likely. These are catering enterprises, food industry, medical institutions and kindergartens, schools. If there are one or more routes of transmission of the bacterium, these places often become sites of bacteriological outbreaks that cause epidemics. Typhoid fever is most active in summer and autumn.

Children and adults demonstrate different susceptibility to the disease; the largest part of all those who have recovered from the disease in Russia are people aged 15 to 45 years.

If typhoid fever is suspected, the patient must be hospitalized in the infectious diseases department of the hospital. Strict bed rest is required for him; he can sit down only from the 8th day of the course of the disease, and walk no earlier than 10 days after the appearance of the first symptoms.

Treatment of the disease consists of the following measures:

1. Therapy using antibiotics. Most often these are amoxicillin, ciprofloxacin, and the latest generation cephalosporins.
2. Stopping body intoxication and restoring water and electrolyte balance. Occurs with the help of colloidal and crystalloid solutions (Ringer's solution, glucose solution).
3. Relieving symptoms. Prescribed medications are designed to alleviate the condition of a sick person.
4. General strengthening of the body. For this purpose, vitamin and mineral complexes, probiotics, and immunomodulators are used.
5. Diet restrictions. It is necessary in order to limit the irritating effect on the suffering intestines. Fermentable foods are excluded from the diet.

Returning the patient home becomes possible only after confirming the absence of the pathogen in the body. According to statistics, this occurs only three weeks after the first symptoms appear.

Prevention and vaccination against typhoid fever

Human illness from typhoid fever can be prevented. To do this, it is necessary to carry out actions to disinfect the intestines, to exclude the possibility of transmission of infection.

General disease prevention should include the following measures:

1. Following the rules of personal hygiene: careful processing of food, monitoring the quality of drinking water.
2. Compliance with sanitary rules in catering establishments.
3. Conducting a systematic bacteriological examination of citizens who once suffered from the disease. To exclude relapse, which becomes possible during the chronic course of the disease.

One of the key methods of preventing infection is vaccination against typhoid fever.

The main indications for its use are:

• traveling to countries with a high incidence of typhoid fever;
• regular communication with people who are infected with typhus;
• contact with the pathogen when working with it (for example, medical workers, laboratory assistants).

Typhoid fever is a disease with a rather complicated course. Careful adherence to all measures to prevent infection is the main task of both the healthcare system and the person himself.

If you suspect a disease, you should immediately consult a doctor. Self-treatment is unacceptable.

Typhoid fever in adults and children - features

The picture of the disease observed in adults remains virtually unchanged in children. If the disease occurs in infants, it is quite difficult to recognize it. Even in fatal cases, the involvement of the lymphatic system is very small. The course of the disease resembles the development of sepsis.

The course of the disease in children is short, the temperature does not rise to critical levels. Diarrhea, flatulence, and vomiting often lead to thoughts of gastritis, but if the fever lasts, it is worth remembering the likelihood of contracting typhoid fever.

Children in the first year of life may experience the following symptoms:

• enlarged spleen;
• single roseola;
• apathy, depression;
• neck rigidity;
• tension of the fontanelles;
• angina;
• thrush;
• development of laryngitis;
• tachycardia (not always);
• erythema (skin rash);
• redness of the cheeks;
• marbling of the limbs.

The skeletal system is rarely involved in the course of the disease. Relapses in children occur frequently and depend largely on external conditions. In general, the prognosis for recovery is quite favorable with high-quality diagnosis and proper treatment.

Differential diagnosis - mandatory research

Some symptoms characteristic of typhoid fever are similar to the symptoms of other diseases: lymphogranulomatosis, pneumonia, malaria, sepsis, typhus, tuberculosis. They are also accompanied by prolonged fever and signs of intoxication of the body.

To make a diagnosis of typhoid fever, you should rely on the following key characteristics:

1. Prolonged increase in body temperature, indicators can reach critical values.
2. Pale skin tone.
3. Pain in the iliac region and rumbling in the abdomen.
4. Bradycardia.
5. Enlarged tongue.
6. A rash on the abdomen and lower chest that appears at the beginning of the second week of the disease.

To reliably determine the pathogen, it is imperative to carry out all the necessary laboratory tests, without which treatment cannot be complete.


In case of improper therapy, the patient can suffer serious complications:

1. Perforation of the thin intestinal wall, developing at the end of 2 weeks of the disease. The classic consequence of this complication is peritonitis.
2. Infectious-toxic shock, developing as a consequence of severe intoxication of the body and characterized by a decrease in body temperature and blood pressure.
3. Bleeding in the intestines. It develops at the same time as perforation of the intestinal wall. Bleeding can be completely asymptomatic and can be detected by the presence of blood clots in the stool.

If the described complications occur, resulting from an incorrectly defined type of disease and erroneous therapy, severe vomiting, reminiscent of coffee grounds, is possible.

Forecast, why infectious diseases are dangerous

A favorable prognosis for the treatment of typhoid fever is possible with the current level of development of medicine. In most cases, the development of the disease can be stopped and complete recovery occurs.

A worsening prognosis is also possible, but only in cases where the disease was diagnosed untimely, resulting in complications: perforation of the intestinal wall and bleeding.

In the case when the symptoms of the disease are ignored, the patient self-medicates, refuses medical care (both intentionally and out of ignorance), infectious diseases progress and the following complications may occur:

• bleeding inside the intestines;
• peritonitis;
• infectious-toxic shock;
• pneumonia;
• myocarditis;
• thrombophlebitis;
• otitis;
• bedsores;
• mumps;
• cystitis.

In order to prevent the development of these complications, it is necessary to be attentive to the symptoms of the disease and seek medical help as quickly as possible.

Typhus - a disease caused by Provacek's rickettsia, is characterized by a cyclical course with fever, a typhoid state, a peculiar rash, as well as damage to the nervous and cardiovascular systems.

The source of infection is only a sick person, from whom body and head lice, having fed on blood containing rickettsia, transmit them to a healthy person.

A person becomes infected by scratching bite sites and rubbing lice excrement into the skin. When the louse bites itself, infection does not occur, since the causative agent of typhus is absent in their salivary glands. People's susceptibility to typhus is quite high.

Symptoms and course

The incubation period lasts 12-14 days. Sometimes at the end of incubation a slight headache, body aches, and chills are noted. Body temperature rises with slight chills and by the 2-3rd day it is already at high levels (38-39 0C), sometimes it reaches its maximum value by the end of 1 day.

Subsequently, the fever is constant with a slight decrease on the 4th, 8th, 12th day of illness. A sharp headache and insomnia appear early, loss of strength quickly sets in, and the patient is excited (talkative, active). The face is red and puffy. Small hemorrhages are sometimes visible on the conjunctiva of the eyes. There is diffuse hyperemia in the pharynx, and pinpoint hemorrhages may appear on the soft palate. The tongue is dry, not thickened, covered with a grayish-brown coating, and sometimes sticks out with difficulty. The skin is dry, hot to the touch, and there is almost no sweating in the first days.

There is a weakening of heart sounds, increased breathing, enlargement of the liver and spleen (from 3-4 days of illness). One of the characteristic signs is typhus exanthema. The rash appears on the 4th-5th day of illness. It is multiple, abundant, located mainly on the skin of the lateral surfaces of the chest and abdomen, in the bend of the arms, covers the palms and soles, and is never on the face. The rash occurs within 2-3 days, then gradually disappears (after 7-8 days), leaving pigmentation for some time. With the onset of the rash, the patient's condition worsens. Intoxication increases sharply. Excitement gives way to depression and lethargy. At this time, collapse may develop: the patient is in prostration, the skin is covered with cold sweat, the pulse is frequent, the heart sounds are muffled.

Recovery is characterized by a decrease in body temperature, accelerated lysis on days 8-12 of illness, a gradual decrease in headaches, improved sleep, appetite, and restoration of the activity of internal organs.

Typhoid fever

An acute infectious disease caused by bacteria from the genus Salmonella. The pathogen can survive in soil and water for up to 1-5 months. Kills when heated and exposed to conventional disinfectants.

The only source of infection spread is a sick person and a bacteria carrier.

Typhoid fever bacilli are transmitted directly by dirty hands, flies, and sewage. Outbreaks associated with the consumption of contaminated foods (milk, cold meats, etc.) are dangerous.

Symptoms and course

The incubation period lasts from 1 to 3 weeks. In typical cases, the disease begins gradually. Patients report weakness, fatigue, and moderate headache.

In subsequent days, these phenomena intensify, body temperature begins to rise to 39-40 0C, appetite decreases or disappears, sleep is disturbed (drowsiness during the day and insomnia at night). There is stool retention and flatulence. By the 7-9th day of illness, a characteristic rash appears on the skin of the upper abdomen and lower chest, usually on the anterolateral surface, which is small red spots with clear edges, 2-3 mm in diameter, rising above the skin level (roseola).

Disappearing roseolas may be replaced by new ones. The patients are characterized by a peculiar lethargy, pale face, slow pulse and decreased blood pressure. Scattered dry rales 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 from plaque, with tooth marks. There is a rough rumbling of the cecum and pain in the right iliac region, the liver and spleen are enlarged on palpation.

The number of leukocytes in the peripheral blood, especially neutrophils and eosinophils, decreases. ESR remains normal or increases to 15-20 mm/h. By the 4th week, the patients’ condition gradually improves, body temperature drops, headache disappears, and appetite appears.

Serious 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 iliac region of the abdomen, enlarged liver and spleen. From laboratory tests, to clarify the diagnosis, bacteriological (immunofluorescence method) blood culture on Rappoport's medium or bile broth is used; serological studies - Vidal reaction et al.

Typhoid treatment

Typhus
The most effective antibiotics are the tetracycline group, which are prescribed 0.3-0.4 g 4 times a day. You can use chloramphenicol. Antibiotics give up to 2 days of normal temperature, the course duration is usually 4-5 days. For detoxification, a 5% glucose solution is administered. Oxygen therapy is used.

In cases of severe agitation, barbiturates and chloral hydrate are indicated. Good nutrition and vitamin therapy are of great importance. Proper care for the patient plays an important role: complete rest, fresh air, comfortable bed and linen, daily hygiene of the skin and oral cavity.

Typhoid fever
The main antimicrobial drug is chloramphenicol. Prescribe 0.5-0.75 g, 4 times a day for 10-12 days until normal temperature. A 5% glucose solution and an isotonic sodium chloride solution (500-1000 mg) are administered intravenously.

In severe cases - corticosteroids (prednisolone at a dose of 30-40 ml per day). Patients must observe strict bed rest for at least 7-10 days.

Typhoid fever is an acute anthroponotic infectious disease with a fecal-oral transmission mechanism, characterized by a cyclic course, intoxication, bacteremia and ulcerative lesions of the lymphatic system of the small intestine.

ICD code -10 A01.0. Typhoid fever.

Etiology (causes) of typhoid fever

The causative agent is Salmonella typhi, belongs to the genus Salmonella, serological group D, family of intestinal bacteria Enterobacteriaceae.

S. typhi has the shape of a rod with rounded ends, does not form spores or capsules, is mobile, gram-negative, and grows better on nutrient media containing bile. When it is destroyed, endotoxin is released.

The antigenic structure of S. typhi is represented by O-, H- and Vi-antigens, which determine the production of the corresponding agglutinins.

S. typhi preserves relatively well at low temperatures and is sensitive to heat: at 56 °C it dies within 45–60 minutes, at 60 °C - after 30 minutes, when boiled - in a few seconds (at 100 °C almost instantly). A favorable environment for bacteria is food products (milk, sour cream, cottage cheese, minced meat, jelly), in which they are not only preserved, but are also capable of reproduction.

Epidemiology

Typhoid fever belongs to the group of intestinal infections and typical anthroponoses.

Source of infection with typhoid fever - only a person - a patient or a bacteria excretor, from whose body the pathogens of typhoid fever are released into the external environment, mainly with feces, less often - with urine. The pathogen is excreted in feces from the first days of the disease, but massive excretion begins after the seventh day, reaches a maximum at the height of the disease and decreases during the period of convalescence. Bacterial excretion in most cases lasts no more than 3 months (acute bacterial excretion), but in 3–5% chronic intestinal or, less commonly, urinary bacterial excretion develops. The most dangerous epidemiologically are urinary carriers due to the massiveness of bacterial excretion.

Characteristic of typhoid fever fecal-oral transmission mechanism pathogen, which can be carried out by water, food and household contact. Transmission of the causative agent of typhoid fever through water, which prevailed in the past, plays a significant role at the present time. Water epidemics grow rapidly, but quickly end when they stop using the contaminated water source. If epidemics are associated with drinking water from a contaminated well, the diseases are usually focal in nature.

Sporadic diseases are now often caused by the consumption of water from open reservoirs and process water used in various industrial enterprises. Outbreaks associated with the consumption of food products in which typhoid bacteria can persist and multiply for a long time are possible (milk). Infection can also occur through household contact, in which surrounding objects become transmission factors. Susceptibility to typhoid fever is significant.

The infectiousness index is 0.4. People aged 15 to 40 years are most often affected.

After an illness, persistent, usually lifelong immunity is developed, however, in recent years, due to antibiotic therapy of patients and its immunosuppressive effect, apparently, the intensity and duration of acquired immunity have become less, as a result of which the frequency of recurrent cases of typhoid fever has increased.

Typhoid fever during epidemic spread is characterized by summer-autumn seasonality.

Measures to prevent typhoid fever

Specific

According to epidemiological indications (incidence is above 25 per 100 thousand.

population, travel to countries with high incidence, constant contact with bacteria carriers in conditions conducive to infection) vaccination is carried out with typhoid alcohol dry vaccine♠ (typhivac♠). The vaccine is used at the age of 15–55 years. Administered subcutaneously at a dose of 0.5 ml, the second vaccination after 1 month at a dose of 1 ml, revaccination after 2 years at a dose of 1 ml. From the age of 3, the typhoid vaccine Vi-polysaccharide liquid♠ (Vianvac♠) is used in a dose of 0.5 ml subcutaneously once. Revaccination at the same dose after 3 years.

Nonspecific

Nonspecific prevention includes control over water supply, disinfection of drinking water, disinfection of wastewater, compliance with the rules of preparation, storage and sale of food, personal hygiene, sanitary educational work with the population, and improvement of residential areas. Employees of food enterprises and children's institutions are examined upon entry to work in order to promptly identify carriage (bacteriological examination of stool, RPGA with O- and Vi-diagnosticums).

An epidemiological examination is carried out in the focus of typhoid fever to identify the source of the pathogen and transmission factors. For each case of illness, an emergency notification is sent to the Sanitary and Epidemiological Supervision authorities. Patients are hospitalized. The fireplace is subject to final disinfection. Contact persons are monitored for 21 days and examined for bacterial carriage.

Employees of food and child care institutions, as well as children visiting them, are not allowed into them until the results of the examination are received (bacteriological examination of stool, RPHA with Vi-antigen).

Pathogenesis of typhoid fever

The pathogenesis of typhoid fever is characterized by cyclicity and the development of certain pathophysiological and morphological changes. Infection occurs through the mouth, and the primary site of localization of pathogens is the digestive tract. It should be especially noted that infection does not always lead to the development of the disease. The pathogen can die in the stomach under the influence of the bactericidal properties of gastric juice and even in the lymphoid formations of the small intestine. Having overcome the gastric barrier, the pathogen enters the small intestine, where it multiplies, is fixed by solitary and group lymphoid follicles with further accumulation of the pathogen, which penetrates through the lymphatic vessels into the mesenteric lymph nodes. These processes are accompanied by inflammation of the lymphoid elements of the small and often proximal colon, lymphangitis and mesadenitis. They develop during an incubation period, at the end of which the pathogen breaks into the bloodstream and bacteremia develops, which becomes more intense every day. Under the influence of bactericidal blood systems, the pathogen is lysed, LPS is released and an intoxication syndrome develops, which is manifested by fever, damage to the central nervous system in the form of adynamia, lethargy, sleep disturbances, damage to the autonomic nervous system, characterized by pallor of the skin, decreased heart rate, intestinal paresis and stool retention. . This period approximately corresponds to the first 5–7 days of illness. Inflammation of the lymphoid elements of the intestine reaches a maximum and is characterized as brain-like swelling.

Bacteremia is accompanied by contamination of internal organs, primarily the liver, spleen, kidneys, and bone marrow, where specific inflammatory granulomas are formed. This process is accompanied by an increase in intoxication and the appearance of new symptoms: hepatosplenomegaly, increased neurotoxicosis, and characteristic changes in the blood picture. At the same time, stimulation of phagocytosis, synthesis of bactericidal antibodies, specific sensitization of the body occur, and the release of the pathogen into the environment through the bile and urinary system sharply increases. Sensitization is manifested by the appearance of a rash, the elements of which are a focus of hyperergic inflammation at the site of accumulation of the pathogen in the vessels of the skin. Repeated penetration of the pathogen into the intestine causes a local anaphylactic reaction in the form of necrosis of lymphoid formations.

In the third week, a tendency towards a decrease in the intensity of bacteremia is noted. Organ damage persists. In the intestine, necrotic masses are rejected and ulcers are formed, the presence of which is associated with typical complications of typhoid fever - perforation of ulcers with the development of peritonitis and intestinal bleeding. It should be emphasized that disturbances in the hemostatic system play a significant role in the development of bleeding.

At the 4th week, the intensity of bacteremia sharply decreases, phagocytosis is activated, granulomas in organs regress, intoxication decreases, and body temperature decreases. The ulcers in the intestines are cleansed and scarring begins, the acute phase of the disease ends. However, due to the imperfection of phagocytosis, the pathogen can persist in the cells of the monocytic phagocyte system, which, with an insufficient level of immunity, leads to exacerbations and relapses of the disease, and in the presence of immunological deficiency - to chronic carriage, which in typhoid fever is considered as a form of infectious process. In this case, from the primary foci in the system of monocytic phagocytes, the pathogen penetrates into the blood, and then into the bile and urinary system with the formation of secondary foci. In these cases, chronic cholecystitis and pyelitis are possible.

Immunity for typhoid fever is long-lasting, but there are repeated cases of the disease after 20–30 years. Due to the use of antibiotic therapy and insufficient immunity, repeated cases of the disease occur at an earlier date.

Clinical picture (symptoms) of typhoid fever

The incubation period ranges from 3 to 21, more often 9–14 days, which depends on the dose of the infected infection, its virulence, the route of infection (shorter for food and longer for infection through water and direct contact) and the state of the macroorganism.

Classification

By the nature of the flow: - typical; - atypical (erased, abortive, outpatient; rare forms: pneumotyphoid, meningotif, nephrotyphoid, colotyphoid, typhoid gastroenteritis).

By duration: - acute; - with exacerbations and relapses.

According to severity: - mild; - moderate severity; - heavy.

According to the presence of complications: - uncomplicated; - complicated: - specific complications (intestinal bleeding, intestinal perforation, ITS), - nonspecific (pneumonia, mumps, cholecystitis, thrombophlebitis, otitis, etc.).

The main symptoms of typhoid fever and the dynamics of their development

The initial period of typhoid fever characterized by gradual or acute development of intoxication syndrome. In modern times, both options are almost equally common.

With a gradual increase in symptoms in the first days, patients note increased fatigue, increasing weakness, chills, worsening headache, deterioration or lack of appetite.

Body temperature increases step by step and by the 5th–7th day of illness reaches 39–40 °C. With an acute onset, already in the first 2–3 days all symptoms of intoxication reach full development, i.e. the duration of the initial period is reduced, resulting in diagnostic errors and late hospitalization.

When examining patients in the initial period of the disease, some lethargy and adynamia attract attention. Patients are indifferent to their surroundings and answer questions in monosyllables, not immediately. The face is pale or slightly hyperemic, sometimes a little pasty. With shorter incubation, a more rapid onset of the disease is more often noted.

Changes in the cardiovascular system in the initial period are characterized by relative bradycardia and arterial hypotension. Some patients report coughing or nasal congestion. Auscultation of the lungs often reveals hard breathing and scattered dry wheezing, which indicates the development of diffuse bronchitis.

The tongue is usually thickened, with imprints of teeth on the lateral surfaces. The back of the tongue is covered with a massive grayish-white coating, the edges and tip are free of plaque, and have a rich pink or red color. The pharynx is slightly hyperemic, and sometimes enlargement and hyperemia of the tonsils are observed. The abdomen is moderately distended.

By palpation in the right iliac region, a rough, large-caliber rumbling in the cecum and small-caliber rumbling and soreness along the terminal ileum are determined, indicating the presence of ileitis. The shortening of the percussion sound in the ileocecal region (Padalka's symptom) is determined, which is caused by hyperplasia and the presence of mesadenitis. This is also evidenced by the positive “cross” Sternberg symptom. Stool tending to constipation. By the end of the 1st week of the disease, the liver and spleen become accessible to palpation.

The hemogram in the first 2–3 days is characterized by moderate leukocytosis, and from the 4–5th day of illness leukopenia with a shift to the left is determined; their degree depends on the severity of the disease. In addition, aneosinophilia, relative lymphocytosis and thrombocytopenia are observed. ESR is moderately increased. These changes in the hemogram are a natural consequence of the specific effect of typhoid Salmonella toxins on the bone marrow and the accumulation of leukocytes in the lymphatic formations of the abdominal cavity. Oliguria is noted. Changes in the urogram are determined: proteinuria, microhematuria, cylindruria, which fit into the “infectious-toxic kidney” syndrome.

All symptoms of the disease reach their maximum development by the end of the first - beginning of the second week, when the period of the height of the disease begins. This period lasts from several days to 2-3 weeks and is the most difficult for the patient. In the modern course, this period of the disease is much shorter and easier, it is characterized by an increase in intoxication and high fever, changes in the central nervous system. The patients are in a state of stupor. In severe cases, they are not oriented in place and time, do not recognize others well, are drowsy during the day and do not sleep at night, do not complain about anything, and sometimes become delirious. These changes in the neuropsychic state characterize the typhoid status, which is rarely encountered in its modern course.

In some patients, in the second week of the disease, small ulcerations occur on the anterior palatine arches - Duguay's angina. Body temperature during this period is increased to 39–40 °C and in the future may have a constant or wave-like character.

In 55–70% of patients with typhoid fever, on the 8–10th day of illness, a characteristic exanthema appears on the skin - pinkish-red roseola with a diameter of 2–3 mm, located mainly on the skin of the abdomen and lower chest, and in cases of profuse rash, covering the limbs . The rash is monomorphic; as a rule, scanty; the number of elements rarely exceeds 6–8. Roseolas often rise slightly above the level of the skin (roseola elevata) and are clearly visible against its pale background. When pressing or stretching the skin along the edges of roseolas, they disappear, after which they appear again, which indicates their inflammatory nature. In severe forms, the rash may become petechial in nature. The duration of existence of roseola is from 1 to 5 days, more often 3–4 days. After the rash disappears, barely noticeable skin pigmentation remains. The phenomenon of falling asleep is characteristic, which is associated with the wave-like course of bacteremia. Roseola may appear in the first days of the convalescence period at normal temperatures.

In some patients, Filippovich's symptom is found - icteric staining of the skin of the palms and soles of the feet - endogenous carotene hyperchromia of the skin, which occurs due to the fact that the conversion of carotene into vitamin A is disrupted as a result of liver damage.

At the height of the disease, relative bradycardia persists, dicrotia of the pulse occurs, arterial and venous pressure decreases even more, auscultation reveals dullness of heart sounds, and a soft systolic murmur is heard at the apex and base of the heart.

In patients with typhoid fever, a decrease in vascular tone is observed, and in 1.4% of patients, acute vascular insufficiency is observed. Sudden tachycardia may indicate complications: intestinal bleeding, intestinal perforation, collapse - and has a poor prognostic value.

Changes in the respiratory system during this period are expressed by the phenomena of bronchitis. Pneumonia is also possible, caused both by the causative agent of typhoid fever and by the accompanying microflora.

Changes in the digestive organs at the height of the disease reach their maximum severity. The lips are dry, often covered with crusts and cracked. The tongue is thickened, densely covered with a gray-brownish coating, the edges and tip of it are bright red with imprints of teeth (“typhoid”, “roasted” tongue). In severe cases, the tongue becomes dry and takes on a fuliginous appearance due to the appearance of bleeding transverse cracks. Dry tongue is a sign of damage to the autonomic nervous system. The stomach is swollen. There is retention of stool, in some cases it is liquid, greenish in color, sometimes in the form of “pea soup”. Rumbling and pain on palpation of the ileocecal intestine, a positive Padalka's sign, become distinct. The liver and spleen are enlarged. Sometimes cholecystitis occurs, and it occurs more often in women.

At the height of the disease, the amount of urine decreases. Proteinuria, microhematuria, and cylindruria are determined. Bacteriuria occurs, which sometimes leads to pyelitis and cystitis. In some cases, mastitis, orchitis, epididymitis, dysmenorrhea may develop, and in pregnant women - premature birth or abortion.

During the height of the disease, such dangerous complications as perforation of typhoid ulcers and intestinal bleeding may occur, which occur in 1–8% and 0.5–8% of patients with typhoid fever, respectively.

Disease resolution period does not exceed one week and is characterized by a decrease in temperature, which often becomes amphibolic before normalization, i.e. daily fluctuations reach 2.0–3.0 °C. Headache disappears, sleep normalizes, appetite improves, tongue cleanses and moisturizes, diuresis increases.

In the modern course of typhoid fever, the temperature is often reduced by a short lysis without an amphibolic stage. However, a normal temperature should not be taken as a sign of recovery. Weakness, increased irritability, mental lability, and weight loss persist for a long time. Low-grade fever is possible as a result of vegetative-endocrine disorders. During this period, there may be late complications: thrombophlebitis, cholecystitis.

Subsequently, the impaired functions are restored, the body is freed from pathogens. This is a recovery period, which is characterized by asthenovegetative syndrome for 2–4 weeks. During the recovery period, among those who have had typhoid fever, 3–5% become chronic bacteria carriers.

Exacerbations and relapses. When the disease subsides, but even before the temperature normalizes, exacerbations are possible, characterized by a delay in the infectious process: fever and intoxication increase, fresh roseola appears, and the spleen enlarges. Exacerbations are often one-time, and if not treated correctly, they can be repeated. Under antibiotic therapy and in the modern course of the disease, exacerbations are rarely observed.

Relapses, or return of the disease, occur when the temperature is normal and the intoxication has disappeared. In modern conditions, the frequency of relapses has increased, which, apparently, can be associated with the use of chloramphenicol, which has a bacteriostatic effect, and especially glucocorticoids.

Precursors of relapse are low-grade fever, persistence of hepatosplenomegaly, aneosinophilia, low levels of antibodies. The clinical picture of relapse, repeating the picture of typhoid fever, is nevertheless distinguished by a milder course, a more rapid rise in temperature, earlier appearance of the rash, and less pronounced symptoms of general intoxication. Their duration ranges from one day to several weeks; two, three relapses or more are possible.

Complications of typhoid fever

Intestinal bleeding most often occurs at the end of the second and third week of illness. It can be profuse or insignificant depending on the size of the ulcerated blood vessel, the state of blood clotting, thrombus formation, blood pressure, etc. In some cases, it has the character of capillary bleeding from intestinal ulcers.

Some authors indicate that a transient increase in blood pressure, the disappearance of pulse dichotomy, increased heart rate, a critical decrease in temperature, and diarrhea make one fear intestinal bleeding. Bleeding is promoted by flatulence and increased intestinal motility.

A direct sign of bleeding is melena (tarry stool). Sometimes the presence of scarlet blood is noted in the stool. General symptoms of internal bleeding are pallor of the skin, a drop in blood pressure, increased heart rate, a critical decrease in body temperature, which is accompanied by a clearing of consciousness, activation of the patient and creates the illusion that his condition has improved. With massive bleeding, hemorrhagic shock can develop, which has a serious prognosis. Due to a decrease in the volume of circulating blood due to the deposition of blood in the celiac vessels, patients are very sensitive to blood loss and general symptoms of bleeding may appear with blood loss significantly less than in healthy people. The most dangerous bleeding is from the colon. Bleeding can be one-time or repeated - up to six times or more; due to blood clotting disorders, it can last for several hours.

A more serious complication is intestinal perforation, which occurs in 0.5–8% of patients. Observations indicate that there is no relationship between anatomical changes and the severity of intoxication, making it difficult to predict the development of perforation. It most often occurs in the terminal ileum at a distance of approximately 20–40 cm from the ileocecal valve. Usually there is one (rarely two or three or more) perforated hole up to the size of a two-ruble coin. Occasionally, perforation occurs in the colon, gall bladder, or appendix, the lymphatic apparatus of which is actively involved in the inflammatory process. Perforations are usually single, but three- and five-fold occur, and they occur more often in men.

Clinical manifestations of perforation are acute abdominal pain localized in the epigastric region somewhat to the right of the midline, muscle tension in the abdominal press, and a positive Shchetkin-Blumberg sign.

The pulse is frequent, weak, the face turns pale, the skin is covered with cold sweat, breathing is rapid, and in some cases severe collapse is noted. The most important clinical signs of intestinal perforation are pain, muscle protection, flatulence, and loss of peristalsis. Pain, especially “dagger” pain, is not always pronounced, especially in the presence of typhoid status, which is why doctors often make mistakes when making a diagnosis.

Important symptoms are flatulence combined with hiccups, vomiting, dysuria and absence of hepatic dullness. Regardless of the intensity of pain in patients, local muscle rigidity in the right iliac region is determined, but as the process progresses, tension in the abdominal muscles becomes more widespread and pronounced.

Perforation of the intestine is promoted by flatulence, increased peristalsis, and abdominal trauma. The development of peritonitis is also possible with deep penetration of typhoid ulcers, with necrosis of mesenteric lymph nodes, suppuration of splenic infarction, and typhoid salpingitis. Late hospitalization and late start of specific therapy contribute to the development of intestinal bleeding and perforation.

The picture of perforation and peritonitis during antibiotic therapy is often erased, so even mild abdominal pain should attract the attention of a doctor, and an increase in fever, intoxication, flatulence, tachycardia, blood leukocytosis, even in the absence of local symptoms, indicate the development of peritonitis.

In 0.5–0.7% of patients, as a rule, during the height of the disease, ITS develops.

The clinical picture of ITS is characterized by a sudden sharp deterioration in condition, chills, hyperthermia, confusion, arterial hypotension, leukemia and neutropenia. The skin becomes pale, moist, cold, cyanosis and tachycardia increase, DN (“shock lung”) and oliguria develop. Azotemia is noted in the blood (the concentration of urea and creatinine increases).

Mortality and causes of death

When treated with antibiotics, the mortality rate is less than 1%; the main causes of death are peritonitis and ITS.

Diagnosis of typhoid fever

Diagnosis of typhoid fever is based on epidemiological, clinical and laboratory data.

Clinical diagnosis

From epidemiological data, contact with febrile patients, consumption of undisinfected water, unwashed vegetables and fruits, unboiled milk and dairy products prepared from it and purchased from private individuals, food in public catering establishments with signs of sanitary problems, high incidence of intestinal infections at the place of stay are significant. sick. Of the clinical data, the most important are high fever, roseolous rash, adynamia, a characteristic appearance of the tongue, flatulence, enlarged liver and spleen, stool retention, lethargy, sleep disturbance, headache, anorexia. All patients with fever of unknown origin should be examined on an outpatient basis for typhoid fever.

Specific and nonspecific laboratory diagnostics

The most informative method is isolating a blood culture of the pathogen.

A positive result can be obtained throughout the entire febrile period, but more often at the beginning of the disease. Blood cultures should be performed daily for 2–3 days, the first time preferably before prescribing antimicrobial drugs. Blood is taken in an amount of 10–20 ml and inoculated onto 100–200 ml of Rappoport medium or bile broth, respectively. From the second week of illness until recovery, it is possible to isolate copro-, urine- and biliocultures, however, if the test result is positive, the possibility of chronic carriage must be excluded. Bile examination is carried out on the tenth day after normalization of body temperature. These substrates, as well as scarified roseola, sputum, and CSF are inoculated onto selective media (bismuth sulfate agar, Ploskirev’s media, Endo and Levin agars). The preliminary result of a bacteriological study can be obtained in two days, the final result, including determination of sensitivity to antibiotics and phage typing, in 4–5 days.

To confirm the diagnosis, RA (Widal reaction) is also used, as well as the more sensitive and specific RNGA with H-, O- and Vi-antigen, which has almost completely replaced the Widal reaction. The study is carried out upon admission and after 7–10 days. A fourfold increase in the O-antibody titer or a titer of 1:200 or higher is of diagnostic significance. A positive reaction with the H-antigen indicates a previous illness or vaccination; with the Vi-antigen, it indicates chronic typhoid carriage. In recent years, ELISA has also been used to diagnose typhoid fever.

Differential diagnosis

Differential diagnosis is carried out with many diseases that occur with fever; more often with influenza, pneumonia, adenovirus infection, as well as with malaria, brucellosis, leptospirosis, psittacosis, rickettsiosis, trichinosis, generalized form of yersiniosis, sepsis, miliary tuberculosis (Table 17-1).

Table 17-1. Differential diagnosis of typhoid fever

Indications for consultation with other specialists

Consultation with a surgeon if intestinal bleeding or intestinal perforation develops.

An example of a diagnosis formulation

A01.0. Typhoid fever, severe. Complication: intestinal bleeding.

Treatment of typhoid fever

Modern treatment of patients with typhoid fever is based on the complex use of etiotropic and pathogenetic therapy (Table 17-2).

Table 17-2. Treatment regimen for patients with typhoid fever

According to federal standards for the volume of medical care provided to patients with typhoid fever, the average duration of hospitalization for patients with mild forms is 25 days, moderate - 30 days, severe - 45 days.

Therapy for patients with typhoid fever, in accordance with federal standards, is carried out in the following areas: antibacterial, detoxification and plasma replacement solutions, desensitizing agents, vitamin therapy, antispasmodics, biological products, symptomatic agents, amino acids, sugars and preparations for parenteral nutrition, hormones and their analogues (according to indications) (see Table 17-2).

Until the sixth or seventh day of normal temperature, the patient must remain in bed, from the seventh to eighth day he is allowed to sit, and from the tenth to eleventh day of normal temperature, in the absence of contraindications, he is allowed to walk.

Patients who have recovered from the disease are discharged from the hospital after clinical recovery, but not earlier than 21–23 days after the temperature normalizes and after receiving a double negative bacteriological examination of feces and urine and a single negative bacteriological examination of duodenal contents.

Forecast

In the pre-antibiotic period, the mortality rate for typhoid fever was 3–20%, with modern therapy - 0.1–0.3%.

Clinical examination

Those who have recovered from typhoid fever, regardless of profession and employment, after discharge from the hospital are subject to dispensary observation at the clinic's clinical health center for 3 months. For timely detection of relapse, convalescents are subject to medical observation with thermometry once a week in the first 2 months and once every 2 weeks during the 3rd month.

All patients who have had typhoid fever (except for food industry workers and persons equivalent to them) undergo a monthly bacteriological examination of feces and urine during a 3-month clinical observation, and by the end of the third month, an additional bile culture and Vi-hemagglutination reaction are performed. Further, these persons are registered with the sanitary and epidemiological surveillance authorities for two years. During this period, they undergo bacteriological examination of feces and urine twice a year, and at the end of the observation period, bile culture is performed. If the results of bacteriological tests are negative, those who have recovered from the disease are removed from the register.

Convalescents of typhoid fever from among workers of food enterprises and persons equivalent to them are not allowed to work in their specialty for a month after discharge from the hospital. At this time, in addition to medical observation, it is necessary to conduct five-time bacteriological examination of feces and urine with an interval of 1-2 days, a single culture of bile and a Vi-hemagglutination reaction.

Persons with a positive Vi-hemagglutination reaction are not allowed to work. They undergo additional bacteriological examination of secretions at least five times and bile once. Only with negative results of bacteriological examination and good health are such convalescents allowed to work in their specialty.

Upon receipt of negative results, convalescents are allowed to work in food and similar institutions with mandatory monthly bacteriological examination of feces and urine for a year and by the end of the third month - with bile culture and Vi-hemagglutination reaction.

Subsequently, these persons are registered with the KIZ for 5 years with a quarterly bacteriological examination of feces and urine, and then throughout their entire working career they undergo bacteriological examination of feces and urine twice annually.

Chronic bacterial carriers of typhoid microbes remain registered with the sanitary and epidemiological surveillance authorities and in the KIZ for life and are subjected to bacteriological examination and clinical examination twice a year.

Convalescents of typhoid fever, in whom typhoid microbes were isolated from their bile during their hospital stay, are subject to the same registration and are subject to a similar examination. Chronic bacteria carriers, as well as persons living with them, are suspended from work in food industry, public catering and trade enterprises, in medical, sanatorium and resort institutions, pharmacies, etc.

Memo for patients

It is recommended that convalescents be rationally employed for 2–3 months with exemption from heavy physical labor, sports, and business trips. Dietary food for a period of 2–3 months with the exception of spicy foods, alcohol, animal fats, adherence to diet and personal hygiene rules.

Typhoid fever in adults and children

Typhoid fever is an acute cyclic intestinal anthroponotic infection. It develops after the pathogenic bacterium Salmonella typhi enters the body through nutritional transmission routes. This means that the mode of movement of the infectious agent is from the infected organism to the susceptible immune system. It can get inside through already contaminated water, food or dirty hands. That is why it is important to follow basic personal hygiene rules.

After infection, a person feels a feverish state, and the body is subjected to general intoxication. The body gradually develops a typhoid status, roseola rashes appear on the upper layers of the epidermis, as well as specific damage to the lymphatic system in the lower parts of the small intestine.

Features of the bacterium Salmonella typhi

The main causative agent of typhoid fever, Salmonella typhi, is an active gram-negative rod that has slightly rounded ends. It stains well if you use aniline dyes to identify it. After entering the body, the bacterium begins to produce endotoxin, which is considered pathogenic only for humans; the process occurs without the formation of spores.

Salmonella is quite resistant to environmental conditions. It can be found in bodies of water where there is fresh water. The bacterium retains its vital activity for one month if it is in liquid. But if it is placed in a milky environment, the bacteria begin to actively multiply and gradually accumulate.

How can you get typhoid fever?

The mechanism of transmission of typhoid fever occurs through ingestion of contaminated food or water. Patients who experience this disease can transmit the bacteria through water supplies after going to the toilet. The patient's stool contains a huge number of pathogenic microorganisms that are well preserved in water.

Some people have a mild type and degree of typhoid fever, so they are not even aware of its existence. It is also difficult to identify in everyday life. As a result, they remain carriers of very dangerous microorganisms for a long time.

Bacteria tend to multiply in the gallbladder, ducts and liver. A carrier of typhoid fever Salmonella typhi may not have any signs or symptoms, so he is unaware of his illness and poses a danger to healthy people. The pathogens retain their viability well in wastewater.

Types of typhoid fever

Increasingly, people are faced with the following types of typhoid fever:

• Typhus. It belongs to a separate group of infectious diseases, which in most cases develop after rickettsia enters the body. The main carriers of the disease from a sick person to a healthy person are body, head or pubic lice, which can spread lice. There are several varieties of this disease - this is epidemic typhus of the rickettsia species R.mooseri and Rickettsia prowazekii. Mice and lice act as pathogens and carriers of infections.
• Relapsing fever. This term is used to designate pathogenic spirochetes of the disease when lice and ticks act as carriers. In this case, the infectious disease of typhoid fever occurs with alternating symptoms. A person may suddenly feel an attack of fever, after which the body temperature returns to its normal value.
• Typhoid fever (dysentery). This is an infectious disease or intestinal anthroponosis, which begins to develop after salmonella bacteria enter the body. There are several clinical forms of this disease - typical and atypical.

There are also several stages of typhoid fever - mild, moderate and severe. For any manifestations of this disease, you must seek qualified medical help. It is also worth constantly observing the rules of personal hygiene, especially in public places.

In the initial phase of typhoid fever, the patient feels a lack of appetite, severe headaches, weakness, malaise, fever, diarrhea and a state of apathy. If no measures are taken in time, a person may experience a relapse of typhoid fever.

Are there complications with typhoid fever?

If you do not consult a doctor in time, the disease may develop into a more severe form, which will complicate the treatment and recovery of the patient. Several centuries ago, even before the introduction of chloramphenicol into medicine, typhoid fever became the cause of the development of severe asthenia, and led to rapid weight loss and malnutrition. In extremely severe forms of the disease, patients experienced internal intestinal bleeding and perforation of the large intestine.

In the first case, erosion of blood vessels occurs in Peyer's patches, as well as places where there is a high accumulation of mononuclear cells in the intestinal walls. Patients note the appearance of blood streaks in the feces. Heavy bleeding occurs three weeks after the onset of the disease. The main clinical sign to pay attention to is a rapid decrease in blood pressure, blood pressure, and body temperature. These are specific complications of typhoid fever that need to be addressed immediately.

Intestinal perforation implies the development of a pathological process in the lymphoid tissue. Gradually, the infection spreads to the muscular and serous layers of the intestinal walls, resulting in its perforation. Antimicrobial drugs help to cope with clinical manifestations in the shortest possible time, as well as prevent complications.

The typhoid fever bacterium in some cases is localized in any internal organs, where it causes the formation of a local purulent process. These processes cause the development of meningitis, chondritis, periostitis, osteomyelitis, arthritis, and pyelonephritis.

The most common complications include pneumonia, which occurs after a bacterial infection enters the body.

Which doctor should I contact if I suspect typhoid fever?

If a person notices the first symptoms of typhoid fever, he should immediately seek advice from an infectious disease specialist. He will listen carefully to all the patient’s complaints and prescribe a full examination to determine the causative agent of the disease. The specialist will definitely pay attention to the medical history and also determine the epidemiological history. This includes identifying contact with infected patients or traveling to infected areas. Often, the doctor may require additional examination, after which he will prescribe the necessary treatment.

To determine typhoid fever, you will need to take cultures and smears for microflora, perform PCR diagnostics, biochemical analysis and blood markers. It is important to remember that the incubation period of typhoid fever is about two weeks, after which the disease begins to develop in an acute form. It is necessary to identify the disease in time for a quick recovery.

Typhoid fever in children

The transmission routes for typhoid fever are varied, and young children often do not wash their hands well after walking, so salmonella infections can easily enter the intestines. Parents will be able to notice the first symptoms very quickly. The child’s behavior and condition change, he becomes lethargic, physical activity decreases, as does his attitude towards his favorite toys.

The acute form of typhoid fever in children is characterized by the appearance of high temperature, fever, pronounced symptoms of intoxication, as well as the detection of roseola rashes on the skin. Children, unlike adults, are more likely to experience negative consequences, so it is important to promptly contact an experienced infectious disease specialist for qualified help.

Children require mandatory hospitalization, where they will receive complex treatment and a special diet. It is important to maintain careful oral hygiene and take care of your skin to protect yourself from developing stomatitis.

Symptoms

Symptoms of typhoid fever depend on the clinical form and severity of the disease. There are typical and atypical (abortive, erased) forms, different types of disease course: recurrent, cyclical. Signs of typhoid fever change as the disease progresses:

• Incubation period. Characterized by general weakness, nausea, and a feeling of weakness. May last from three days to three weeks.
• Temperature increase. The temperature rises gradually and can reach 40 degrees a week after the first symptoms of the disease appear in children.
• Rash on the stomach and chest. The rash of typhoid fever is not bright, round, and has clear contours. Appears after two weeks of illness.
• Intoxication of the body. The patient develops dizziness, weakness, delirium, and sweating.
• Damage to the small intestine and lymph nodes. For typhoid fever, the doctor pays attention to Padalka's syndrome. When tapping the abdominal wall, the specialist may notice that the sound changes in the lower right section. Pain appears in the lower abdomen.
• Damage to the liver, spleen. The liver enlarges, and the person begins to develop jaundice.

If treatment is not carried out, intestinal bleeding may develop with typhoid fever. The disease is dangerous due to its complications: peritonitis, meningitis, cholecystitis and other consequences.

Initial stage of the disease

In adults, symptoms of typhoid fever begin to appear during the incubation period. Patients report malaise, weakness, loss of appetite, headaches and muscle pain. The temperature stays between 37.5-38.5 degrees, rising in the evening.

Peak of the disease

The patient's condition is deteriorating rapidly; with typhoid fever, the temperature can reach 39.5-40 degrees. Patients complain of a number of unpleasant symptoms:

• insomnia, lack of appetite;
• thirst, dry mouth, bitterness on the tongue;
• increased heart rate;
• sweating;
• pain in muscles and joints;
• abdominal pain, bloating;
• lethargy, loss of consciousness.

The timing of the appearance of a rash with typhoid fever ranges from one week to two. The rashes are pinkish, with clear contours, most often in the lower chest, on the sides, and in the upper abdomen. The elements of the rash do not cause any discomfort to the patient. The spots disappear after 3-5 days, new elements may be added, the skin remains slightly pigmented for a short period of time.

During the acute period of the disease, the spleen and liver enlarge. The patient's face becomes pale and puffy. With typhoid fever, unstable stools are noted. Constipation alternates with diarrhea. If a complication develops, bleeding in the intestines and bloody diarrhea appear.

In severe cases of the disease, specialists diagnose patients with “typhoid status,” which is accompanied by the following symptoms:

loss of consciousness;

lethargy;

the patient confuses day and night;

hallucinations;

trembling in the limbs;

muscle spasms and cramps.

Reasons for the development of complications: lack of treatment, severe manifestations of the disease.

Fading of symptoms

The acute period of the disease can last about two to three weeks, then the manifestations of typhus begin to gradually fade away. The temperature gradually decreases to normal, stool returns to normal, and symptoms of intoxication disappear. The patient's tongue is cleared of plaque and appetite appears. It is recommended that patients get up only 7-10 days after the temperature has returned to normal.

Complications

If a patient with typhoid fever is not provided with timely medical care, complications may develop with a significant decrease in immunity.

Intestinal bleeding.

Perforation of the wall of the small intestine - occurs in case of excessive development of salmonella.

Meningoencephalitis. The nervous system and brain are affected.

Peritonitis. The peritoneal mucosa becomes inflamed.

Kidney failure.

Typhoid psychosis. Characterized by a disorder of the patient's nervous system.

Pneumonia. Occurs due to lack of movement of a patient with a high temperature.

Cholecystitis. Damage to the biliary tract.

Myocarditis. Disruption of the heart muscle.

Osteomyelitis. Damage to bone tissue and joints.

Damage to the urinary tract.

Death.

After recovery, the causative agent of typhoid fever can live for a long time in the bile ducts and duodenum of a person. Therefore, often a patient who feels absolutely healthy is dangerous to others and can infect healthy family members. Salmonella bacteria can be shed in your stool for more than a year.

Prevention and adherence to hygiene rules will help to eliminate typhoid fever: washing hands after each visit to the toilet, exterminating flies in the premises. If a person’s work involves contact with patients with typhoid fever, it is advisable to get vaccinated.

Diagnostics

The main causative agent of the disease is Salmonella. The bacterium enters the human body through the mouth. The microbe then passes through the large intestine and lymph nodes. It is at this stage that bacteria multiply and enter the circulatory system. In this regard, intoxication syndrome develops.

Diagnosis of typhoid fever. External signs

External indicators are very important when identifying typhoid fever. At the initial stage (duration of the disease is 3-5 days), the patient’s body temperature will reach the highest levels. The face is swollen, the skin is dry, bluish, and roseola-shaped pimples may appear in the chest area.

The patient's tongue is swollen and dry, covered at the base with a blue-gray film, and tooth marks may be found along the edges. The abdomen is swollen, there is rumbling and pain. Testing for typhoid fever in the first 2 days shows a normal white blood cell count. At the last stage of the disease, lymphocytosis, leukopenia, a significant increase in ESR and neutropenia are detected.

Diagnosis using laboratory tests

The most reliable method for detecting the disease is to determine the amount of Salmonella blood culture isolated. Early diagnosis allows one to obtain positive results throughout the entire period of the patient's febrile state.

A typhoid fever test should be performed daily for 3 days. It is recommended to carry out examination on the 1st day before taking antimicrobial drugs. Blood for typhoid fever is taken from the patient in the amount of 5-10 ml per 100 ml of bile-containing medium. For diagnostic purposes, tests are carried out until the patient’s temperature returns to normal. Pus, sputum, exudate fluid, and feces are also subject to examination. They are usually taken for analysis in the 2nd or 3rd week from the onset of the disease. Studies can be repeated if necessary every 5-7 days.

It is worth saying that the bacterial bacillus that caused the disease can be found in the urine and feces not only of a patient with typhoid fever, but also of bacteria carriers during any febrile conditions.

Serological testing for typhoid fever is also of great importance in diagnosis. Research is carried out 7-10 days from the onset of the disease. Serodiagnosis of typhoid fever is aimed at identifying the accumulation of O-antibody titers.

Thus, a positive response with type Vi antigen indicates prolonged carriage of the pathogen. A positive reaction to typhoid fever with the H-antigen indicates that the patient had suffered the disease previously or had been vaccinated. Recently, the disease is increasingly diagnosed using ELISA.

Testing for typhoid fever is carried out by taking stool and bile samples. In this case, diagnosis is aimed at identifying typhoparatyphoid carriage.

Remember: only a doctor should make a diagnosis, since many signs of the abdominal type correspond to symptoms of other diseases. Self-diagnosis (and especially treatment) can lead to irreversible consequences.

Specific prevention of the abdominal type consists of mandatory vaccination enriched with the Vi antigen. Vaccination is carried out for adults and children under 7 years of age. Mandatory and graded vaccination against typhoid fever is carried out for children under 15 years of age and adults.

As for nonspecific prevention, in this case general sanitary measures should be carried out aimed at combating flies (frequent carriers of bacteria), improving the quality of water supply and sanitary cleaning of populated areas, etc.

Treatment

All patients are treated in a hospital setting. Hospitalization is mandatory for the following reasons:

• the disease is infectious;

there is a risk of infecting others;

Availability of quality care is the most important factor for a complete and successful recovery.

At the first suspicion of typhus, etiotropic treatment is prescribed, aimed at eliminating the pathogen.

Use of antibiotics and pathogenetic agents

Salmonella bacteria are eliminated by ceftriaxone or ciprofloxacin (these antibiotic drugs are prescribed for infectious and inflammatory diseases). Treatment of typhoid fever with antibiotics helps lower the temperature and reduce intoxication. In some cases, an allergic reaction is observed: skin rashes, irritation, stomatitis. Drug intolerance may be accompanied by prolonged vomiting, as a result of which the prescription of antibiotics is canceled.

Pathogenetic therapy involves detoxification, which involves the administration of drugs orally or intravenously: hemodez, glucose, vitamin complexes, etc.

Diet

The method of treating the disease includes following a therapeutic diet. Therapeutic nutrition has a gentle effect on the intestines and does not cause fermentation (putrefactive) processes after consumption. For food to be easily digestible, it must be semi-liquid (kefir, liquid cottage cheese, broths, soups) or rubbed through a sieve. The therapeutic diet for typhoid fever is low-calorie; the patient should eat three times a day in small portions. Medical experts recommend drinking plenty of liquid with your servings.

Patient care

In addition to the above measures, the patient is prescribed bed rest for an average of 10 days. The prescription must be strictly followed, otherwise straining the abdominal muscles may lead to bleeding or perforation of the intestine. It is necessary to observe hygienic conditions, both in patient care and in nutrition.

Treatment with folk remedies

The purpose of using traditional medicine for this disease is to reduce the signs and symptoms of the disease and assist in recovery. The following recipes are known, the use of which must be agreed with a doctor.

Young willow bark will help fight the signs of typhoid fever. It has anti-inflammatory and disinfectant properties. Brew two tablespoons of willow bark in boiling water. It is necessary to insist for two hours. Drink the infusion three to five times a day.

To eliminate fever, traditional healers advise washing the patient. Start the process with the face and neck, and immediately wipe with a dry towel. The wet towel should be in a basin of water, the temperature of which does not exceed +27 degrees. Then they wash their hands, chest, stomach, legs.

Valerian preparations are considered very useful and effective due to their antibacterial and choleretic properties.

Treatment of typhoid fever in children

Children and adolescents with this disease are also subject to mandatory hospitalization in an infectious diseases hospital. As a rule, children are isolated in separate boxes in order to prevent an outbreak and spread of infection.

During the period of fever, an infectious disease doctor prescribes bed rest and careful care of the skin and oral cavity. A special diet with the necessary nutrients, vitamins, and microelements is prescribed. Spicy foods are removed from the diet.

The doctor prescribes antibiotics in the usual dosage. If, during long-term treatment, sluggish repair is observed and the child becomes weaker, a blood transfusion is performed.

Preventive measures for typhoid fever

According to epidemiological indications, vaccination of the population is carried out by subcutaneous injection of a liquid anti-typhoid drug into the shoulder. The World Health Organization recommends three types of vaccines. Each of them has its own characteristics, a certain adaptation period of the body and dosage.

Vaccination against typhoid fever is recommended for those traveling abroad, to the countries of Latin America, Africa, and Asia. Doctors recommend vaccination against typhoid fever a week before travel. The average duration of vaccination is 3 years. It is important to consult with your doctor about the age of the last vaccination and the relevance of the new one.

Prevention of typhoid fever

Universal compliance with sanitary and hygienic rules (from personal hygiene to water supply).

Wash your hands often with warm water and soap.

Get the appropriate vaccination.

In areas with poor sanitation, doctors recommend consuming only bottled water.

Consult a doctor immediately if the first signs of the disease are detected.

Prevention of the disease also includes: supplying the population with high-quality water, timely removal of garbage and sewage from populated areas, and control of insects.

Repeated illness is an extremely rare occurrence; typhoid fever usually leaves lasting immunity.

The treatment method for typhoid fever includes:

use of antibiotics and pathogenetic agents;

diet;

patient care;

treatment with folk remedies.

It is also necessary to pay attention to the treatment of the disease in children, measures to prevent the disease and prevention.

All treatment procedures to combat typhoid fever are aimed at neutralizing the infection, increasing the body's immunity and stopping the transmission of the infectious disease.

The disease is diagnosed and treated by infectious disease doctors.

Medicines

A patient with suspected abdominal type is subject to immediate hospitalization in the infectious diseases department. But how and with what to treat typhoid fever? Treatment should be comprehensive and include fighting infection and measures against dehydration, especially with intestinal bleeding.

Antimicrobial drugs that combat typhoid fever are sulfonamides and antibiotics. The active ingredient of a large number of sulfonamide antibacterial drugs is trimethoprim. Co-trimoxazole is prescribed orally, 2-3 tablets per day, for five to fourteen days. Contraindications include breastfeeding and intolerance to trimethoprim. Analogues of Co-trimoxazole are drugs such as Biseptol, Bactrim, Sulfatone.

In medical reference books, the antibiotic chloramphenicol is recommended as an antimicrobial drug in the treatment of typhoid fever. It is taken half an hour before meals (up to four times a day for one to two weeks). Contraindication is intolerance to chloramphenicol. Over time, races of salmonella resistant to chloramphenicol have appeared; in addition, chloramphenicol itself destroys not only pathogenic bacteria, but also beneficial microbes, causing diarrhea (diarrhea).

Among the antibiotics of the penicillin group, Amoxicillin is used in the treatment of typhoid fever. The tablets are taken three times a day. The duration of treatment is prescribed by the doctor; as a rule, treatment with amoxicillin lasts from five to twelve days. Contraindications are intolerance to penicillin and breastfeeding.

Among the new generation of antibiotics, Salmonella are sensitive to cephalosporins: ciprofloxacin, azithromycin, ceftriaxone.

Ciprofloxacin tablets are taken on an empty stomach twice a day for ten days. Contraindications include hypersensitivity, pregnancy and lactation.

Azithromycin (Azitrox) is available in the form of tablets and capsules. Taken between meals: one hour before and two hours after. It is convenient because it is taken once a day, and the course of taking this medicine is only three days. Since azithromycin and ciprofloxacin belong to the same group of antibiotics, the contraindications for their use are similar.

It is known that with complicated typhoid fever, the lungs, intestines and abdominal organs, liver, kidneys, meninges and other organs are affected. Ceftriaxone will cope with both salmonella and secondary microflora. One of the symptoms of typhoid fever is vomiting, which can make taking medications in pill form useless. An important advantage of ceftriaxone is its injection form of administration.

Medicines that combat typhoid fever are not limited to antibiotics. Depending on the severity of the disease, intravenous injections of glucose-saline solutions are prescribed to remove toxins from the blood. To bind poisons in the intestines, sorbents are needed that act like activated carbon.

And to develop beneficial microflora that can fight salmonella in the intestines, probiotics and prebiotics are used. If the course of typhoid fever is complicated by bleeding, then hemostatic drugs such as aminocaproic acid and vikasol are used.

Folk remedies

Folk remedies can only be effective in preventing this disease, but not in the treatment process. If this disease manifests itself, consult a doctor and follow his recommendations. Folk remedies in combination with medications can only speed up the recovery process from typhoid fever.

Here are fairly simple ways to avoid this disease or increase the effectiveness of traditional treatment:

• To protect yourself from typhoid fever, traditional medicine recommends chewing raw calamus root, which has a bactericidal effect.
• In conjunction with drug treatment, it is useful to take burnet root. To prepare a decoction, crushed burnet root is poured with water, then boiled and filtered through cheesecloth. The decoction should be cooled before use.
• To improve heart function in the event of viral diseases, take currant juice.
• St. John's wort has beneficial properties. It promotes faster tissue healing and also has an astringent, antibacterial and immune-strengthening effect. This herb should be consumed as an infusion.

A collection of centaury, medicinal chamomile and sage, which is poured with boiling water and infused, is also popular. It is believed that this remedy has no side effects, however (as with any recipe from traditional medicine), it is imperative to consult a specialist before using it.

Plantain helps with disorders of the gastrointestinal mucosa and bloody diarrhea. A decoction is prepared from it. In this case, the seeds are boiled and consumed shortly before meals; sometimes plantain leaves are also used.

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.