Typhoid fever

[shāng hán]

Acute infectious disease of typhoid fever

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Typhoid bacillus Caused by Typhoid disease In typhoid epidemic season and region, the patients are persistent High fever (40~41 ℃) for more than 1~2 weeks, with a special toxic face, Relatively slow pulse , skin Roseola ， Hepatosplenomegaly , Around Hemogram white blood cell The total is low, Eosinophils Disappear, Myelogram With Typhoid cell (ring cell), can clinical diagnosis It is typhoid fever.

TCM disease name: Typhoid fever
Foreign name: typhoid fever
Visiting department: Infectious Disease Department

Common causes: Caused by Salmonella typhimurium
common symptom: High fever Poisoned face, slow pulse, skin roseola, hepatosplenomegaly
infectivity: yes

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pathogeny

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Typhoid bacillus In nature Vitality It can survive for 2-3 weeks in water and 1-2 months in feces. It can not only survive but also reproduce in milk. It is resistant to low temperature and can survive for several months in a frozen environment, but has weak resistance to light, heat, drying and disinfectants. It will die after being exposed to direct sunlight for several hours. It will die 30 minutes after being heated to 60 ℃ or immediately after boiling to disinfect drinking water Residual chlorine It can kill quickly.

clinical manifestation

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incubation period About 10 days, its length is related to the amount of infected bacteria, food type Epidemic outbreak It can be as short as 48 hours, and the duration of water source outbreak can be as long as 30 days. The typical natural course of typhoid fever is about 4 weeks, which can be divided into 4 stages:

1. Initial stage

It is equivalent to the first week of the course of disease. The onset of the disease is mostly slow. Fever is the earliest symptom, often accompanied by general malaise and fatigue, Anorexia ， Pharyngalgia And cough Etc. The condition gradually worsens, and the body temperature rises in a stepwise manner, reaching 39~40 ℃ within 5~7 days Chilliness Less shiver The sweating is not significant when the fever subsides.

two Polar phase

It is equivalent to the second to third week of the course of disease. It often has typical manifestations of typhoid fever, which is helpful for diagnosis.

three Remission period

It is equivalent to the human body's Resistance Gradually increased, body temperature fluctuated and began to decline, appetite gradually improved, abdominal distention Gradually disappear, Splenomegaly Start retracting. However, there is a risk of intestinal bleeding or perforation in this period, which requires special vigilance.

four convalescence

At the end of the fourth week of the course, the temperature returned to normal, appetite improved, and generally recovered completely in about one month.

inspect

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1. Routine inspection

blood white blood cell Most of them are 3 × 10 nine /L～4×10 nine /50. Companion Neutropenia and Eosinophils Disappeared, and the latter gradually recovered with the improvement of the disease. Polar eosinophils are more than 2%, Absolute count More than 4 × 10 eight /L can basically exclude typhoid fever. High fever It may be mild proteinuria 。 Fecal occult blood test Positive.

two bacteriology inspect

(1) Blood culture It is the basis of diagnosis. It can be positive at the early stage of the disease. The positive rate can reach 90% on the 7th to 10th day, and it can drop to 30% to 40% in the third week. It is often negative in the fourth week;

(2) Bone marrow culture The rate of bone marrow culture is higher than that of blood culture, especially for those who have been treated with antibiotics and whose blood culture is negative;

(3) Fecal culture The incubation period can be positive, and the positive rate can reach 80% in the 3rd to 4th week. The positive rate drops rapidly in the 6th week after the disease, and 3% patients can excrete bacteria for more than one year;

（4） Urine culture The positive rate can reach 25% in the late stage of the disease, but fecal contamination should be avoided;

(5) Roseola The scraping or biopsy section of roseola can also obtain positive culture.

diagnosis

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Evidence of typhoid fever epidemiology Data, clinical manifestations and immunology Inspection results clinical diagnosis , but typhoid fever is detected pathogenic bacteria Based on:

1. The clinical diagnosis standard is in the epidemic season and region of typhoid fever.

2. From blood, bone marrow, urine, feces, Roseola Typhoid bacilli were isolated from any of the scrapes.

three Specificity Antibody positive, Widal reaction "O" antibody agglutination titer ≥ 1 ∶ 80, "H" antibody Agglutination titer ≥ 1 ∶ 160, the titer increased more than 4 times during the recovery period.

treatment

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General treatment And Symptomatic treatment , press Infectious diseases of digestive tract Isolation, submit for examination every 5-7 days after clinical symptoms disappear Fecal culture , negative for two consecutive times De isolation 。 fever Stage III patients must stay in bed for rest, 2-3 days after fever abatement Tianke Sit slightly in bed, and slightly exercise 2 weeks after the fever subsides. A diet of high calorie, high nutrition and easy digestion should be given, including adequate carbohydrate ， protein And various vitamins to supplement the consumption during the fever period and promote recovery. During the fever period, it is advisable to use liquid or soft residue free diet, with a small amount of meals. After the fever subsides and appetite increases, gradually Rice porridge ， a man dependent on his wife Avoid eating hard and dregs food to avoid inducing intestinal hemorrhage and Intestinal perforation , usually 2 weeks after the fever subsides Return to normal Diet. Patients should be encouraged to take more water, about 2000-3000ml per day (including diet), to facilitate toxin excretion. 5% for those who cannot eat due to serious illness glucose normal saline Intravenous drip 。

Serious Toxemia Hormones can be used with sufficient effective antibacterial treatment.

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