Enteric fever

Particular strains of salmonellae (section 4.2) such as Sal. typhi, Sal. paratyphi and Sal. typhimurium are able not only to penetrate into intestinal epithelial cells and produce exotoxins but also to penetrate beyond into subepithelial tissues. These organisms therefore produce, in addition to the usual symptoms of salmonellosis, a characteristic systemic disease (typhoid and enteric fever). Following recovery frxm such infection the organism is commonly found associated with the gall bladder, hi this state, the recovered person will excrete the organism and form a reservoir for the infection of others. 

Nontyphoidal0 Trimethoprim-sulfamethoxazole DS twice daily ofloxacin 300 mg norfloxacin 400 mg or ciprofloxacin 500 mg twice daily x 5 days or ceftriaxone 2 g IV daily or cefotaxime 2 g IV three times daily x 5 days Enteric fever Ciprofloxacin 500 mg orally twice daily x 3-14 days (ofloxacin and pefloxacin equally efficacious)... 

Human disease caused by Salmonella generally falls into four categories acute gastroenteritis (enterocolitis), bacteremia, extraintestinal localized infection, and enteric fever (typhoid and paratyphoid fever), and a chronic carrier state. S. typhimurium is the most common cause of salmonellosis. Salmonellosis is a disease primarily of infants, children, and adolescents. 

Salmonella can produce bacteremia without classic enterocolitis or enteric fever. The clinical syndrome is characterized by persistent bacteremia and prolonged intermittent fever with chills. Stool cultures are frequently negative. 

About 80% of patients with enteric fever have positive blood cultures. Bacteremia persists in about one-third of patients for several weeks if not treated. Diagnostic tests other than culture are unreliable. 

Fluoroquinolones such as ciprofloxacin (500 mg orally twice daily for 10 days in adults) are the drugs of choice for enteric fever, particularly in areas where multidrug resistance is common. A short course of 3 to 5 days is effective but a minimum of 10 days is recommended in severe cases. 

Pearson K. Report of certain enteric fever inoculation statistics. Br Med 1904 3 1243 6. 

Thaver D, Zaidi AK, Critchley J, Madni SA, Bhutta ZA. Fluoroquinolones for treating typhoid and paratyphoid fever (enteric fever). Cochrane Database Syst Rev 2005. 

China Mahonia japonica DC Berberine, jatrorhizine.97 Antipyretic, backache, cough, dysentery, enteritis, fever. 

Salmonella enterica (S. enterica) is a rod-shaped Gram-negative facultative anaerobe and a prominent enteric bacterial pathogen capable of causing food- and water-related diseases. Several serovars of S. enterica are associated with human infection. The principle clinical diseases associated with Salmonella infection are typhoid fever and gastroenteritis. S. enterica serovars Typhi S. Typhi) and Paratyphi (,S. Paratyphi) are pathogenically exclusive for humans and are known to cause typhoid or enteric fever (Ohl and Miller, 2001). Typhoid fever is a systemic infection characterized by the development of fever, abdominal pain, enterocolitis, and occasionally, a maculopapular rash. The hallmark feature of typhoid fever is the presence of mononuclear cell infiltration and hypertrophy of the intestinal Peyer s patches and mesenteric lymphoidal tissue (Kraus et al., 1999 Ohl and Miller, 2001). There are approximately 20 million cases of typhoid fever worldwide each year, and this acute and often life-threatening infection is responsible for over 200,000 deaths annually (Crump et al., 2004). 

Group 1, for example, S. typhi and S. paratyphi, causes enteric fever only in humans and in higher primates. 

The onset of symptoms of Salmonella gastroenteritis is usually 6-72 h. Acute symptoms may last for 1-2 days or may be prolonged depending on host factors, ingested dose, and strain. Arthritic symptoms may occur 3 weeks after onset of acute symptoms. Symptoms are more severe in the elderly, infants, and immunocompromised individuals. S. typhi and S. paratyphi A, B, and C produce typhoid and typhoid-like symptoms in humans. Enteric fever (typhoid fever) may develop other symptoms include anorexia, abdominal pain, malaise, myalgias, headache, cough, diarrhea or constipation, and... 

Specific Salmonella serotypes produce characteristic human disease. For example S. enterica serotypes Typhimurium or Enteri-tidis causes gastroenteritis, whereas serotypes Typhi or Paratyphi causes enteric fever. Clinical manifestations produced by Salmonella serotypes commonly include acute gastroeuteritis (euterocolitis), bacteremia, extraiutestiual locahzed iufectiou, euteric fever (typhoid aud paratyphoid fever), aud a chrouic carrier state. 

There is decreasing incidence in rates of salmonellosis in the United States. Foodborne outbreaks of enteric fever are rare, and a small number of cases often are associated with international travel, especially to developing countries. The most common Salmonella serotypes are Typhimurium and Enteritidis, accounting for approximately 50% of isolates from patients. The overall downward trend in rates of salmonellosis is believed to be due to the improved foodhandling practices and water treatment. 

Bacteremia. SahnoneUae can produce bacteremia without classic enterocolitis or enteric fever. Bacteremia rarely occurs in older adults, but it can occur in up to 40% of infants. It is also reported more frequently in persons with severe underlying illness or immunosuppression, including AIDS. The clinical syndrome is characterized by persistent bacteremia and prolonged intermittent fever with chills. Stool cultures frequently are negative. This clinical syndrome is most frequent with serotype Choleraesuis infections (50%). Leukocyte counts are often within the normal range. 

Enteric Eever (Typhoid and Paratyphoid). Enteric fever caused by serotype Typhi is called typhoid fever. If caused by any other serotype, it is referred to as paratyphoid fever. The clinical... 

Antibiotic choice is dictated by susceptibility testing. Fluoroquinolones are the drugs of choice for the treatment of enteric fever. ... 

Enteric fever—Intestinal inflammation and ulceration with high fever and abdominal complaints caused by infection. 

The presence of sewage organisms in oysters and other shellfish, even in small numbers, may be indicative of great danger for, where such organisms exist, the specific cause of enteric fever and allied disorders may ako be found. 

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