Disease Information | Health-Fitness | GoBlog

tag:blogger.com,1999:blog-68631061842973626692009-11-19T01:12:07.884-08:00Disease InformationsDisease Information's Related To Cancer, HIV Aids, Liver, Heart, Blood Pressure, Swine Flue, Kidney, Tuberculosis, Malaria, Asthma, Muscles, Joints, Bones, HepatitisMuhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.comBlogger39125tag:blogger.com,1999:blog-6863106184297362669.post-61175553389955819422009-11-18T00:08:00.000-08:002009-11-18T00:10:25.194-08:00Diarrhea Preventing and InterventionsDiarrhea Preventing

Washing hands regularly, using soap and hot water, always wash your hands:

After using the toilet
Before touching food.
After gardening
After playing with pets
Teach your child to wash their hands regularly and properly

Also prevent from spreading germs by:

Cleaning the toilet with antiseptic after using it
Not sharing towels
Vaccinate all children
Exclusive breast-feeding

Diarrhea Interventions

To reduce the number of cases of diarrhea includes:

Improved sanitation
Access to safe drinking water
Health education about how infections spread
Good personal and food hygiene

Key measures to treat diarrhea includes:

Giving more fluids than usual, including oral rehydration salts solution, to prevent dehydration
Continue feeding
Consulting a health worker if there are signs of dehydration or other problems

Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-83256496712293098002009-11-18T00:07:00.000-08:002009-11-18T00:08:39.462-08:00Diarrhea TreatmentDiarrhea Treatment

Do nothing except ensure adequate fluids
Try eating more but smaller portions. Eat regularly
Don't eat or drink too quickly
Anti-diarrhea drugs
Antibiotics
Intravenous fluids or a "drip"
Dietary manipulation, especially avoid wheat products with celiac disease
Hygiene and sometime isolation
It is claimed that some fruit, such as bananas, mangoes, papaya and pineapple may have positive effects on this condition

You can remove your symptoms by the following steps below

Drink fluids
Rehydration drinks
Eat as soon as you can
Anti-diarrhea medicines
Continue breastfeeding or bottle-feeding
Painkillers

Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-78727644713620467962009-11-18T00:04:00.000-08:002009-11-18T00:07:01.986-08:00Diarrhea Diagnosis and ComplicationsDiarrhea Diagnosis

If you have acute diarrhea, the symptoms are likely to settle down within a week and tests are usually unnecessary
If diarrhea becomes more persistent or if you have other symptoms (such as blood in your stools or dehydration) your may ask for a stool sample to investigate for bacteria
Other tests for chronic diarrhea may include blood tests or a sigmoidoscopy (a procedure that involves passing a thin fiber-optic tube, attached to a viewing lens, through the rectum to view the intestine).

Diarrhea Complications

Complications are uncommon, if you or your children have the following symptoms:

Blood in your stools
Dehydration (signs in children include passing little urine, a dry mouth and tongue, unresponsiveness, glazed eyes, drowsiness and confusion)
Diarrhea that does not clear up after five days
Vomiting that continues for more than a day
Infection that was caught while traveling abroad

Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-14374631594561678532009-11-18T00:02:00.000-08:002009-11-18T00:04:45.089-08:00Diarrhea CausesDiarrhea Causes

Diarrhea occurs when fluid cannot be absorbed from your bowel contents, or when extra fluid is concealed into the bowel, causing watery stools.
There are many causes of diarrhea, including food poisoning, infection, and malnutrition. Diarrhea may also be caused due to a chronic problem like viral stomach flu. Diarrhea occurs when the inside layer of the small or large intestine is irritated. It leads to increased water being passed in the stools

The main causes of diarrhea are listed below

Bacterial Infections, which get into our body through impure food or water.
Viral infections, including rotavirus, Norwalk virus, cytomegalovirus, herpes simplex virus, and viral hepatitis
Parasitic infections
Food Intolerance, some people are not able to digest, such as lactose, the sugar found in milk - which ultimately leads to diarrhea
Some medicines react wrong way
Functional bowel disorders
Intestinal diseases
Sometimes too much swimming also causes diarrhea

Acute (Short Term) Diarrhea
It can be caused by:

Virus, such as norovirus or rotavirus,
Food poisoning
Bacterial infection
Antibiotics
Contaminated food or water

Short-term causes of diarrhea include:

Emotional upset or nervousness
Drinking more alcohol
Drinking more coffee
Some medicines side effect

Chronic (Short Term) Diarrhea
It can be caused by:

Bacterial or viral infection
Laxatives
Poor diet

Long-term causes of diarrhea include:

Ulcerative colitis
Diabetes
Crohn's disease
Pancreatitis.
Irritable bowel syndrome
Coeliac disease,
Lactose intolerance

Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-90178192218597062552009-11-17T23:52:00.000-08:002009-11-18T00:01:59.544-08:00Diarrhea SymptomsDiarrhea Symptoms

Frequent, loose, watery stools
Fever
Headache
Loss of appetite
Abdominal pain
Nausea or Vomiting
Stomach pains
Dehydration
Pricking sensation
Loss of appetite

Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-74840394276671204612009-11-17T23:38:00.000-08:002009-11-17T23:52:42.971-08:00Diarrhea TypesDiarrhea Types

Acute Watery Diarrhea (which lasts several hours or days):

The main danger is dehydration; weight loss also occurs if feeding is not continued

Acute Bloody Diarrhea (also called dysentery):

The main dangers are intestinal damage, sepsis and malnutrition; other complications, including dehydration, may also occur

Persistent Diarrhea (which lasts 14 days or longer):

The main danger is malnutrition and serious non-intestinal infection; dehydration may also occur

Diarrhea With Severe Malnutrition

The main dangers are: severe systemic infection, dehydration, heart failure and vitamin and mineral deficiency.

Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-33074105524153505472009-11-17T23:36:00.000-08:002009-11-17T23:38:18.745-08:00DiarrheaDiarrhea

Diarrhea is also called loose motions or it is the passing of watery stools more than three times a day. It is not itself a disease, but can be a symptom of several diseases. Diarrhea means there are frequent, loose or liquid stools. There may abdominal pain, which may reduce after a stool is passed.
Diarrhea can either be:

Acute Diarrhea that comes on suddenly for a short time, and lasts for five to 10 days
Chronic Diarrhea that lasts for more than two weeks or for a long period of time.

If you have diarrhea for long periods of time, it may very troubling and you may feel very weak and tired.
Diarrhea causes dehydration. Children are more likely than adults to die from diarrhea because they become dehydrated more quickly. It is also a major cause of child malnutrition.
You may recover complete from diarrhea within three to seven days. One out of every ten people with cancer may suffer from diarrhea at some time during their illness. If the diarrhea lasts more than three weeks, it is considered chronic.

Why is Diarrhea Dangerous?

Diarrhea causes rapid reduction of water and sodium - both of which are necessary for life. If the water and salts are not replaced fast, the body starts to "dry up" or get dehydrated. If more than 10% of the body's fluid is lost death occurs.Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-43828464297802515622009-11-11T00:23:00.000-08:002009-11-11T00:28:11.519-08:00Ulcerative Colitis TreatmentUlcerative Colitis Treatment

Treatment for ulcerative colitis should:

control inflammation
correct nutritional deficiencies
reduce abdominal pain, diarrhea, and rectal bleeding

Treatment may include nutrition supplements, drugs, hospitalization, surgery, or a combination of these.

Nutritional treatment.
If symptoms are produced by certain foods, they may be controlled by avoiding foods that upset the intestines, such as seasoned foods or milk sugar called lactose.

Medications.
Different types of medications may be used to treat ulcerative colitis. These include aminosalicylates, corticosteroids and immunomodulators.

Aminosalicylates help to control inflammation. People with mild or moderate ulcerative colitis are usually treated with this type of drug first. Aminosalicylates also help if a person has a relapse.

Corticosteroids also reduce inflammation. They are often prescribed for people with moderate to severe ulcerative colitis or those who don’t find relief with aminosalicylates. Corticosteroids can cause side effects including weight gain, hypertension, diabetes, acne, facial hair, mood swings, bone mass loss and an increased risk of infection. Because of the side effects, it’s not recommended to use them long-term, but they are usually very effective for short-term use.

Immunomodulators reduce inflammation by affecting the immune system. These drugs are usually prescribed to patients who aren’t finding benefits with aminosalicylates or corticosteroids or who are dependent on corticosteroids. It can take up to 6 months before the full benefits of immunomodulators are noticed. Healthcare providers moitor patients taking immunomodulators
in case they would have complications such as pancreatitis, hepatitis, a reduced white blood cell count or an infection. Other drugs may be given to relax the patient or to relieve pain, diarrhea, or infection.

Hospitalization.
Sometimes symptoms are so severe that the person must be hospitalized. Such symptoms include severe bleeding or diarrhea causing dehydration. At the hospital, the doctor will try to stop diarrhea and blood loss, and replace lost fluids.

Surgery.
About 25-40% of ulcerative colitis patients must eventually have their colon removed due to massive bleeding, severe illness, rupture of the colon, or risk of cancer. Sometimes the doctor will recommend removing the colon if medical treatment fails, or if side effects of corticosteroids or other drugs threaten the patient's health. Some surgeries to remove the colon reroute the small intestine to the outside of the body; this is called an ileostomy. In these operations, patients lose bowel control.

Other operations take the colon out and attach the small intestine to the rectum, allowing normal bowel movementsMuhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-62134146231014018052009-11-11T00:22:00.000-08:002009-11-11T00:23:33.464-08:00Ulcerative Colitis DiagnosisUlcerative Colitis Diagnosis

A thorough physical exam and a series of tests may be needed to diagnose ulcerative colitis.

Blood tests can check for low blood count, or anemia, which could indicate bleeding in the intestines. Blood tests may also uncover a high white blood cell count, which is a sign of inflammation. By testing a stool sample, the doctor can tell if there is bleeding or infection in the intestines.

The doctor may need to do a colonoscopy, which involves inserting an endoscope into the anus to see the inside of the large intestine. An endoscope is a long, flexible,lighted tube hooked to a computer and TV monitor. He or she will see any inflammation or bleeding.
During a colonoscopy, the doctor may do a biopsy, which involves taking a sample of tissue from the intestinal lining to look at under a microscope. A barium enema x-ray of the colon may also be needed. The colon is filled with barium, a chalky white solution. The barium shows up white on x-ray film, allowing the doctor a clear view of the colon.Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-67786414168134447672009-11-11T00:21:00.000-08:002009-11-11T00:22:17.917-08:00Ulcerative Colitis SymptomsUlcerative Colitis Symptoms

The most common symptoms of ulcerative colitis are abdominal pain and bloody diarrhea.
Patients with ulcerative colitis may also experience

fatigue
weight loss
loss of appetite
rectal bleeding
loss of body fluids and nutrients

Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-30149124565634260022009-11-11T00:18:00.000-08:002009-11-11T00:21:12.771-08:00Ulcerative Colitis CausesUlcerative Colitis Causes

The cause of ulcerative colitis is still unknown. Doctors think that the immune system reacts to a virus or a bacterium by causing the intestinal wall to become inflamed.The immune system is made of blood cells and chemicals that find bacteria and viruses in the body and destroy them. When the immune system fights against the intestines, it can lead to inflammation, swelling, destruction, and scarring.
Ulcerative colitis usually occurs between the ages of 15-40, although children and older people can also develop it. Ulcerative colitis affects men and women equally and appears to run in some families.Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-41169267366535012792009-11-11T00:17:00.000-08:002009-11-11T00:18:41.192-08:00Ulcerative ColitisUlcerative Colitis

Inflammation is the body's natural way of clearing up damaged tissue. Ulcerative colitis is when the inner layers of the large intestine lining become inflamed.Ulcerative colitis causes swelling and scarring in the tissues of the colon. It may also be called colitis or proctitis.
Ulcers form in places where the inflammation has killed cells in the lining of the colon. The ulcers bleed and produce pus and mucus.
Inflammation due to ulcerative colitis usually occurs in the lower colon and the rectum, but it may affect the whole colon. Ulcerative colitis does not usually affect the small intestine.The main difference between ulcerative colitis and Crohn's disease is the location of the inflammation. Ulcerative colitis usually only affects the colon, whereas Crohn’s disease may affect the whole gastrointestinal tract.
Some people with ulcerative colitis go for long periods, even years, with no symptoms.However, the disease usually comes and goes throughout life.The inflammation causes the colon to be empty most of the time, triggering diarrhea and blood in the stool.Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-62937286163412833352009-11-11T00:06:00.000-08:002009-11-11T00:17:05.693-08:00AnatomyAnatomy

Swallowed food goes through the esophagus,which is the feeding tube.Next, food enters the stomach, where it is digested.
Digested food travels from the stomach to the small intestines, where most nutrients are further digested and absorbed into the body.
Fibers and digested food finally reach the colon. In the colon, the rest of the nutrients get absorbed and stools are formed. Stools are stored in the last part of the colon, the sigmoid and rectum, before being excreted.

The colon has several sections:

The walls of the intestines have 3 layers. The inside layer is called mucosa; it is responsible for digesting and absorbing food. The middle layer of the intestines is muscle that helps push food through. The outer layer of the intestines is called serosa. The serosa is very smooth, so the intestines do not get stuck together in the abdominal cavity.

Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-36206356833004757442009-11-08T05:42:00.001-08:002009-11-08T05:42:41.707-08:00Typhoid Fever CareMedical Care

Typhoid fever is treated with antibiotics which kill the Salmonella bacteria. Prior to the use of antibiotics, the fatality rate was 20%.
If a patient presents with unexplained symptoms described above within 60 days of returning from a typhoid fever (enteric fever) endemic area or following consumption of food prepared by an individual who is known to carry typhoid, broad-spectrum empiric antibiotics should be started immediately. Treatment should not be delayed for confirmatory tests since prompt treatment drastically reduces the risk of complications and fatalities. Antibiotic therapy should be narrowed once more information is available. With appropriate antibiotic therapy, there is usually improvement within one to two days and recovery within seven to 10 days.
Compliant patients with uncomplicated disease may be treated on an outpatient basis. They must be advised to use strict hand washing techniques and to avoid preparing food for others during the illness course. Hospitalized patients should be placed in contact isolation during the acute phase of the infection. Faeces and urine must be disposed of safely.

Surgical Care

Surgery is usually indicated in cases of intestinal perforation. Most surgeons prefer simple closure of the perforation with drainage of the peritoneum. Small-bowel resection is indicated for patients with multiple perforations.
If antibiotic treatment fails to eradicate the hepatobiliary carriage, the gallbladder should be resected. Cholecystectomy is not always successful in eradicating the carrier state because of persisting hepatic infection.
Diet Fluids and electrolytes should be monitored and replaced diligently. Oral nutrition with a soft digestible diet is preferable in the absence of abdominal distension or ileus… The carrier state, which occurs in 3%-5% of those infected, can be treated with prolonged antibiotics. Often, removal of the gallbladder, the site of chronic infection, will cure the carrier state.
For those traveling to high-risk areas, vaccines are now availableMuhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-71310731018000624302009-11-08T05:39:00.002-08:002009-11-08T05:41:53.642-08:00Typhoid Fever TreatmentTyphoid Fever Treatment

If you are being treated for typhoid fever, it is important to do the following:
Keep taking the prescribed antibiotics for as long as the doctor has asked you to take them.
Wash your hands carefully with soap and water after using the bathroom, and do not prepare or serve food for other people. This will lower the chance that you will pass the infection on to someone else

General measures: bed rest, anti-pyretics, cold compress.
Drug therapy:
Chloramphenicole: was the first standard anti-biotic for T.F. (1948-1970), when resistant strains increased, dose: 500 mg/6 hr/ 10 d. orally.
1970: anti-biotic of choice for T.F:
Amoxicillin (750 mg/6 hr /10 d). Or
Ampicillin (1 gm /6 hr/10 d). Or
TMP-SMX (160mg TMP-800mg SMX)tab/12 hr/10d).
1989: appearance of MDR S. Typhi (multi drug resistant): anti-biotic of choice became:
Quinolones: ciprofloxacine, orally, (500mg/BD/14d), IV inf. 200mg/ BD.
Ofloxacine (10mg/kg/BD/2-3d).
3rd generation cephalosporines: ceftriaxone (1-2 gm IV, IM inj /OD/ 10-14 days).
Azithromycine: 1gm orally at day 1, then 500 mg OD, for 5 days.
Temperature may remain elevated for several days (up to 5 days) after starting anti-biotic, and this alone does not mean failure of treatment.
Even with effective anti-biotic, there is still risk of relapse or development of a chronic carrier state.
In severe complicated T.F. there is evidence about the benefit of using dexamethasone ( IV inj. 3mg/kg start then 1mg/kg for 8 doses every 6 hr) mortality decreased with this regimen from 56% to 10%.
Prolonged anti-biotic course (e.g. ciprofluxacine 500mg/ BD/ 6-8weeks) might eliminate the carrier state
But in patients with anatomical abnormalities (e.g. gall stones) the medical eradication usually not successful, and a surgical solution (e.g. cholecystectomy) should be taken into consideration

Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-31560437428892836342009-11-08T05:39:00.001-08:002009-11-08T05:39:35.369-08:00Typhoid Fever at a GlanceTyphoid Fever at a Glance

Typhoid fever is caused by Salmonellae typhi bacteria. Typhoid fever is contracted by the ingestion of contaminated food or water. Diagnosis of typhoid fever is made when the Salmonella bacteria is detected with a stool culture. Typhoid fever is treated with antibiotics. Typhoid fever symptoms are poor appetite, headaches, generalized aches and pains, fever, and lethargy. Approximately 3%-5% of patients become carriers of the bacteria after the acute illness.Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-80410244013393445852009-11-08T05:36:00.000-08:002009-11-08T05:39:11.056-08:00Typhoid Fever InvestigationsTyphoid Fever Investigations

Typhican be isolated from the blood early in the disease. Isolation from urine and stool is possible after the first week of illness. Bone marrow culture is the best confirmation method. Additionally, pulsed-field gel electrophoresis (PFGE) can be useful for characterizing S. Typhiisolates and establishing links between individual cases. A serological testing method, called the Vi antibody test, is available for identification of typhoid fever carriers. The presence of elevated antibody titers to a S. Typhiantigen (purified Vi polysaccharide) is highly suggestive of a chronic carrier state

Blood culture: is the gold standard for diagnosis in the 1st week (90% positive). It drops to 50% during 3rd week of infection.
Stool culture: usually negative during 1st week of infection, becomes highly positive during 2nd & 3rd week. The disadvantage is that, it does not distinguish between acutely infected patient and a chronic carrier.
Urine culture: less frequent, less sensitive.
Culture of G.I. secretion: using duodenal string test.
Culture of rose spots: positive in two thirds of patients remains positive even after receiving antibiotics.
Bone marrow culture: highly sensitive, remain positive even after 5 days of antibiotic use. Rarely required due to its invasive nature, except in patient highly suspicious of T.F. who has received antibiotic and his blood culture is negative.
WIDAL test: is a serological test that detects Ab against S.typhi somatic Ag (anti-O), or flagellar Ag (H).
It is unreliable, nonspecific, and insensitive, with high false positive results due to cross-reaction with many other types of salmonella.
Widal test is considered positive, if anti-O titer >1:320 (other references >1:80) or anti-H titer >1: 640. or if there is four fold rise of titer between acute infection and convalescent period.

Additional lab findings:
Hb : variable anemia. Platelets: often diminished.
WBC: typically leucopenia with nuetropenia (15-25%), but can be normal, or leucocytsis with lymphocytosis in little children or secondary infection or complication occur (such as intestinal perforation).
LFT: abnormal results with elevated AST, ALT and Alk.Ph.
ECG: prolonged PR interval, nonspecific ST, T wave changes.

New diagnostic methods:
Polymerase chain reaction PCR, and DNA probe test, that detect S. typhi DNA, they are highly sensitive and specific, but not widely used.Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-87815932625930911392009-11-08T05:34:00.000-08:002009-11-08T05:36:14.760-08:00Typhoid Fever Clinical PictureTyphoid Fever Clinical Picture

Majority of patients recover without complications by receiving adequate antibiotics without delay.
1-5% of cases become asymptomatic chronic carriers, shedding S.typhi in stool and less frequently in urine.
In those carriers, S.typhi resides in gallbladder especially if associated with gallstones or Ca.gallbladder, because anatomical abnormalities allow for prolonged colonization of the organism.
In areas where schistosoma hematobium is prevalent, chronic carriage of S.typhi in urinary bladder is common.

1st Week of Typhoid Fever

Fever (>70%) is slow rising, increasing progressively in step ladder fashion over 4-5 days (38,8-40,5 c), with relative bradycardia.
Non-specific constitutional symptoms: headache, fatigue, malaria, cough, sore throat.
G.I. symptoms: abdominal pain (20-40%), constipation, diarrhea.
Early signs: relative bradycardia, abd. Tenderness (diffuse or localized, usually right lower quadrant).

2nd Week of Typhoid Fever

Abd.distension & tenderness.
Hepato-splenomegaly.
Rose-spots: maculopapular rash, 2-3 mm, in the trunk (chest & upper abdomen), fade on pressure, remains 4-5 days, disappear without scars, occur in 30% of cases, difficult to notice in dark-skinned patients.

3rd and 4th Week of Typhoid Fever

Patient is profoundly ill, complications appear.
Disturbance in consciousness, neuro-psychiatric symptoms (picking bed clothes or imaginary objects), called muttering delirium, coma vigil, typhoid psychosis.
Intestinal perforation or bleeding: shock state, fever disappears, fresh or dark bloody stool.
Cholecystitis, hepatitis, pneumonia, carditis, meningitis, nephritis, arthritis, osteomylitis…etc.
Death.

Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-89934162331079386692009-11-08T05:33:00.000-08:002009-11-08T05:34:08.056-08:00Pathogenesis of Typhoid FeverPathogenesis of Typhoid Fever

> 100,000 organisms are required to survive the gastric acid defensive barrier. (Less number is required in persons with hypochlorhydria, using antacid or PPI)
After ingestion of contaminated food or water, S. Typhi penetrate the epithelium of small intestines, invading and replicating inside the peyrs patches, spreading after that to mesenteric L.N. and reaching systemic circulation via thoracic duct, they grow intracellularly inside the phagocytes of the reticuloendothelial system in liver, spleen and bone marrow. Spreading too many other organs
For better understanding of the molecular pathogenesis of typhoid fever, genomic and proteomic studies will reveal the possibility of new targets for diagnosis and treatment.
But the importance of safe water, sanitation, and immunisation of people at risk remains paramount
Salmonellae are important gram-negative bacilli that cause a spectrum of characteristic clinical syndromes including gastroenteritis, enteric fever, bacteremia, endovascular infections, and focal infections such as osteomyelitis or abscesses.
Enteritis fever, also called typhoid fever or paratyphoid fever, is a systemic febrile illness that is most commonly caused by Salmonella typhi; less frequent causes are S. paratyphi A, S. typhi B (also known as S. schottmuelleri), and S. paratyphi C (also known as Salmonella hirschfeldii). Even "nontyphoidal" Salmonellae may cause severe illness consistent with enteric fever.
Patients with typhoid fever classically present with sustained fever, abdominal tenderness, and hepatosplenomegaly. However, the clinical manifestations of enteric fever are varied and may include diarrhea or constipation, rash (rose spots), and neuropsychiatric symptoms. Late complications are more common in untreated individuals and include intestinal hemorrhage and perforation, or focal infection such as visceral abscesses
In the preantibiotic era, approximately 15 percent of afflicted individuals died, with survivors experiencing a prolonged illness lasting weeks and debilitation often lasting months. Approximately 10 percent of untreated individuals relapse and 1 to 4 percent become chronic carriers of the organism, testaments to the tenacity of these intracellular pathogens. Antibiotic therapy is effective, but increasing resistance of both S. typhi and S. paratyphi to standard antimicrobial agents has become a worldwide problem
The pathogenesis of typhoid fever will be reviewed here. The pathogenesis of gastroenteritis caused by nontyphoidal Salmonellae is discussed separatelyMuhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-55883499845133583472009-11-08T05:32:00.000-08:002009-11-08T05:33:10.739-08:00How to Avoid Typhoid FeverHow to Avoid Typhoid Fever
Two basic actions can protect you from typhoid fever:

Avoid risky foods and drinks.
Get vaccinated against typhoid fever.

It may surprise you, but watching what you eat and drink when you travel is as important as being vaccinated. This is because the vaccines are not completely effective. Avoiding risky foods will also help protect you from other illnesses, including travelers' diarrhea, cholera, dysentery, and hepatitis A.
If you drink water, buy it bottled or bring it to a rolling boil for 1 minute before you drink it. Bottled carbonated water is safer than un-carbonated water.
Ask for drinks without ice unless the ice is made from bottled or boiled water. Avoid popsicles and flavored ices that may have been made with contaminated water.
Eat foods that have been thoroughly cooked and that are still hot and steaming.
Avoid raw vegetables and fruits that cannot be peeled. Vegetables like lettuce are easily contaminated and are very hard to wash well.
When you eat raw fruit or vegetables that can be peeled, peel them yourself. (Wash your hands with soap first.) Do not eat the peelings.
Avoid foods and beverages from street vendors. It is difficult for food to be kept clean on the street, and many travelers get sick from food bought from street vendors.Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-33307054619397325622009-11-08T05:16:00.000-08:002009-11-08T05:31:38.900-08:00Typhoid Fever VaccinationTyphoid Fever Vaccination

Two parenteral (inactivated, killed), one oral (live attenuated). No life-long protection.
Traveling to endemic area.
Household contact with infected patient or carrier.
Lab worker with contact to S. typhi specimen.
Epidemic outbreak.

Vaccine	Age	Route	Dosage	Re-vaccination
Killed whole-cell vaccine	5 Years	Subcutaneous	0.5 ml (0.25 ml for Children less than 10y) ‏x 2 times, 4 weeks apart	3 Years
Vi CPS	2 Years	Subcutaneous	0.5 ml	3 Years
Ty21 a, live	6 Years	Oral	1 capsule every other day, total of 3 capsule	5 Years

1st parenteral has many side-effects. Given in 2 injections 4weeks apart, with booster dose every 3-5 years.
2nd parenteral (viCPS): less S.E. 1 inj. Booster dose every 2 years.
Oral (ty21a): the safest, 1 dose, alternate day for atotal of 4doses, then booster dose every 5 years(C/I in children <6y,>

Typhoid Fever Antibiotics
For uncomplicated cases, use Conventional Therapy:

Chloramphenicol 3-4 gm per day PO in 4 divided doses x 14 days (50-100 mg/kg BW) except it with low WBC
Co-trimoxazole forte or double-strength tab BID PO x 14 days
Amoxicillin 4-6 gm per day PO in 3 divided doses x 14 days

Getting Vaccinated

If you are traveling to a country where typhoid is common, you should consider being vaccinated against typhoid. Visit a doctor or travel clinic to discuss your vaccination options.
Remember that you will need to complete your vaccination at least 1 week before you travel so that the vaccine has time to take effect. Typhoid vaccines lose effectiveness after several years; if you were vaccinated in the past, check with your doctor to see if it is time for a booster vaccination.
Taking antibiotics will not prevent typhoid fever; they only help treat it.
Typhoid fever's danger doesn't end when symptoms disappear. Even if your symptoms seem to go away, you may still be carrying S. Typhi. If so, the illness could return, or you could pass the disease to other people. In fact, if you work at a job where you handle food or care for small children, you may be barred legally from going back to work until a doctor has determined that you no longer carry any typhoid bacteria.Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-39610037928287128122009-11-08T05:13:00.001-08:002009-11-08T05:16:20.041-08:00Typhoid Fever PreventionTyphoid Fever Prevention

Choose foods processed for safety
Prepare food carefully
Foods prepared by others (avoid if possible)‏
Keep food contact surfaces clean
Eat cooked food as soon as possible
Maintain clean hands
Steam or boil shellfish at least 10 minutes
All milk and dairy products should be pasteurized
Control fly populations
Improved sanitation and health education.
Checking food-handlers by periodic stool culture.

Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-88443205994013990582009-11-08T04:28:00.000-08:002009-11-08T05:15:05.881-08:00Typhoid Fever DiagnosisDiagnosis of Typhoid Fever:

CBC (normal WBC despite fever), platelet count
Tourniquet Test
Typhi dot test (if illness is 4 days or longer)
Malarial smear (Differential diagnosis)‏
Chest X-ray
Urinalysis
First Week of illness: Blood C/S
Second Week of illness: Urine G/S, C/S
Third Week of illness: Stool C/S

Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-65449158675289978062009-11-08T04:27:00.001-08:002009-11-08T04:27:52.480-08:00Typhoid Fever SymptomsTyphoid Fever Symptoms

The incubation period is usually one to two weeks, and the duration of the illness is about four to six weeks. The patient experiences poor hunger, headaches, generalized aches and pains, fever, tiredness, and diarrhea. Patients with typhoid fever usually have a sustained fever as high as 103 to 104 degrees Fahrenheit (39 to 40 degrees Celsius).
• Diarrhea may occur
• Active infection
• Severe Headache
• Abdominal Pain
• Anorexia
• Fever [usually higher in the evening]
- Intermittent Fever initially
- Sustained Fever to high temperatures later
Chest congestion develops in many patients, and abdominal pain and discomfort are common. The fever becomes constant. Improvement occurs in the third and fourth week in those without complications.
About 10% of patients have recurrent symptoms (decline) after feeling better for one to two weeks.Muhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0tag:blogger.com,1999:blog-6863106184297362669.post-59700732198670692572009-11-08T04:22:00.000-08:002009-11-08T04:24:17.961-08:00How Bacteria Cause Typhoid FeverHow Bacteria Cause Typhoid Fever

After the eating or drinking of infected food or water, the Salmonella bacteria invade the small intestine and enter the bloodstream temporarily. The bacteria are carried by white blood cells in the liver, irritation, and bone marrow. The bacteria then multiply in the cells of these organs and reenter the bloodstream. Patients develop symptoms, including fever, when the organism reenters the bloodstream. Bacteria attack the gallbladder, bleary system, and the lymphatic tissue of the bowel. Here, they multiply in high numbers. The bacteria pass into the intestinal tract and can be identified for diagnosis in cultures from the stool tested in the laboratoryMuhammad Rameezhttp://www.blogger.com/profile/16368153550065955672noreply@blogger.com0