My own expirence to treat enteric fever
Case no 1 .
One day i used to be in my clinic , young twenty year recent boy came to Pine Tree State for consultation concerning his downside. He was littered with high grade fever together with rigor ,chilliness, headache, nausea slight abdominal pain since 2 days.on examination, force per unit area is 130/80, pulse is 100/m,temperature is 102f, I came to conclusion that fever may be protozoal infection .I had suggested for mp check by protozoal infection speedy check card within which p. Vivex was positive. thus I started lariago D's , pcm together with pantoparzol and primalin D's .
once three day patient came to Pine Tree State for follow up with relief from fever however complain concerning weakness and uneasiness .I thought that it'd thanks to weakness thus I compel syr vitomin z tonic .
once three days patient once more came to Pine Tree State with high fever and body ache.I had examined him for once more and came to conclusion that he may been sufferd from enteric fever among with protozoal infection , and he was recommendation to try to to some biopsy like blood profile, malaria, humour widal, piddle routine small.report prompt enteric fever , alternative worth was traditional. On the premise of current report ,patient was treated by the tab ofloxacin four hundred mg for seven day and patient was began to get over next day.
what is enteric fever or typhoid fever?
Typhoid fever is usually caused by s.typhi. bacteria or s.paratyphi. bactria and occasionally by other salmonella bacteria.s.typhi organism is gram negative bacillus ,a humen pathogens which depends on humen to humen transfer for continued existence and service for many weeks in sewage.main source of contamination of s.typhi bacteria is from contamination of food and water with faces from infected patients and carriers.after injection and passage through gastric acid barrier ,the organisms attach to small intestinal mucosa and penetrate it, and are transported by the lymphatics to the mesentric lymph nodes. Following multiplication ,they enters blood stream via thoracic duct,then spread to bone narrow,spleen and liver,whrer they multiply.secondary invasion of blood and reinvasion of bowel via infected bile then occurs.a particularly strong inflamatory response occurs in the ileal payer's patches and may lead to necrosis ,ulceration ,bleeding and occasionally perforation.
Typhoid fever is have classical gradual onset of fever in the first week,remittent in second week and falling in third week.patient complain of headache,anorexia,vague abdominal pain ,constipation or diarrhoea and dry cough.rigor are uncommon occasional feature include sore throat ,epistaxis,coated tongue and relative bradycardia. In the second week tender hepatomegaly and palpable spleen and sign of bronchitis may develops.rose spots are scanty pink macule usually on the trunk they branch on pressure are seen from second weeks onwards.untreated patient can become toxic,mentally stuporous and dehydrated and may develops ileal perforation ,GI hemorrage,coma,shock,pneumonia, nephritis and acute psychosis.
How to diagnosed typhoid fever? It can be diagnosed by blood culture test which is a gold standard test but sensitivity may be low in epidemic areas with high rates of antibiotics use.bone narrow culture is also have greater sensitivity but invasive thus of limited clinical value .urine and stool culture are not used routinely because of low sensitivity. PCR has similar sensitivity to blood culture but has lower specificity. Widal serological test is routinely used classical test in clinical practice because of it is less expensive and sensitive test.
How to manage and treat patient of typhoid fever? He should be advice for rest for at least week .fluid and electrolyte should be replaced by liquid and water. Diet shoulde be had 3000 calories per day.diet contain milk,lactose,tosts ,butter,mashed patatoes,lightly boiled eggs,boiled chicken or fish ,cornflour,bananas and apples and feed 2 hourly.complication of typhoid fever should be treated symptomatically like abdominal distension by omiting sugar,reduced amount of milk and apply flatus tube if abdominal distension is more.diarrhoea can be managed by reducing quantity of milk or dilute it further ,gives butter milk and sago cancer or rice cancer in water ,apple juice or in pomegranate juice .fever can be managed by tepid sponging ,ice bag to head,sponging with ice water and ice water enema.most episode of GI bleeding are self limiting and only very few patients may required blood transfusion.antibiotics should be given for long time to treat episode of typhoid fever.relapse of second episode of fever usually milder than the first ,occurring 1 to 2 weeks after recovery from the episode .it is managed as in the initial episode.
what is enteric fever or typhoid fever?
Typhoid fever is usually caused by s.typhi. bacteria or s.paratyphi. bactria and occasionally by other salmonella bacteria.s.typhi organism is gram negative bacillus ,a humen pathogens which depends on humen to humen transfer for continued existence and service for many weeks in sewage.main source of contamination of s.typhi bacteria is from contamination of food and water with faces from infected patients and carriers.after injection and passage through gastric acid barrier ,the organisms attach to small intestinal mucosa and penetrate it, and are transported by the lymphatics to the mesentric lymph nodes. Following multiplication ,they enters blood stream via thoracic duct,then spread to bone narrow,spleen and liver,whrer they multiply.secondary invasion of blood and reinvasion of bowel via infected bile then occurs.a particularly strong inflamatory response occurs in the ileal payer's patches and may lead to necrosis ,ulceration ,bleeding and occasionally perforation.
Typhoid fever is have classical gradual onset of fever in the first week,remittent in second week and falling in third week.patient complain of headache,anorexia,vague abdominal pain ,constipation or diarrhoea and dry cough.rigor are uncommon occasional feature include sore throat ,epistaxis,coated tongue and relative bradycardia. In the second week tender hepatomegaly and palpable spleen and sign of bronchitis may develops.rose spots are scanty pink macule usually on the trunk they branch on pressure are seen from second weeks onwards.untreated patient can become toxic,mentally stuporous and dehydrated and may develops ileal perforation ,GI hemorrage,coma,shock,pneumonia, nephritis and acute psychosis.
How to diagnosed typhoid fever? It can be diagnosed by blood culture test which is a gold standard test but sensitivity may be low in epidemic areas with high rates of antibiotics use.bone narrow culture is also have greater sensitivity but invasive thus of limited clinical value .urine and stool culture are not used routinely because of low sensitivity. PCR has similar sensitivity to blood culture but has lower specificity. Widal serological test is routinely used classical test in clinical practice because of it is less expensive and sensitive test.
How to manage and treat patient of typhoid fever? He should be advice for rest for at least week .fluid and electrolyte should be replaced by liquid and water. Diet shoulde be had 3000 calories per day.diet contain milk,lactose,tosts ,butter,mashed patatoes,lightly boiled eggs,boiled chicken or fish ,cornflour,bananas and apples and feed 2 hourly.complication of typhoid fever should be treated symptomatically like abdominal distension by omiting sugar,reduced amount of milk and apply flatus tube if abdominal distension is more.diarrhoea can be managed by reducing quantity of milk or dilute it further ,gives butter milk and sago cancer or rice cancer in water ,apple juice or in pomegranate juice .fever can be managed by tepid sponging ,ice bag to head,sponging with ice water and ice water enema.most episode of GI bleeding are self limiting and only very few patients may required blood transfusion.antibiotics should be given for long time to treat episode of typhoid fever.relapse of second episode of fever usually milder than the first ,occurring 1 to 2 weeks after recovery from the episode .it is managed as in the initial episode.