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Dr.T.V.Rao MD
Dr.T.V.Rao MD
Manifest with
Rose spots
Aches and pains High fever
Diarrhea
Chest congestion
Typhoid Meningitis
Clinical manifestation
Head ache, malise,anorexia ,coated tongue Abdominal discomfort, Constipation / Diarrhea Step ladder type fever, Relative bradycardia, A soft palpable spleen Hepatomegaly Rose spots appear
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Blood Culture
1 st week Positive in 90 % 2 nd week Positive in 75 % 3 rd week Positive in 60 % > 3 weeks positive in 25 % Draw 5 10 cc of Blood by venipuncture. ADD to 50 -100 ml of Bile broth. Incubate at 37 c /Subculture in MacConkey At regular intervals
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Clot culture
Clot cultures are more productive in yielding better results in isolation. A blood after clotting, the clot is lysed with Streptokinase ,but expensive to perform in developing countries.
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Biochemical Characters
Non Lactose fermenter, Motile Indole MR + VP - Citrate + Ferment Glu/Mal/Man Do not ferment Lactose/Sucrose
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Serology
WIDAL Test Tube agglutination test. Detects O and H antibodies Diagnosis of Typhoid and Paratyphoid Testing for H agglutinins in Dryers tubes, a narrow tube floccules at the bottom Testing for O agglutinins in Felix tubes, Chalky Incubated at 37 c overnight
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Widal Test
In 1896 Widal A professor of pathology and internal medicine at the University of Paris (191129), he developed a procedure for diagnosing typhoid fever based on the fact that antibodies in the blood of an infected individual cause the bacteria to bind together into clumps (the Widal reaction).
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Widal test
S.typhi O and H tubes Paratyphi A/B H agglutinins only Common antigens O in all Factor sharing 12 Significance I st week negative. Titers raise in 2nd week Raise of titers diagnostic
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Widal Test
Single test not diagnostic. Paired samples tests Diagnostic. O > 1 in 80 H > 1in 160 H agglutinins appear first False positives in Unapparent infection, Immunization Previously infected
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Widal test
Anamnestic response previous infection and responding to unrelated infection Other Diagnostic tests CIE and ELISA Detection of Circulating antigens Co agglutination test.
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False Positive and Negative Reactions with WIDAL Test The Widal test should be interpreted in the light of baseline titers in a healthy local population. This is especially important when there is a high local prevalence of non-typhoid salmonellosis. The Widal test may be falsely positive in patients who have had previous vaccination or infection with S typhi.
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Key points
Antibiotics have no place in the management of salmonella gastroenteritis unless invasive complications are suspected. Clean water, sanitation and hygienic handling of foodstuffs are the keys to prevention.
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Programme Created by Dr.T.V.Rao MD for Medical and Paramedical students in the Developing world Email doctortvrao@gmail.com
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