Questions about typhoid fever reported by Group 1 :: 3-A

Good day! Kindly post your questions here for our group regarding typhoid fever.. Thank you!

~Mark Gonzales

I have taken care a patient with typhoid fever in San Lazaro, and it is indicated to your report that I can be a source of infection as the person who took care or handled the patient, will I be symptomatic (if yes, what are they?) or will I be asymptomatic (why?).. Also, are there tests that would tell that I am positive in carrying the infection?

It is indicated in your report that fever is usually high in the morning than afternoon (is it not?), I cannot recall it, but the essence of the question is, why is it that fever usually high in the morning than in the afternoon?

The pathognemonic sign of your case is "rose spots" is it right? Are these patches the lymph nodes in the intestines or the Peyer's patches that are inflammed? Why AND how can the infectious agents travel and PASS through the stomach? What is it there is in the Peyer's patches that makes it the SPECIFIC TARGET of the infectious agent? (is it not?)

zack9090 wrote:I have taken care a patient with typhoid fever in San Lazaro, and it is indicated to your report that I can be a source of infection as the person who took care or handled the patient, will I be symptomatic (if yes, what are they?) or will I be asymptomatic (why?).. Also, are there tests that would tell that I am positive in carrying the infection?

Thank you for the question..Ü First of all, it should be considered if you were wearing gloves during the student-nurse — client interaction.. It should be considered that the transmission is usually via fecal-oral oral route (hand-to-mouth), which is probably be due to poor hand hygiene..

Quoted from Kidshealth.org: "Symptoms of most salmonella infections usually appear within 3 days of contamination and typically go away without medical treatment." Meaning, you may no longer a candidate of developing symptoms since the incubation period has been surpassed.. But The incubation period is from five to forty days with a mean of ten to twenty days, thus, there is still a possibility.

You will only be a carrier if you got infected during or after taking care of the said patient..

Here is an excerpt from MayoClinic.com regarding Typhoid carriers
Even after treatment with antibiotics, a small number of people who recover from typhoid fever continue to harbor the bacteria in their intestinal tract or gallbladder, often for years. These people, called chronic carriers, shed the bacteria in their feces and are capable of infecting others, although they no longer have signs or symptoms of the disease themselves.

Yes, there diagnostic tests, these are the following: Typhidot (a confirmatory test), ELISA, Widal (although according to emedicine.com, this is no longer acceptable) or Rectal Swab (C&S test). Radiography, CT scanning and MRI could also be considered but expensive.

zack9090 wrote:The pathognemonic sign of your case is "rose spots" is it right? Are these patches the lymph nodes in the intestines or the Peyer's patches that are inflammed? Why AND how can the infectious agents travel and PASS through the stomach? What is it there is in the Peyer's patches that makes it the SPECIFIC TARGET of the infectious agent? (is it not?)

Rose spots appear on the abdomen.. "These are bacterial emboli to the dermis and occasionally develop in persons with shigellosis or nontyphoidal salmonellosis."

Most of the salmonella typhi microorganisms die due to the acidic environment of the stomach but some are still able to pass through, then proceeds to the intestines..

According to Wilmes-Riesenberg, E.R., et.al.: "During its life cycle, Salmonella typhimurium is exposed to a variety of acidic conditions. Survival in the acidic
environments within the host may require the adaptive acid tolerance response (ATR), which is characterized
by the induction of several Salmonella proteins upon exposure to mildly acidic conditions. These induced
proteins protect the bacterium from death under severe acid challenge."

It suggests that there is a protective mechanism being utilized by the bacteria in order for it to survive the acidic environment of the stomach.. Another thing considered is that the bacteria is not affected by phagocytes thus when it reaches the lymph nodes in the Peyer's patches, it then reproduces there..

Peyer's patches has a rich population of macrophages thus make it the target organ of the bacterium.. "Salmonella typhimurium invades host macrophages and induces apoptosis and the release of mature proinflammatory cytokines." (Monack, D.M., et.al. 2000)

References:
Brusch, J.L. (2008). Typhoid Fever. Retrieved December 14, 2008 from http://emedicine.medscape.com/article/231135-diagnosis

Klein, J. (2008). Salmonella Infections. Retrieved December 14, 2008 from http://kidshealth.org/parent/infections/bacterial_viral/salmonellosis.html

Mayo Clinic Staff. (2008). Typhoid fever. Retrieved December 15, 2008 from http://www.mayoclinic.com/health/typhoid-fever/DS00538/DSECTION=causes

Monack, D.M., et.al. (2000). Salmonella exploits caspase-1 to colonize Peyer's patches in a murine typhoid model. Retrieved December 17, 2008 from http://lib.bioinfo.pl/pmid:10899911

Mondejar-Navales, D. (2008). Handbook of Common Communicable and Infectious Diseases, Revised Edition. 1672 Quezon avenue, South Triangle QC: C&E Publishing, Inc.

Wilmes-Riesenberg, M.R., et.al. (1996). Role of the Acid Tolerance Response in Virulence
of Salmonella typhimurium. Retrieved December 17, 2008 from http://iai.asm.org/cgi/reprint/64/4/1085.pdf.

This question also bothered me, lymph nodes in the intestines (Peyer's patches) are inflammed when there is typhoid fever, the question is, will there be a tendancy or by any chance, that other lymph nodes will be inflammed too? Will there also be a systemic effect or benefits for the body if the Peyer's Patches are inflammed? Or is it just a mere indicator that the host is suffering from typhoid fever?

zack9090 wrote:This question also bothered me, lymph nodes in the intestines (Peyer's patches) are inflammed when there is typhoid fever, the question is, will there be a tendancy or by any chance, that other lymph nodes will be inflammed too? Will there also be a systemic effect or benefits for the body if the Peyer's Patches are inflammed? Or is it just a mere indicator that the host is suffering from typhoid fever?

It was stated in Handbook of Common Communicable and Infectious Diseases that there will come a time if the bacteria will enter the bloodstream.. It may be possible that it could inflame other lymph nodes since the infection would be systemic..

Inflammation of the Peyer's patches suggests that there is invasion of the pathogen.. There may seem no benefit since necrosis proceeds..