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home - Colon - Colonic Infection - Salmonella Enteric Fever Written by Dr Sebastian Zeki
Knowledge

Recognises the range of important inflammatory conditions of the
intestine other than inflammatory bowel disease
Knows the range of potential aetiologies including infection and
ischaemia
Understands how diverticular disease can give rise to complications mini-CEX, SCE 1
Knows how diseases can affect the peritoneum and how such
conditions can present both in the acute and chronic situation
Knows the range of both acute and chronic intestinal infections and
their various presentations
Knows the means of investigations of infectious diseases and
understands the principles and use of antimicrobial therapy

Skills
Makes a full clinical assessment of patients presenting with infective
and inflammatory conditions
Recognises the potential urgency of the clinical situation. Selects
appropriate investigations and treatments

Behaviours
Manages patients with inflammatory and infective conditions carefully,
competently and sympathetically.

Salmonella Enteric Fever

Treatment and prevention of typhoid fever Causes of Typhoid and paratyphoid fever:Salmonella typhi(most common).S. paratyphi A.S. typhi B (also known as S. schottmuelleri).S. paratyphi C (also known as Salmonella hirschfeldii). 5 to 21 days after ingestion The incubation period and inoculum needed to cause disease vary depending: Week 3 — HepatosplenomegalyIntestinal bleeding and perforation, related to ileocecal lymphatic hyper-plasia of the Peyer's patches15% get altered conscious state or shockRelative bradycardia Mortality rates 15% Diagnostic methods:Blood cultures (70%).Bone marrow (50%).Stool culture (35%).Urine or rose spot culture.Widal test may be +ve in previous infection.ELISA for antibodies to the capsular polysaccharide Vi antigen is useful for detection of carriers but not for the diagnosis of acute illness.Can get leukopoenia or leukocytosis.Abn LFT’s. Enteric Fever- Typhoid Fever Week 1— Rising ("stepwise") fever and bacteremia Week 2 — Abdomi-nal pain and rash (rose spots, which are faint salmon colored macules on the trunk and abdomen) ? Chronic carriage It is chronic if organism excreting >12m after the acute infection.There is a rate of 3%- more common with hepatobiliary problems.Patients have high levels of immunity so are asymptomatic but are a public health risk so should be eradicated.Treat with longer course of quinolones and con-sider cholecystectomy.Chronic urinary carriage of S. typhi is rare.It is usually associated with abnormalities of the urinary tract. Relapse There is a 15% relapse rate.Relapse occurs 2-3w after resolution of fever. Antimicrobial regi-mens — With treatment, resolves in 3-5 days Multidrug resistant strains — 20% are resistantNalidixic acid-resistant organisms — Often indicates fluoroquinolone resistance.Occurs in up to 80% of isolates in some parts of Nepal, India and Vietnam Adults — 1st line- ciprofloxacin or ofloxacin po or iv unless from South Asia (high resistance).Ceftriaxone/ cefixime Azithromycin (Use for resistant strains)Chloramphenicol.Corticosteroids — Can give steroids with antibiotics in severe shock. Prevention“Boil it, cook it, peel it, or forget it."Typhoid vaccine — For travelers to high-risk areas but no 100% effective against typhoid or paratyphoid AgeGastric acidityImmunologic status. Written by Dr Sebastian Zeki

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