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Typhoid/ Enteric fever

Typhoid/ Enteric fever. Dr. Jyotsna Agarwal Professor, Dept. Microbiology KGMU. Salmonella. Salmonella is Gram-negative, rod-shaped Facultative anaerobe in family Enterobacteriaceae Motile, Non lactose fermenting Over 2400 serotypes. Faeco-oral transmission

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Typhoid/ Enteric fever

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  1. Typhoid/ Enteric fever Dr. Jyotsna Agarwal Professor, Dept. Microbiology KGMU

  2. Salmonella • Salmonella is Gram-negative, rod-shaped • Facultative anaerobe in family Enterobacteriaceae • Motile, Non lactose fermenting • Over 2400 serotypes

  3. Faeco-oral transmission • Refrigeration does not kill bacteria, Heat at 600C destroys

  4. Pathogenesis • Bacteria penetrates intestinal cell in ileocaecal region • Inflammatory response to bacterial multiplication in the cell • Prostaglandins secreted • Increase in C-AMP

  5. Virtually non existent in developed world • In developing countries endemic • Typhoid more common than paratyphoid

  6. Pathogenesis of Enteric fever • M cells on Peyers patches • Invade intestinal lining cells • bloodstream (primary bacteremia) • Phagocytosis • Transported (R E system), continue to replicate

  7. Pathogenesis contd… • Second week:re-enter bloodstream (secondary bacteremia) endotoxemia • Second to third week: gallbladder, secreted in bile,re-infect intestinal tract

  8. Complications: Intestinal haemorrhage, perforation, cholecystitis • Less commonly: Bronchopneumonia, arthritis, osteomyelitis

  9. Early 1900- Mary Mallon

  10. Diagnosis of Typhoid Fever • Clinical: • For Lab diagnosis, specimen & diagnostic tests according to duration of fever: • Blood for Culture • WIDAL • Stool culture • Urine culture

  11. Blood Culture • In blood culture bottle • Repeated cultures may be required • Subculture on MacConkey medium (NLF colony) • Clot culture- put clot in blood culture bottle, lyse it with streptokinase in B/C bottle • Use serum for WIDAL

  12. Selective media for subculture from blood culture bottle: MacConkey, Wilson Blair, Tellurite blood agar • Enrichment broth for culture of stool/urine: Selenite F broth, Tetrathionate broth

  13. Serological test- WIDAL • For detecting antibody • Agglutination test • Endemic titre • Paired sera • For carriers - antibody against Vi antigen • Rapid test- Typhi dot

  14. Salmonella vaccines • TAB: Salmonella typhi, paratyphi A &B, killed whole cell • Oral Ty21-A: Live attenuated, Salmonella typhi vaccine • Vicapsular polysaccharide vaccine

  15. Summary- Enteric fever • S. typhi / S. paratyphi • Mode of spread /Pathogenesis • Clinical features / Complications • Laboratory diagnosis • Treatment/vaccines

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