Typhoid fever in adults

In total, several types of typhus are known: typhus, relapsing and abdominal. They are united by the presence of periods of fever, against which disturbances of consciousness and severe intoxication develop.

What is typhoid fever

The term typhoid fever refers to an acute intestinal disorder that has a cyclic course. The intestinal lymph nodes are predominantly affected, severe intoxication and skin rashes occur.

Causes of typhoid fever in adults

The main cause of typhoid fever is infection with a pathogenic bacterium, a special type of salmonella. The source of infection can be people with typhoid fever, or asymptomatic carriers of the infection.

In some people, salmonella can be shed for years after illness, and they are especially dangerous to others.

The causative agent of typhoid fever

The disease is caused by Salmonella typhi, a bacterium with flagella. It can survive in the environment for several months, actively multiplies in food products – milk, minced meat, cottage cheese, sausages.

Bacteria are able to withstand freezing, but they are quickly killed by disinfectants and boiling.

Ways of transmission of typhoid fever in adults

Bacteria are excreted in large numbers in the stool and urine. You can become infected through poor-quality water and food. In addition, flies are carriers of typhus. Especially often the infection is detected in summer and autumn.

Periods of typhoid fever in adults

The disease proceeds with a change of certain periods:

• the incubation period – from the moment the bacteria enters the body to the first symptoms;
• initial stage with nonspecific symptoms;
• peak or peak of the disease;
• stage of fading of symptoms.

Each stage has its own manifestations of symptoms, on the basis of which doctors adjust the treatment.

The defeat of the large intestine in typhoid fever has distinct stages:

• the first week – swelling of the lymphoid formations of the intestine (Peyer’s patches and solitary follicles);
• the second week – necrosis of lymphoid formations;
• third week – rejection of necrotic masses;
• fourth week – the formation of clean ulcers;
• the fifth-sixth weeks – the healing of ulcers.

Symptoms of typhoid fever in adults

The incubation period for typhoid fever ranges from 3 to 21 days.

The disease can begin gradually or acutely, with sharp and vivid symptoms.

With the gradual development of infection, the temperature slowly rises, reaching a peak by 4-6 days of illness. At the same time, intoxication increases – a headache, weakness, muscle pain, appetite and sleep disorders appear.

The fever period can last up to 3 weeks with daily temperature fluctuations of several degrees. The dynamics of the increase and decrease in temperature determine the features of the course of the disease.

One of the first symptoms that occurs in the first days is pallor and dryness of the skin.

On examination, you can see a thickening of the tongue with imprints of teeth along the edges. In the center of the tongue may be covered with a white thick coating. When probing the abdomen, swelling of the intestinal loops is felt, it rumbles in the region of the right side. You may also have difficulty emptying your bowels. By about 5-7 days, the liver and spleen may increase.

At the beginning of the disease, coughing, dry (sometimes wet) rales in the lungs are possible. At the peak of the disease, there may be a slow heartbeat (bradycardia) with severe fever, that is, the pulse does not correspond to body temperature. A two-wave pulse (the so-called dicrotia), muffled heart sounds, and a decrease in pressure are possible.

At the height of the disease, fever, intoxication are expressed, the nervous system suffers: delirium, lethargy occur, and there may be hallucinations.

On the 8th – 9th day of illness, a rash appears on the skin of the abdomen, shoulders, chest in the form of small pink spots up to 3 mm in diameter. When pressed with a finger, they become paler. Rashes can persist for 5 days and periodically appear during the entire period of fever. If rashes occur against the background of a severe course of the disease, they may take the form of hemorrhages. The chair reminds “pea soup”, becomes more frequent up to 2 – 3 times a day.

At 3 weeks of illness during the formation of ulcers, intestinal bleeding may develop, at 3-4 weeks – intestinal perforation.

As the temperature goes down, patients report that they are getting better. But sometimes, shortly after the symptoms disappear, the temperature may rise again, signs of intoxication, skin rashes appear. This is an exacerbation of typhoid fever.

With relapses, the course of the disease is usually easier, the temperature fluctuates within 38 ° C. Sometimes they can only reduce eosinophils in the tests and slightly increase the spleen. Usually, disturbances in the daily routine, nutrition, refusal to take antibiotics, and stress contribute to the development of relapses. Against the background of adequate antibiotic therapy, relapses and exacerbations of typhoid fever are extremely rare.

Separately, it is necessary to single out the abortive form of typhus, which is characterized by a typical onset of the disease, then a rise in temperature for a short time, and then the manifestation of symptoms decreases. The main signs in this form of the disease are not very pronounced, the intoxication is insignificant, typhoid is short-lived.

Treatment of typhoid fever in adults

In the treatment of typhoid fever, it is important to follow all the doctor’s recommendations. Patients are hospitalized in an infectious diseases hospital for the duration of the entire acute course of the disease, then they are observed at home for up to 3 months. At the same time, the temperature is measured once a week and once a month, feces and urine are examined for the presence of bacteria. After 1 months of observation, bile culture and serological studies are performed. Dispensary observation lasts up to 3 years, while once every 2 months, feces and urine are examined for the presence of bacteria.

The patient is removed from the dispensary when bile cultures and serological reactions give negative results.

Diagnostics

The diagnosis can be made on the basis of clinical manifestations or if contact with patients with typhus is known. Bacteriological examination and serological blood tests will help confirm the diagnosis.

Already in the early stages, it is possible to isolate pathogens in the blood during sowing (hemoculture), in the study of urine and feces. The results of bacteriological studies with the determination of sensitivity to antibiotics can be obtained approximately 4-5 days.

Starting from the 6th day of the disease, antibodies to the causative agent of typhoid fever are tested using the methods of the Vidal reaction, the reaction of indirect hemagglutination (RNHA), as well as paired sera with a second study at 2-3 weeks of illness. Diagnostically significant figures are a titer of 1:200 or more.

In recent years, enzyme-linked immunosorbent assay (ELISA) and PCR (polymerase chain reaction) have also been used for diagnosis. They also do general blood and urine tests, conduct biochemical studies, look at the level of electrolytes, protein, lipids.

Modern treatments

Any patient with typhoid fever requires hospitalization. This is important because patients require full care and complex therapy under the supervision of an infectious disease specialist.

For the entire period of fever, strict bed rest is necessary, which must then be observed for another 6 to 7 days. Then you can sit down slightly in bed, and you are allowed to get up only 12-14 days after the temperature normalizes.

The diet is shown – semi-liquid food with enough calories (soups, broths, dairy products, cereals, steam cutlets, vegetable purees). And plenty of drink.

Antibiotics are prescribed taking into account the sensitivity of the pathogen to the drugs. They are taken all the time while the high temperature persists, and then for another 10 days after it has returned to normal.

Against the background of severe intoxication, crystalloid and colloid solutions are administered intravenously to alleviate the patient’s condition and remove toxins. Treatment is supplemented with vitamins, drugs to maintain vascular tone and heart function, and sedatives.

In case of intestinal bleeding, urgent measures are taken, the supervision of a surgeon is necessary.

Patients are discharged when all symptoms disappear and cultures are negative. But not earlier than 3 weeks from normalization of temperature.

With prolonged isolation of bacteria, exacerbations and relapses, immunomodulators and typhoid vaccine are used.

Prevention of typhoid fever in adults at home

The basics of prevention are strict adherence to sanitary rules when taking water, processing farmland, controlling the food industry, public catering, and transporting products.

It is also important to maintain personal hygiene, use only good-quality, properly processed food, fight flies.

Employees of catering enterprises and a number of other groups should undergo routine examinations for the intestinal group. If dangerous bacteria are found in them, they are suspended from work for the entire period of treatment.

Identification of patients requires quarantine measures – isolation for the duration of the fever and another 23 days after it ends, being registered with the dispensary for at least 3 months. Upon contact with the patient, a specific bacteriophage is prescribed.

Popular questions and answers

We asked the most common questions about typhoid fever infectious disease doctor Tatyana Kovaleva.