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Typhoid fever in children
Last reviewed: 17.10.2021
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Typhoid fever is an acute infectious disease, a typical anthroponosis with enteral mechanism of infection caused by typhoid bacilli and characterized by a predominant lesion of the lymphatic apparatus of the small intestine, high fever, marked intoxication and bacteremia, rosaceous rash, hepatosplenomegaly. Often with a wavy current and prolonged bacterial excretion.
ICD-10 code
- A01.0 Typhoid fever (infection caused by Salmonella typhi ).
- A01.1 Paratyph A.
- A01.2 Paratyph B.
- A01.3 Paratyph S.
- A01.4 Unspecified paratyphoid (infection caused by Salmonella paratyphi, BDU).
Epidemiology
The source of the infection is a patient or bacteriovirus, from which the pathogen enters the external environment with feces and urine. Particularly great is the role of excretory-giving children of preschool and school age, as they more easily infect surrounding objects and environment. After the transferred typhoid, the bacteriocarrier is formed in 2-10% of children.
Transmission of the pathogen is carried out by contact, water, food, and flies. The main importance for young children is the contact-household way of transmission of infection.
- In one way infection with typhoid remains important mainly in rural areas. Children can become infected when swimming in polluted water bodies, when drinking inferior water, especially if there are violations in the water supply and sewerage system (sewage into rivers, closed water bodies, wells, etc.). Water flares are relatively lighter than food flashes.
- Food outbreaks of typhoid fever occur mainly with the use of infected milk and dairy products - in food, salmonella typhus is able to multiply and accumulate in large quantities (especially in milk). Sometimes outbreaks of typhoid fever occur with the use of confectionery, ice cream, salads, pates, sea shellfish. Children of early age are ill with typhoid fever very rarely, which is explained by their greater isolation, more strict hygiene regimen, control of nutrition, etc.
Classification of typhoid fever
The disease is classified by type, severity and flow.
- For typical include disease with characteristic clinical symptoms (fever, typhoid status, rash, hepatosplenomegaly, etc.). Individual clinical manifestations of the disease may fall out, but the overall picture of the disease remains typical.
- To atypical typhoid fever include erased and subclinical forms, as well as forms with the predominant lesion of individual organs - pneumothyphoid, meningotif, nephrotiph, etc. These forms in children are extremely rare, their diagnosis is particularly difficult.
The severity of clinical manifestations distinguishes between light, medium and heavy forms.
With the course of the typhoid, typhoid is acute, smooth, with exacerbations, relapses, complications and the formation of chronic typhoid fever.
Causes of typhoid fever
The typhoid rod, or Salmonella typhi, belongs to the family of enterobacteria, gram-negative, spores and capsules do not form, mobile, grows well on ordinary nutrient media, especially with the addition of bile, facultative anaerobic.
The pathogenicity of typhoid bacteria determines endotoxin, as well as "aggression enzymes": hyaluronidase, fibrinolysin, lecithinase, hemolysin, hemothoxin, catalase, etc., secreted by bacteria during colonization and death.
Pathogenesis of typhoid fever
The entrance gate of the infection is the gastrointestinal tract. Through the mouth, stomach and duodenum the pathogen reaches the lower part of the small intestine, where the primary colonization takes place. Intruding into the lymphoid formations of the intestine - solitary follicles and Peyer's plaques, and then into the mesenteric and retroperitoneal lymph nodes, the typhoid sticks multiply, which corresponds to the incubation period.
Symptoms of typhoid fever
The incubation period varies from 3 to 30 days, in rare cases lasts up to 50 days (an average of 10-14 days). In the clinical course of the disease, the period of the increase in clinical symptoms (5-7 days), the period of heat (8-14 days), extinction (14-21 days) and the period of convalescence (after the 21-28th day of the disease) can be conventionally identified. The dynamics of clinical manifestations essentially depends on the age of the children.
Diagnosis of typhoid fever
Typhoid fever is diagnosed on the basis of a prolonged fever, headache, increasing intoxication with the development of typhoid status, typical language changes, the appearance of flatulence, rose-rash rash, hepatosplenomegaly and changes in peripheral blood.
Laboratory diagnosis is based on the detection of an agent in the biomaterial and specific antibodies in the patient's blood. Determining the causative agent in the blood (haemoculture), urine (urinoculture), feces (coproculture), bile (bilikultura), as well as in the bone marrow, cerebrospinal fluid, roseola, pus or exudate is crucial.
Treatment of typhoid fever
With diarrhea syndrome, the diet is built on the same principles as with other intestinal infections. In toxicosis with exsicosis, oral rehydration is performed, and in severe dehydration (grade II-III) - rehydration infusion therapy in combination with detoxification (a solution of 1.5% reamberin, isotonic, electrolyte solution with antihypoxic activity) and post-dandruff treatment.
Prevention of typhoid fever
It is in compliance with sanitary and hygienic requirements: proper water supply, construction of sewerage, strict observance of the technology of harvesting, transportation and sale of food products, especially those that are not subjected to heat treatment before consumption.
Those who have been ill with typhoid fever are subject to follow-up and laboratory examination. Bacteriological examination is conducted no later than the 10th day after discharge from the hospital 5 times, with an interval of 1-2 days. In the next 3 months, the urine and urine are examined once a month, later (for 2 years) - once a quarter, three times. With negative results of these studies (except for the decreed categories of the population), those who have recovered with typhoid are removed from the SES.