Typhoid fever

Typhoid ( typhus abdominalis, also typhoid fever or typhoid fever or enteric fever) is an infectious disease caused by a characteristic course of disease 's staged increase in fever, abdominal pain, constipation ( constipation) and for the high body temperature rather slow heartbeat (relative bradycardia) is characterized. The disease is caused by the bacterium Salmonella Typhi ( serovar enterica Typhi Salmonella enterica ssp. ). If left untreated, the disease can run dangerous and lead to death. In Germany, Austria and Switzerland, both a suspect and disease and death from typhoid fever are notifiable.

As paratyphoid is called an attenuated clinical picture of typhoid fever, the causative agent is not Salmonella Typhi, Salmonella Paratyphi but.

Name and etymology

The name derives from the ancient Greek typhoid τῦφος Typhos what, extractor ',' fog ',' smoke ',' steam ', but also figuratively, dizziness ' or ' bene belter state of mind ' means. This refers to neurological symptoms of the disease.

In international usage, such as in English, the disease is said in the German typhus, caused by Rickettsia disease is known as typhoid fever is known as the word denotes typhoid. Typhus was formerly known as typhus or typhoid mildest ambulatorius. DIMDI follows the international nomenclature and refers to the disease described here as " typhoid fever ".

History

The typhus is prevalent since the ancient times. In 1546 he was distinguished from Fracastoro under the name of morbus lenticularis, which also recognized the risk of transmission from person to person. 1556 This assumption was confirmed by epidemics in Naples and in Hungary. It was not until 1760 Boissier de Sauvages struck before the name typhus. Previously the disease was known under the name of nervous fever.

Pathogen

Pathogen is the typhoid bacterium (Salmonella enterica subsp. Enterica serovar Typhi ), a gram-negative, flagellated bacterium that is transmitted fecal-oral route, that is, for example, through contaminated food or polluted water. Nowadays typhus is primarily a problem of developing countries. Cases in industrialized nations are the exception; a large part of typhus occurring here is related to countries with low hygienic standard with long-distance travel of those affected. When traveling in tropical areas (eg India), immunization should be considered, even if it provides only partial protection. Worldwide affected about 32 million people annually.

Clinical picture

The incubation period is, depending on the amount of captured pathogens, typically 1-3 weeks, but the extreme values ​​can be between 3 and 60 days. It will initially cause nonspecific constitutional symptoms such as fatigue, headache, constipation, as well as a step-like increase in fever ( 1 week = stage incrementi ). After 8 days, a stage of sustained high fever (fever continuum with 40 to 41 ° C ) is reached, which can last for weeks (2nd - 3rd week = stage fastigii ). Here you will find a relative bradycardia. This is understood relative to a fever slow heartbeat; Fever is otherwise often accompanied by a faster heart beat ( tachycardia). Furthermore, a lack of white blood cells ( leukopenia ) leaves (again, in contrast to many other bacterial infections ) notice. Adding to this disturbance of consciousness ( hence the name), swelling of the spleen and reddish spotty rash on the upper body and - often on his abdomen - ( roseola ). Also typical is the so-called typhoid tongue clearly shows gray - whitish in the center, at the edges and the tip of the tongue, however, free red edges showing. The destruction of Peyer's patches in the small intestine creates the characteristic erbsbreiartige diarrhea, which can also be completely absent occurs only after about 14 days. Intestinal perforation, hair loss, Knocheneiterungen and meningitis are possible. During the long recovery period the fever decreases gradually from ( = stage decrementi ).

As a result, excrete about 10 % of untreated patients for up to 3 months typhoid bacteria in the stool or urine; 5 % of untreated patients are (> 1 year excretion ) of Salmonella, since the pathogen can persist in the gall bladder and the bile ducts to the so-called Dauerausscheidern. This is promoted by abnormalities of the bile ducts, such as gallstones. The Dauerausscheider can, without even yet to show signs of illness, infect other people.

People who suffer typhoid dominalis and paratyphoid or its suspected may not act or be employed in the manufacture, handling or marketing of food when they are doing come into contact with them, or in kitchens and other catering facilities with or caterers.

Diagnosis

The position of the diagnosis is based on the typical hospital, the patient's history ( travel in tropical regions, especially India, Nepal and Indonesia) and laboratory and bacteriological findings. In the study of the blood can be a reduced number of white blood cells demonstrate ( leukopenia ). Also characteristic is the absence of eosinophilic leukocytes ( eosinopenia ), a type of white blood cells. The bacteriological detection of pathogens using blood cultures succeed in the first two weeks of the disease and confirms the diagnosis. Only initially in the earliest stage of the disease and after two weeks, the pathogen can also breed out of the chair. The antibodies produced by the immune system of the organism, which are directed against specific bacterial antigens ( antibodies against O / h antigen) can be detected around the end of the first week of illness serologically using the Gruber - Widal antibody detection. It was not until the third week of the disease are high titers of antibodies reached ( 1:400-800 ). When initially begun therapy with antibiotics of the detection of antibodies may fail.

Treatment

The treatment of typhoid infection is with antibiotics. Before therapy blood and stool samples are taken to detect the pathogen and - after a successful cultivation of the pathogen - perform resistance testing to commonly used antibiotics. Antibiotics of choice in adults are newer quinolones such as ciprofloxacin or ofloxacin for seven to ten days. Alternatively, the third generation cephalosporins such as ceftriaxone may be used for one or two weeks. If the substances mentioned can not be used because of contraindications or the pathogens are resistant to therapy with cefixime, azithromycin, ampicillin, cotrimoxazole, or chloramphenicol can be performed. However, there are often particular resistance against the three last-mentioned agents.

Prophylaxis

Hygiene is the best protection. The usual measures to tropical destinations such as the elimination of undercooked food and tap water, should be followed in any case. A prophylactic vaccination against typhoid can be performed with both inactivated and live viral vaccines. The live vaccine ( Vivotif, in Germany Typhoral ) contains non- pathogenic ( non-pathogenic ) Salmonella typhi bacteria that stimulate the immune system to the formation of protective antibodies. The live vaccine is administered orally in enteric-coated capsules, is well tolerated and protects about 60 to 70 percent of vaccinees in endemic areas for one to three years. For travelers with a booster dose is recommended after one year. The inactivated vaccine containing a polysaccharide capsule of Salmonella typhi, which also leads to the formation of antibodies in the vaccinee. The vaccine is administered intramuscularly or subcutaneously, is well tolerated and provides about 64 to 72 percent of subjects had a protection for about three years.