Salmonella enterica (salmonella enterica)

Description

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.

Salmonella

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20.07.2012

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bacteria, microflora, salmonella

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Salmonella is the name of a bacterium familiar to most adults. In the media we hear every now and then about food poisoning associated with this microbe. What kind of “beast” is this?

Salmonella is a genus of bacteria in the family Enterobacteriaceae . Salmonella is classified as pathogenic microorganisms for the reason that most of them cause various intestinal diseases . We can say that this numerous genus has been studied almost thoroughly. All pathogens of salmonellosis belong to the species Salmonella enterica , which is divided into six subspecies. The subspecies Salmonella enterica enterica includes groups A, B, C, D, E. Epidemics of typhoid fever, which at one time raged throughout the world, were caused by salmonella , and specifically by Salmonella typhi, which belongs to group D.

Salmonella are distinguished by the structure of somatic (O) and flagellar (H) antigens. The different antigens have been numbered to facilitate classification, with the flagellar antigen having two phases which are numbered separately. Each new serovar (antigenic variant) received its own name, which may be associated with the area where salmonella was isolated (Moscow, London, Dublin), or with the name of a scientist, or, much less commonly, with the name of an animal (gallinarum - cockerel, or cholera -suis - swine cholera). More than 2,000 serovars are now known. The culprits of most food poisoning in our territory are mainly salmonella enteritidis and typhimurium . Although, at one time others were quite common, for example Salmonella infantis .

Salmonella can survive for quite a long time (according to some sources, up to three months) in animal droppings and human excrement. At a temperature of 40C they do not reproduce, but retain their viability. The optimal temperature for life activity and, accordingly, reproduction is 370C. As, in principle, for most pathogenic microorganisms.

One of the most dangerous diseases for humans caused by salmonella is typhoid fever. Salmonella typhi parasitizes inside cells because it has properties that help it evade recognition by immune cells . There is a known case when Salmonella typhi penetrated in this way even into the human knee joint , causing periodic inflammation, but without spreading beyond the joint. For many years, a person was a carrier of this microorganism until intra-articular fluid was taken for analysis.

In people with reduced immunity, as well as in those patients who have low acidity of gastric juice, the likelihood of developing severe typhoid fever is much higher. Since Salmonella typhi has high resistance (tolerance) to various antibiotics , treatment takes a long time. The mortality rate, regardless of treatment, for typhoid fever reaches 4%.

The latent, that is, incubation or asymptomatic period of typhoid fever lasts up to 14 days. Infection occurs through ingestion of contaminated food, in particular through milk, in which bacteria thrive and can even multiply. Animals do not suffer from typhoid fever, but can be carriers of pathogens. After entering the small intestine, the bacteria infect lymphoid cell accumulations and penetrate into the blood through the lymph flow. As a result of the destruction of bacterial cells, toxins are released that affect the liver, spleen and other organs. Patients in the first stage of the disease experience pale skin, weakness, headaches, fever, diarrhea and constipation, and bloating. Then (after 9-12 days) a pinkish rash appears, which disappears with pressure. The rash is localized mainly on the abdomen and chest. During the same period, lethargy and hallucinations are noted. During the recovery period, a new relapse of the disease may begin, since some of the microorganisms through the bloodstream again enter the lower parts of the small intestine and bacteria actively multiply there.

In order to become infected with typhoid fever, a fairly high dose of bacteria is required - about 10,000,000 microorganisms per milliliter of liquid or gram of food. From this we can conclude that an organism with a healthy immune system and normal microflora has a much better chance of encountering Salmonella typhi. In 2010, 49 cases of typhoid fever were registered in Russia.

A much less dangerous, but more common disease caused by salmonella is salmonellosis. Gastrointestinal manifestations of this disease begin to appear quite quickly (from several hours for food poisoning, up to 3 days) . Vomiting and diarrhea are typical The stool is watery, greenish and foul-smelling because bacteria produce hydrogen sulfide during their life. Temperatures can rise to 41°C .

Symptoms such as:

• rumbling in the stomach;
• pain in joints and muscles;
• dizziness and headache;
• muscle cramps in the arms and legs.

The disease is also transmitted through food and, most often, through milk and eggs . There is an opinion that quail eggs do not cause salmonellosis . This is wrong. Indeed, the shell of quail eggs is thicker, so it is more difficult for bacteria to penetrate inside than into chicken eggs. But, at the same time, quails are also carriers of salmonella , so poorly washed eggs containing remnants of bird feces can cause salmonellosis . In addition, people use quail eggs less often as food, so cases of salmonellosis through this product are not observed so often.

Prevention of diseases caused by different serogroups of salmonella consists, first of all, in good heat treatment of products of animal origin . Boiling milk, boiling and frying eggs until the yolk is solid, avoiding rare steaks and finished food products of dubious production will protect you, if not a hundred, then 99% from salmonellosis. We do not urge you to renounce barbecue outdoors, but be sure to marinate them thoroughly before leaving. After all, the acidic environment used for marinade (kefir, vinegar) can destroy many types of pathogenic and opportunistic microorganisms, and not just salmonella. And remember that strong immunity and healthy intestinal microflora are the guarantee that infectious gastrointestinal diseases will bypass you.

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Symptoms

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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;
• rave;
• 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 typhoid fever can last about two to three weeks, then a gradual decline in the manifestations of typhoid fever begins. 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

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The main causative agent of typhoid fever 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.

Publications in the media

Typhoid fever (BT) is an acute infectious disease (generalized salmonellosis), characterized by ulcerative lesions of the lymphatic system of the small intestine, bacteremia; manifested by intoxication, typical fever, roseola rashes on the skin, enlarged liver and spleen. Incidence : 0.12 per 100,000 population in 2001

Classification • According to clinical forms •• Typical form (classical clinical variant) •• Atypical forms: ••• Erased ••• Subclinical ••• With a predominance of damage to individual organs and systems (colotif, meningotif, pneumotyphoid, etc.) • By severity: •• Mild form •• Moderate form •• Severe form • By course: •• Uncomplicated •• With complications and relapses.

Etiology . Salmonella typhi is an aerobic gram-negative rod of the Enterobacteriaceae family.

Epidemiology • BT is an anthroponotic disease. Sources of infection are sick people and bacteria carriers. The greatest epidemiological danger is posed by bacteria carriers and patients with erased and mild forms of the disease. Chronic bacteria carriers are the main reservoir of infection in nature • Summer-autumn seasonality is typical • The mechanism of infection is fecal-oral. The water factor is of primary importance in the occurrence of epidemic outbreaks of BT. Contact-household and food transmission routes cause sporadic cases of the disease.

History • Contact with a patient with BT or a bacteria carrier 1 month before the onset of the first symptoms of the disease • Stay of the patient in a region that is epidemiologically unfavorable for BT.

Clinical picture

• Periods of the course •• Incubation (7–25 days, on average 12–14) •• Initial (4–7 days) •• Height of the disease (1–2 weeks) •• Resolution of the disease (up to 1 week) •• Reconvalescence ( 2–4 weeks).

• Clinical symptoms •• Fever is the most consistent objective symptom. BT is characterized by 3 types of temperature curves ••• Trapezoidal Wunderlich temperature curve - classic, with a sequential change of stages of increasing body temperature, constantly high values ​​and decline; their duration corresponds to the initial period of the disease, its height and resolution ••• Botkin’s wavy temperature curve with a sequential alternation of 3-4-day episodes of febrile and subfebrile body temperature ••• Kildyushevsky’s temperature curve with a short (1-2 days) stage of constantly high temperature and a long (2–2.5 weeks) decline stage; typical for children • • Intoxication (anorexia, headache, insomnia) - at altitude the development of delirium, psychotic states and disorders of consciousness (status typhosus) is possible • • Damage to the gastrointestinal tract - thickened tongue coated with a gray-brown coating with tooth marks on the lateral surfaces ( typhoid tongue), shortening of percussion sound over the ileocecal area (Padalka's symptom), pain and infiltration determined by palpation of this area (Obraztsov-Gausman symptom), symptoms of enterocolitis (flatulence, diarrhea with stool in the form of pea puree or constipation), colotyphoid • • Hepatosplenomegaly (determined by palpation from the end of the first or beginning of the second week) • • Skin lesions - pallor of the skin, roseola rash protruding above the surface of the skin (roseola elevata), not abundant, discrete, appears on the 8-12th day of illness, localized on the skin of the chest and abdomen, persists for 3–4 days and disappears without a trace. During the period of resolution, elements of prickly heat (crystallina miliaria) and yellow discoloration of the skin of the palms and feet (Fillipovich's symptom) may appear. • Damage to the cardiovascular system - bradycardia and dicrotia of the pulse, moderate arterial hypotension. With the development of complications - collapse, tachycardia • • Damage to the central nervous system - meningitis and meningoencephalitis of a serous and purulent nature, meningotif • • Damage to the respiratory system - infiltrative forms of pneumonia, pneumotyphoid • • Damage to the kidneys - symptoms of nephritis or hemolytic-uremic syndrome, nephrotyphoid.

Laboratory studies • Isolation of the pathogen or detection of its Ag •• Bacteriological method: sowing and isolation of the pathogen from blood (hemoculture), feces (coproculture), urine (urinoculture), bile (bilinoculture), bone marrow (myeloculture); positive results of pathogen isolation are an absolute diagnostic sign of BT •• Immunofluorescent analysis methods for detecting pathogen Ag in biological fluids • Detection of antibodies to pathogen Ag in the RNGA •• AB to O-Ag (thermostable lipopolysaccharide, endotoxin) is detected in the first week of the disease •• AT to H-Ag (heat-labile, flagellated) is recorded in convalescents and vaccinated people, appears on days 6–8 of the disease and persists during the period of convalescence; a simultaneous positive result of the reaction with O- and H-Ag with a predominance of O-agglutinin titers indicates an actively ongoing process •• Antibodies to Vi-Ag (heat-labile, somatic) do not have diagnostic or prognostic value, the reaction is used to identify carriers (positive reaction - 1:5 and higher) and vaccinated (Vi-Ag is included in vaccines) • CBC - leukopenia, relative lymphocytosis, aneosinophilia; an increase in the number of eosinophils in peripheral blood is a prognostically favorable sign.

Differential diagnosis is carried out with all diseases with a gradual increase in body temperature during the first 5–7 days and with high body temperature that persists for more than a week, especially if no other causes of its occurrence are identified. Wunderlich's rule: the diagnosis of BT is unlikely if on the 1st or 2nd day a body temperature of 40 °C is noted, and on the 4th day the body temperature does not reach 39 °C.

TREATMENT

• Mandatory hospitalization.

• Bed rest until the 10th day of normal body temperature.

• Diet with mechanical, thermal and chemical sparing; diet No. 2, complex of vitamins.

• Causal treatment - antibiotic therapy, does not prevent the development of relapses, complications and chronic bacterial carriage • • Chloramphenicol. Treatment regimen for adults: 0.5 g 4 times a day until the 4th day of normal body temperature, 0.5 g 3 times a day until the 8th day and 0.5 g 2 times a day until the 12th day of normal body temperature. The treatment regimen for children is the same, but the initial dose is 75–80 mg/kg/day, followed by a dosage reduction by 25% and 50%, respectively. The drug is recommended to be taken 1 hour before or 2 hours after meals, washed down with plenty of water • • Ceftriaxone 30 mg/kg/day IV or IM in 2 divided doses (1 g every 12 hours) or cefoperazone 60 mg/ kg/day IV in 2 doses for 14 days • • Ampicillin 1.5 g orally 4 times a day or amoxicillin 2 g 3 times a day until the 10th day of normal body temperature (for 4–6 weeks during carriage) • • Co-trimoxazole, ciprofloxacin, ofloxacin.

• Symptomatic therapy - relief of intoxication (infusion detoxification therapy), improvement of repair processes of the intestinal mucosa and correction of metabolic disorders (infusions of immunoglobulins and other blood products, vitamins).

• Treatment of emergency conditions •• For infectious-toxic shock - infusion of plasma replacement drugs (for example, polyglucin), GC in high doses (prednisolone up to 30 mg/kg IV or dexamethasone for 48 hours, first 3 mg/kg IV, then 1 mg/kg every 6 hours), dopamine, sodium bicarbonate • • For intestinal bleeding - strict bed rest, cold on the stomach, fasting for 8-10 hours, infusions of blood products, fibrinolysis inhibitors; if possible - abstain from surgery • • In case of perforation of the intestinal wall - emergency surgery.

Complications can develop with mild or even erased forms of BT • Intestinal bleeding develops at 2–3 weeks of illness, accompanied by a sudden decrease in body temperature (“incision” of the temperature curve), increased heart rate, disappearance of its dicrotia, decreased blood pressure, clearing of consciousness (apparent well-being) , tarry stools (sometimes mixed with scarlet blood). With massive bleeding, death is possible • Typhoid perforation of the intestine occurs at 3–4 weeks of illness, and can be single or multiple. Symptoms: abdominal pain localized in the right iliac region (the first few hours), symptoms of peritoneal irritation, sudden decrease in body temperature, tachycardia, increased leukocytosis • Infectious-toxic shock is typical for severe forms, observed during the first week of the disease.

Current and prognosis . The course of BT is relapsing. Relapses in typhoid-paratyphoid diseases mean the return of the main symptoms of the disease during periods of resolution and convalescence against the background of normal body temperature. Relapses appear in the first 1.5-3 weeks of the convalescence period, and sometimes later - after 2-3 months of normal body temperature; there can be several of them - from 1 to 9 (usually one). Each relapse is accompanied by bacteremia, and its clinical picture does not differ from that during the main wave of the disease. The fundamental difference is the short duration of manifestations (7–10 days). With timely and adequate treatment of BT and its complications, the prognosis is favorable.

Prevention • Prescription of convalescents no earlier than 21 days from the moment of normalization of body temperature and receipt of negative results of a three-time bacteriological examination of feces, urine and a single study of bile (bile is examined on the 10th day of normal body temperature) • The first collection of material is carried out on the 5th day of normal body temperature , and then at 5-day intervals • Convalescents are subject to 3-month dispensary observation to identify possible relapse and bacterial carriage • Active prevention is carried out in regions with high incidence rates (25 or more cases per 100,000 population) using combined chemical vaccines • Children up to Typhoid bacteriophage is prescribed for 7 years • Disinfection is carried out at the source of TB • Contact persons are placed under medical observation for 25 days with daily thermometry and mandatory bacteriological examination of feces and urine • General measures: strict control of the quality of drinking water and the activities of production, processing and sales enterprises food products.

Features of BT in children • Infants, due to their dietary habits and relative isolation from potential sources of infection, rarely get sick • With age, the risk of the disease increases • Predominance of symptoms of gastrointestinal tract damage - frequent vomiting, diarrhea, up to the development of intestinal toxicosis • Temperature curve or the wrong type, or Kildyushevsky type • Intoxication is manifested by central nervous system excitation (restlessness, psychomotor agitation, convulsive seizures, meningism) • Complications are rarely observed • Absence of characteristic bradycardia • Favorable course.

Reduction . BT - typhoid fever

ICD-10 • A01 . 0 Typhoid fever

Treatment

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Typhoid fever is diagnosed and treated by infectious disease doctors. All patients undergo therapy in an inpatient setting. Hospitalization is required for the following reasons:

• the disease is infectious;
• there is a risk of infecting others;
• the development of dangerous complications is possible;
• Availability of quality care is the key to a complete successful recovery.

Patients are prescribed a special diet. Etiotropic and symptomatic treatment measures are carried out. Procedures to combat typhoid fever are aimed at neutralizing the infection, increasing the body's immunity and stopping the transmission of the infectious disease. It is also necessary to pay attention to prevention.

Diet

Therapeutic nutrition has a gentle effect on the intestines and does not cause fermentation (putrefactive) processes after consumption. In order for food to be easily digestible, it must be semi-liquid (broths, soups) or rubbed through a sieve. The diet for typhoid fever is high in calories. Frequent consumption of food in small portions is recommended. Drinking plenty of fluids is recommended, preferably warm tea.

Patient care

In addition to the above measures, the patient is recommended to rest in bed for 7-10 days. The prescription must be strictly followed, otherwise straining the abdominal muscles may lead to bleeding or perforation of the intestine. Subsequently, gradual activation is carried out. It is necessary to observe hygienic conditions, both in patient care and in nutrition. Discharge is permitted no earlier than 23 days from the date of admission.

Treatment of typhoid fever in children

Children and adolescents with this disease are also subject to mandatory hospitalization in a hospital. Patients are usually isolated in separate rooms to prevent outbreaks 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. The specialist uses antibiotics and symptomatic medications in appropriate age-appropriate dosages. In case of severe intoxication, infusion therapy is carried out.

Vaccination

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

Vaccination is recommended for those traveling abroad to the countries of Latin America, Africa, and Asia. The optimal time for administering the vaccine is a week before the trip. The average duration of vaccination is 3 years. If you have a history of this procedure, you should consult your doctor about the age of the last vaccination and the relevance of the new one.

Prevention of typhoid fever

As part of prevention, the following activities are carried out:

• It is necessary to strictly follow established sanitary and hygienic rules (from maintaining personal hygiene to organizing water supply).
• You should wash your hands often with warm water and soap.
• According to indications, you should get the appropriate vaccination.
• In areas with poor sanitation, it is recommended to consume only bottled water.
• When the first signs of the disease appear, you should immediately consult a doctor.

Disease prevention also includes supplying the population with high-quality water, timely removal of garbage and sewage from populated areas, insect control, and isolation of infected people.

Salmonella enterica (salmonella enterica)

Salmonella enterica

(or
intestinal salmonella
, lat.
Salmonella enterica
) is a type of bacteria from the genus Salmonella.
Common abbreviation for S. enterica
. All Salmonella pathogenic to humans belong to this species.

Content

• Salmonella classification
• Salmonella S. typhimurium, S. enteritidis
  and other pathogens of salmonellosis
• Salmonella S. typhi
• Salmonella S. paratyphi A, B
  and
  C

Salmonella in the taxonomy of bacteria

Species salmonella enterica
in the genus Salmonella (lat.
Salmonella
), family enterobacteria (lat.
Enterobacteriaceae
), order enterobacteria (lat.
Enterobacteriales
), class gamma-proteobacteria (lat.
γ proteobacteria
), phylum proteobacteria (lat.
Proteobacteria
), kingdom Bacteria.
Many serotypes of Salmonella enterica
are causative agents of human diseases, including typhoid fever, paratyphoid fever, and salmonellosis.
Salmonella species Salmonella bongori
are not pathogenic to humans.
The species Salmonella enterica
includes 7 subspecies (each of which has many serotypes):

• (I) enterica
• (II) salamae
• (IIIa) arizonae
• (IIIb) diarizonae
• (IV) houtenae
• (VI) indica
• VII

Previously designated by the number V, the subtype S. enterica
, according to the modern classification, is separated into a separate species -
S. bongori.
Salmonella enterica enterica subspecies

includes the following serogroups:

• A (in this serogroup the best known serotype is paratyphi A
  )
• B (serotypes: typhimurium, agona, derby, heidelberg, paratyphi B
  , etc.)
• C (serotypes: cholerae suis, infantis, newport, muenchen, virchow, paratyphi C
  , etc.)
• D (serotypes: dublin, enteritidis, moscow, rostock, sendai, typhi,
  etc.)
• E (serotypes: anatum, London
  , etc.)

Salmonella S. typhimurium, S. enteritidis and other pathogens of salmonellosis

Most Salmonella enterica
are pathogenic for both humans and animals and birds, but from an epidemiological point of view, only a few of them are the most significant for humans.
90% of salmonellosis cases are due to S. typhimurium, S. enteritidis, S. panama, S. infantis, S. newport, S. agona, S. derby
and
S. london
.
More than 50% of all salmonella-related illnesses in the United States are caused by the S. typhimurium
and
S. enteritidis
, and the incidence of salmonellosis, including in developed countries, has been increasing in recent years.
This is due to the emergence of Salmonella strains S. typhimurium
and
S. enteritidis,
resistant to modern antibiotics, and the spread of these strains throughout the world.
Hospital-acquired (nosocomial) salmonellosis is one of the serious problems of modern healthcare. In 80% of cases, the causative agent of nosocomial salmonellosis is S. typhimurium.
On the incidence of salmonellosis in Russia, see the article “Salmonella”, in the USA: “Salmonellosis in the USA”.
See also "Salmonella (non-typhoid) ".
WHO Information Bulletin N°139. By Order of the Ministry of Health and Social Development of Russia No. 1664n dated December 27, 2011 “On approval of the nomenclature of medical services,” the following medical services are included in the nomenclature of medical services, section 26:

• “A26.06.073 Determination of antibodies to Salmonella enterica in the blood”
• “A26.06.074 Determination of antibodies to Salmonella paratyphy A in the blood”
• “A26.06.075 Determination of antibodies to Salmonella paratyphy B in the blood”
• “A26.06.076 Determination of antibodies to Salmonella paratyphy C in the blood”
• “A26.06.077 Determination of antibodies to Salmonella typhi in blood”
• "A26.14.001 Bacteriological examination of bile for Salmonella typhi"
• "A26.19.002 Bacteriological examination of stool for typhoid-paratyphoid microorganisms (Salmonella typhi)"
• "A26.19.003 Bacteriological examination of stool for salmonella (Salmonella spp.)"

Salmonella enteritidis
may cause spontaneous bacterial peritonitis.

Salmonella S. typhi

One of the dangerous diseases caused by salmonella is typhoid fever. The causative agent of typhoid fever is Salmonella enterica enterica
serotype
typhi
(very often called without specifying the species and subspecies:
salmonella typhi
).
Typhoid fever affects only humans. Salmonella typhi
is a short, motile bacterium, a facultative intracellular parasite that grows well in the presence of oxygen, although it can grow in its absence.
The optimal growth temperature is 37°C, but can grow in a temperature range from 4 to 40°C.
Milk is
a good breeding ground for S. typhi Salmonella typhi
remains viable outside the human body: in wastewater for a week, in feces for 1 to 2 months.

The incubation period is about 2 weeks. Typhoid fever occurs through exposure to Salmonella typhi

into the human body through the mouth.
The infectious dose is 103–107 bacteria. S. typhi
first penetrates the mucous membrane of the small intestine, where it infects lymphoid collections.
With the lymph current, S. typhi
enters the blood, where it is destroyed in large quantities.
The released endotoxin causes symptoms of the disease. S. typhi
that survives in the blood settles in the gall bladder, bone marrow, and spleen.
Abdominal rashes contain large amounts of Salmonella typhi
.
During the further development of the disease, S. typhi
returns through the bile ducts to the intestine, where it actively multiplies.

Patients with immunodeficiencies or low acidity of gastric juice have a higher risk of infection and the disease is more likely to be severe. Regardless of the treatment used, the mortality rate reaches 4%. From 1 to 4% of recovered patients remain carriers of S. typhi

in the intestines or gall bladder for several months or years.

Salmonella typhi

is highly resistant to various antibiotics. In particular, its resistance to chloramphenicol reaches 100%, and to ampicillin - 85%.

Typhoid fever incidence statistics

According to official data, the number of registered cases of typhoid fever in the Russian Federation in 2009 and 2010, including among children and adolescents under 17 years of age inclusive, is as follows:

In 2011, 41 cases of typhoid fever were registered in the Russian Federation, in 2012 - 30, in 2013 - 69, in 2014 - 12, in 2015 - 29, in 2106 - 13.

Salmonella S. paratyphi A, B and C

The causative agents of paratyphoid fevers A, B and C are Salmonella species enterica
subspecies
enterica
serotypes, respectively,
paratyphi A, B
and
C
(very often called without specifying the species and subspecies:
Salmonella paratyphi A, B
or
C
).
Salmonella paratyphi B
is sometimes also called
Salmonella schottmuelleri
, and
Salmonella paratyphi C
is
Salmonella hirschfeldii.
Salmonella
S. paratyphi A
and
S. paratyphi B
infect only humans.

Paratyphoid fevers A and B are similar in clinical manifestations and epidemiology to typhoid fever, differing in a more acute onset, less severe course and shorter duration. Paratyphoid C, as an independent disease, is rare; most often it occurs in patients weakened by other diseases and usually occurs in the form of food poisoning.

Antibiotics active against Salmonella enterica

Antibacterial agents (those described in this reference book) active against salmonella Salmonella enterica
: rifaximin, furazolidone, nifuroxazide, ciprofloxacin.
Nifuratel is active against Salmonella typhi, Salmonella typhimurium, Salmonella enteritidis
.

On the website GastroScan.ru in the “Literature” section there is a subsection “Microflora, microbiocenosis, dysbiosis (dysbacteriosis)”, containing articles addressing the problems of microbiocenosis and dysbiosis of the human gastrointestinal tract.

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Medicines

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Treatment of typhoid fever is complex, aimed at fighting infection, eliminating intoxication and dehydration, and preventing complications. Antimicrobial therapy is carried out using antibiotics and sulfonamides. Medicines are prescribed in tablets; in case of frequent vomiting, they are administered parenterally. The duration of the course is usually 7-10 days.

Sorbents are used to remove toxins from the intestines. In severe cases and severe intoxication, intravenous infusions of colloid and crystalloid solutions are indicated. In case of disturbances in the functioning of various organs and systems, appropriate symptomatic remedies are prescribed: sedatives, drugs to improve heart function, vitamin complexes, etc. To normalize the microflora after antibiotic therapy, probiotics and prebiotics are used.

Folk remedies

Typhoid fever is a serious pathology; in the absence of specialized treatment, it can lead to serious complications, including those that pose a threat to the patient’s life. Self-medication is unacceptable; at the first signs of illness you should consult a doctor. Folk remedies are not indicated during the height of the disease. During the recovery phase, a gentle diet with a high content of proteins, vitamins and minerals is recommended. Vitamin teas and decoctions are allowed.

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.