What is Salmonella Typhi?
In the salmonella Typhi and enteric diseases, a distinction is. Cause of Typhi salmonellosis (Typhi fever, paraTyphi A, B and C), Salmonella enterica serotype typhi or paratyphi A, B and C include salmonella to the family of Enterobacteriaceae. Morphologically it is non-spore-forming, facultative anaerobic, flagellated and thus moving peritrich gram-negative rods. They can be good study material from human cultured in special culture medium.
To differentiate the various serovars are Lysotypie systems available. In addition come molecular biological methods (eg pulsed-field gel electrophoresis) are used. The serovars have O, K and H antigens (Kauffmann-White scheme). In addition, the Vi capsular antigen (originally from virulence).
Salmonella Typhi epidemiology
S. typhi is found only in humans. In subclinically infected Dauerausscheidern and the pathogens usually found in the gall bladder or bile ducts. According to the Robert Koch Institute in Germany was the number of diseases can be greatly reduced by improving the hygienic conditions since the 1950s. According to the notification requirements under IfSG in 2004 were sent to the RKI abdominalis 82 cases of Typhi fever. The nationwide incidence was 0.1 cases per 100,000 population. About 86% of cases were imported from countries such as India, Pakistan, Turkey or Morocco. The incidence of paraTyphi fever dropped sharply in recent decades.
Salmonella Typhi pathogenesis
Salmonella Typhi pass through fecal contaminated food or drinking water in the gastrointestinal tract. Is excreted in the urine or faeces. The minimum infectious dose is less than salmonella enteritis.
Typhi and parathyroid fever A, B and C are septicaemic disease. After passing through the intestinal wall is the lymphatic and hematogenous spread with secondary settlement in the spleen, liver, bone marrow, bile ducts, skin, and Peyer's patches.
The disease runs in certain stages. When Typhi fever runs the incubation period (stage I) without any particular signs. In stage II, the first symptoms occur. The patient suffers from nonspecific symptoms such as headaches, body aches, possibly low-grade fever. In untreated cases, occurs within 2-3 days (Typhus, Greek mist) to a season-shaped rising high fever, with temperatures between 39 ° C and 41 ° C, incipient consciousness and uncharacteristic abdominal pain (splenomegaly). The high temperatures may persist for up to three weeks. It will initially be for constipation, it is often too mushy diarrhea and bright red skin lesions (rose spots), mostly on the abdominal skin.
Striking is a relative bradycardia. It can lead to complications such as intestinal bleeding and perforation with peritonitis, necrotizing cholecystitis, thrombosis, embolism, osteomyelitis, endocarditis or meningitis. In patients without treatment, the fever takes off from the fourth week, with the risk of intestinal bleeding or a perforative persists. Despite successful antibiotic treatment, it is not uncommon to recur.
The clinical course is similar to that of paraTyphi fever. The proceeds, however, less severe symptoms. S. typhi and paraTyphi A, B and C can survive inside macrophages. Up to 5% of those infected permanently divorced after recovering from disease pathogens.
Salmonella Typhi therapy
See www.ndrugs.com for medications. The drug of choice are ciprofloxacin (Cipro Others, 1 g orally for 2 weeks) or ceftriaxone (Rocephin etc., 2 g / day over 1-2 weeks). Other fluoroquinolones such as levofloxacin (Tavanic etc.) or moxifloxacin (Avelox, etc.) are effective. Are also suitable as trimethoprim-sulfamethoxazole (COTRIMHEXAL etc.) and amoxicillin (Amoxypen etc.). For children also comes azithromycin (Zithromax, etc.) in question. As more multi-resistant S. typhi strains are isolated is to recommend the preparation of an antibiogram. Adequate antibacterial therapy is especially successful in the early stages of the disease. The mortality rate is then generally below 1%.
Salmonella Typhi diagnosis
The course of the disease is in accordance with the cultural detection of the pathogen in the first week of illness from the blood. From the second Week, the pathogen in the stool and urine.
Identification is based on the pattern of biochemical metabolic properties ("Bunte Reihe"). The serovars is determined by detection of the antigen structure (Gruber-Widal reaction) of the O and H antigens in patient serum. A minimum of four times the increase in titer during the illness or a titer of more than 160 are regarded as an indication of an existing infection.