Typhoid

Typhoid's disease overview

What is

What are typhoid?

typhoid is a systemic bacterial infection caused by Salmonella bacillus. The disease usually starts suddenly and has many severe complications such as gastrointestinal bleeding, intestinal perforation, myocarditis, encephalitis ... which can lead to death. However, there are also minor cases with little or no symptoms.

Typhoid is an acute infectious disease that is strongly spread and may flare into a large epidemic. Salmonella bacteria that cause patiently spread from person to person through the roads of eating or close contact with the infected person.

Typhoids are common in most tropical and subtropical countries in Asia, Africa, Middle East, Oceania and Central and South America, circulating mainly in areas with conditional areas. L ... less hygienic activities, polluted water sources, untreated waste and sometimes it can explode into epidemics. In Vietnam, the disease is often the most common and dangerous outbreak after the rainy seasons.

typhoid is still a global health problem. It is estimated that about 16 million new people each year and about 600,000 people die from typhoid. The rare disease in developed countries, appearing dispersed by tourists or immigrants from the circulating areas. However, in many developing countries, the disease often causes epidemics, especially in areas such as India, Southeast Asia, Central America, South America and Africa, especially in places where water, food , pepper, drainage systems do not meet the permitted hygienic standards. In Vietnam, there have been a number of services in some provinces in the Mekong Delta, and some northern provinces.

Việc bùng phát dịch thương hàn có liên quan đến các vấn đề như: dân số phát triển nhanh, tăng sự đô thị hoá, xử lý chất thải không kịp thời, đầy đủ, nguồn cung cấp nước sạch hạn chế, và Health care system is overloaded. Bệnh có thể xảy ra quanh năm tuy nhiên các vụ dịch thương hàn thường xảy ra vào mùa hè (khoảng từ tháng 6 đến tháng 9).

The disease can also occur with anyone and at any age. However, the disease is common in people aged 15 to 30 years old.

Causes of Typhoid's disease

Typhoid is caused by Salmonella Typhi typhoid.

Salmonella has good vitality and resistance, withstand cold. In ice water, bacteria still live for 2-3 months, usually in the water is usually> 1 month, in vegetables 5-10 days, in stool 1 to several months

Salmonella is killed at 550C for 30 minutes or 1000C for 5 minutes, 900C alcohol for a few minutes, conventional disinfectants can also kill bacteria easily.

Humans are the only host of Salmonella bacteria, so the disease can only spread through direct contact with the sick. Therefore, people who are suffering from typhoid or chronic bacteria are important sources in the community.

Typhoid bacteria found in feces, urine, vomiting, pus ... of the patient, of which the amount of bacteria in the stool is the most important source of infection. Even when the disease has retreated, in the recovery period, about 20% of patients continue to discharge bacteria through stool for 2 months and 10% continue to discharge bacteria for 3 months.

Chronic people: about 3% of typhoid patients after being treated continued to carry Salmonella bacteria in the body to become a good person and continue to eliminate. Bacteria out of the environment for over 1 year. Good people are more common in women than men, people with gallbladder and bile ducts. This is an important source of disease, very difficult to control, especially people who sell food, health workers, child care, and service at the food store. Therefore, in some countries, there is a regular medical examination regulations for those who work in these industries to limit the spread of the disease from this source.

Objects that are easily exposed to typhoid bacteria include: travelers in the area where there is circulating epidemic, laboratory in the laboratory, close contact with the disease. Typhoids or good people with chronic coincidence (for example, people in the same family, medical staff to take care of patients with typhoid ...).

Symptoms of Typhoid's disease

Clinical symptoms

in the typical form, the disease is as follows:

Incubation period : oscillation 3-21 days (on average from 7-14 days) and often have no special symptoms.

The onset period : usually slowly evolved with the following manifestations:

Fever increases day by day, usually increasing in the afternoon in the first 5-7 days of the disease.

Headache accompanied by fatigue, anorexia, muscle pain, insomnia.

Abdominal pain, nausea, vomiting, constipation

Nosebleeds, usually only in children.

dry cough, abdominal pain, chest tightness less.

The full period : From the 2nd week and last 2-3 weeks.

Fever is the most important symptom, 39 - 40oC continuous high fever accompanied by headaches and fatigue. Cold trembling and sweating only one third of the case.

Autral pyrolytic circuit: Today is very rare.

Signs of severe body poisoning infections: dry lips, red cheeks, dirty tongue, bad breath; Patients are not awake and gradually turn into coma.

Going out of liquid feces (5-6 times/day), smells; bloating, flatulence, mild pain spread throughout the abdomen; Big liver, spleen see 30-50% of cases.

The tongue is dirty white, the edge of the tongue and the red tongue (the tongue sign).

Old sole ulcer.

Ban: meet 30% of cases, appear on Saturday to the 10th day of the disease, 2-4mm in diameter; Common location in the abdomen, chest, hips; and takes 2-3 days.

Heart and lung examination: Signs of heart failure, pneumonia

Against disease

If there is no complication, the disease will turn to the period of retreat in the 3rd - 4th week. The patient will reduce fever, symptoms from improvement, and gradually recover.

Typhoid in children under 5 years of age is usually not typical, or having diarrhea, vomiting, rarely constipation, high fever causing body convulsions.

For children under 1 year of age, very serious typhoid disease, high mortality and complications. In addition, in patients with vapor immunodeficiency such as biliary tract deformities, diabetes, malaria, ... there are also severe illnesses

Subclinical

Some tests need to be done for diagnosis and treatment, including: blood formula; Transplanting specimens (such as blood, bone marrow fluid, bile fluid, urine, stool) to identify pathogenic bacteria and make antibiotics to find appropriate antibiotics for treatment; Immunological tests such as Widal, RIA, ELISA, PCR ... have high diagnostic value.

If not treated, complications usually appear in the 3rd week of disease.

Typhoid complications in the gastrointestinal tract:

Perforation: accounting for 3% of cases, usually occurring in the 3-4 week of the disease

Molecular complications: commonly cholecystitis and hepatitis

Other complications: such as colitis, appendicitis, bowel paralysis, pancreatitis ...

Cardiovascular complications: Cardiovascular, myocarditis, pericarditis, arterial obstruction, veins, endocarditis ...

Complications of the nervous system

The most common is the disorder of consciousness from sleeping to a coma.

encephalitis: there are signs of conscious disorders, body temperature disorders ... The prognosis is usually severe.

Meningitis, encephalitis, horizontal cut inflammation, skull neuritis ... less common.

Urinary tract complications: glomerulonephritis, fatty kidney syndrome.

Complications of localized infections: can be encountered in most organs such as pneumonia, sore throat, pyelonephritis, cystitis, bone inflammation, .... >

Transmission route of Typhoid's diseaseTyphoid

Typhoid bacteria spread through the gastrointestinal tract. Most cases of disease are caused by food and water infected.

Due to eating food, drinking water is not cooked. This is an important transmission and often causes great epidemics. In foods, often encounter typhoid bacteria in dairy and meat products. Typhoid bacteria can grow in milk and preparations that still do not change its taste properties.

Due to direct contact with patients, people carrying bacteria: Healthy people after contacting the sources of bacteria are not clean before eating ( Mainly do not wash your hands before eating) and get the disease. However, the current reality due to the hygiene conditions as well as the sense of hygiene of the community has been significantly improved, so far rarely encountered this way of transmission. Subjects often infected with this path are mainly children, or indirectly spread through flies, insects carrying bacteria from feces to food, legs, arms, contaminated utensils ... This sugar often causes small fluids , scattered.

Prevention of Typhoid's disease

Ensuring environmental hygiene, protecting water sources, treating feces, thoroughly, hygienic waste.

Ensuring food hygiene and safety in food processing, manufacturing and trading.

Practice cooking, drinking.

Wash your hands clean: Before processing food, before eating and after going to the toilet.

Flies prevention.

Waste treatment of patients such as feces, urine, blood samples ...

Isolate patients at the hospital.

Treatment of good people.

Vaccination with typhoid vaccine is not widely indicated because of the prevention effect of about 65-70% and has a significant side of side effects.

Diagnostic measures for Typhoid's disease

Definite diagnosis based on:

Epidemiology: Living or has been to the area where there is a typhoid circulating, or in contact with patients with typhoid.

Clinical: There are clinical symptoms suggesting such as fever more than a week of unknown reasons, accompanied by digestive disorders are usually diarrhea; liver, spleen enlarged, hong ban. Clinical: Blood blood cells do not increase; Bacterial implant results (+); or serum reactions like Widal, Elisa, RIA, PCR ... (+)

Typhoid's disease treatments

Choose the appropriate antibiotic (preferably according to antibiotics). However, now in Vietnam as well as many parts of the world, typhoid bacteria have been resistant to many types of antibiotics

Support treatment: antipyretic at temperature> 38.5oC; Water compensation, electricity

Good care and adequate nutrition. Attention should eat soft, easy -to -digest foods, enough calories, no restrictions on eating.

Prevention, detection and timely treatment of complications.

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