This article treats Typhoid fever . Not to confuse with the Typhus!
The typhoid fever (of the Greek tuphos, torpor) or abdominal typhus is a Infectious illness described in 1818 by Pierre Bretonneau, caused by a Bactérie of the kind Entérobactérie, class of the Salmonelle S and for which the species responsible are: Salmonella enterica - typhi or paratyphi has, B, C -. Salmonella enterica typhi is still called Bacille of Eberth.
Epidemiology
According to WHO, the number of patients reached all over the world would be included/understood between 16 and 33 million people, with nearly 500.000 annual deaths. The contamination is done by the ingestion of drinks or food soiled by the saddles of an infected, sick Man or healthy carrier. The disease is almost absent in the developed countries, but remains frequent in the others. Its prevalence is important in Southeast Asia and power station and South Africa. The generally responsible germ remains Salmonella typhi , nearly 10 times more found than the Salmonella paratyphi .
Clinical aspects
48 hours after the contamination occurs a transitory episode of Diarrhée. This episode lasts ten days (8 to 15), and corresponds to the Incubation, during which there is multiplication of the Salmonelle S in the mesenteric ganglia, which precedes the phase by dissemination of the germ in blood (Septicémie).
At the beginning of the septicemic phase, one observes minor disorders:
- headaches (without stiffness of the nape of the neck);
- Insomnia, fatigability (Asthenia);
- a Fever reaching a plate with 40 °C, without acceleration of the pulse;
- a large spleen (Splénomégalie);
- possible nosebleed (épistaxis), language blanchâtre (known as saburrale);
- abdominal pains, diarrhea or constipation, abdomen increased of volume and tightened Météorisme.
The patient is prostrate (prostration being able to go until the torpor, is delirious it) and has intense digestive signs (diarrheas). It is the destruction of the salmonellas which, releasing a toxic substance (the Endotoxine), causes ulcerations responsible for hemorrhages and digestive perforations. This phase is responsible for the complications which can involve the death in 30% of the cases in the absence of treatment.
The diagnosis
- the germ is not found in blood (Hémoculture) only in 60% of the cases. It can be found in an inconstant way in the saddles and the urines.
- the standard blood assessment shows only nonspecific anomalies: increase in the white globules (Hyperleucocytosis), sometimes reduction in the number of blood plates announcing serious forms.
- the search for Antibodies directed against the Antigen S O and H of the salmonellas ( test of Widal ) does not make it possible to distinguish a current infection from an old and cured attack. There exists since of other more specific tests but of difficult realization in a Third World country.
Treatment and prevention
The germ was initially sensitive to the Chloramphénicol but of many resistances appeared in the Seventies which makes that this treatment, with the many side effects, was gradually abandoned. In the same way, of resistances to other antibiotics (Co-trimoxazole and Amoxicilline) appeared in the Eighties.
After having hospitalized and isolatehaving isolated the patient, the treatment currently calls with the Fluoroquinolone S of second generation or upon the Ceftriaxone. The rehydration, often by intravenous way, is imperative to compensate for the liquid losses secondary with the diarrhea. A treatment against the fever (Antipyrétique) can sometimes be necessary.
Preventive medication
The prevention passes by the improvement of the conditions of hygiene in the countries of endémie and by the Vaccin ation. The visitors will have to be wary of local water and raw food.
Obligatory declaration
In France and Belgium, this disease is on the list of the Infectious illness to obligatory declaration.
Sources and references
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