Methods of diagnosis; Bacteriologic on Rapeport medium

Salmonellosis

Main source – Cattle, pigs, birds, ducks

Factor of transmission – Meat, milk, Products from infected animals especially uncooked eggs (fresh)

Classifications:

a) Generalised forms

b) GIT lesions: Gastritis

Gastroenteritis etc

Syndroms:

1. Intoxication syndrome: Malaise

Headache

2. Gastritis / Gastroenteritis: Nausea

Vomiting

Diarrhea

Diarrhea is of liquid stool with green colour – due to ↑ peristalsis, thus fast movements of feaces and bile cant transform to stercobilinogen that fast therefore green-yellow colour. Maybe with slime if colon is involved.

3. Dehydration syndrome due to ↑ vomiting and diarrhea

Complications of GIT form of Salmonellosis

• Infectious toxic shock (due to high intoxication)

Signs: Symtoms of CVS insufficiency

- acrocyanosis

- tachycardia

- ↓AP

• Hypovolumic shock (due to high vomiting and diarrhea)

Signs: Symtoms of CVS insufficiency

Symtoms of intensive hypovolumia

- Hoarse voice

- dry skin

- muscle cramps

- oligo / anuria

Generalised form of salmonellosis

Bacterimia – bacteriological examination (blood and urine), growth on Rapoports Media (with bile)

Main sign is: Fever – prolonged and high, duration of fever duration of diarrhea

Clinical signs of typhoid: Hepatomegally

Prolonged fever

Anemia

Renal failure Rash (pastules), emteric fever rash –

raseolas and pastules

Tretament

• Pathogenic therapt in GIT forms
• Antibiotics in generalized forms

Typhoid

Etiology: Salmonella typhi

Transmission:Oral

Source: Carrier of salmonella

Water(lake, rivers)

Characteristics: Severe fever disease

Severe complications

↑ Lethality rate

Bacteremia

Oral intake of salmonella typhi

Intestine (penetrate mucosal membrane into lymphoid tissue of intestine and mesenteric lymphatic nodes) Therefore mesenadenitis. Seen by symptoms of “Paldechy” (percussion of abdomen on right flank)

Blood stream – Bacteremia

Clinicals:

Gastritis; vomiting, diarrhea (not sure)

Stool is chyme like, not watery wth green colour stool compared with pea soup

Severe intoxication: Temperature increases by degree each day till 40* C and decreases

Severe headache

Mallaise

Russian name – “Typh”

1. Enteric fever / typhoid fever
2. Epidemic fever

· Both enteric fever and epidemic fever called as typh as general name, due to general clinical of change of central nervous system (sign due to lesions of CNS; delirium, hallucinations)

Change in CNS can occur from the first day

· End of 8^th day, typical sign occurs, i.e. rash (Roseola, papullas); pink, not bright, arise on skin of abdomen and lateral parts of chest

Rash is difficult to see because it is not bright and disappears after 3 – 4 days

· Changes in CVS; Relative bradycardia

Decrease Arterial pressure

· Changes in respiration; Crepitations in lungs

Symptoms of bronchitis, pneumonia

· Symptoms of meningism; there will be positive meningeal signs, headache but no increased cells. It is not inflammation, different from meningitis. After spinal puncture can see large increase number of cells (leucocytosis – purulent; lymphocytosis – serous) in meningitis.

· Oedemic large tongue of dark brown colour

· Meteorism of abdomen

· Positive sign of Padechy (mesenteric lymph nodes)

· Chyme like stool (sometimes)

Methods of diagnosis; Bacteriologic on Rapeport medium

Methods of diagnosis

1. Cuprologic method
2. Blood analysis
3. Culture (bacteriologic)
4. Seologic tests; antibodies to salmonella in blood, specific antibodies to certain type of salmonella

Treatment:

Must be differentiated with gastroenteriticolitic form of dysentery

1. Antibiotics: Depends on stage on severity

Gentamycin IM

Teplox per os

2. Rehydration therapy: transfuse Asesol, trisol, Phillips solution

Treatment of typhoid:

Death of patient due to large ulcers (3^rd week); Bleeding from ulcers and perforation leading to peritonitis

1. Antibiotics: Tocolinones

Duration – feverish period and 10 days of normal temperature

1. Diet: Increased fluid

Non dense food (to avoid provocation of perforation)

No fresh fruits and vegetables or brown bread (to avoid meteorism to avoid ulcers)

1. Detoxication therapy: Crystalloid solutions

Physiological solutions

Glucose solutions

3:1 crystalloid to colloid; Rheopolyglycine, Hemadose, plasma

Treatment of complications:

• Perforation of ulcers (acute pain, positive peritoneal signs)
• Bleeding (Melena and CVS failure signs – acrocyanosis, dyspnoea, quick pulse)

Treatment by surgery

Differential diagnosis of enteric fever with other fevers;

· Typhus

· Sepsis

GIT forms of salmonellosis differentiated with;

• Food poisoning
• E – Coli
• Viral diarrhea (viral infections – Rotor, Entero, Adeno)
• Cholera

Дата добавления: 2015-10-29