Enteric fever

Enteric Fever

1. Definition

Enteric fever is a bacterial infection caused by Salmonella Typhi and Salmonella Paratyphi, which affects the gastrointestinal tract. It is characterized by high fever, abdominal pain, and diarrhea. Additional context: Enteric fever is also known as typhoid fever.

2. Synonyms

• Typhoid fever
• Paratyphoid fever
• Enteric fever

3. Causes / Etiology

• Salmonella Typhi: This bacterium is the primary cause of enteric fever. It is transmitted through contaminated food and water, as well as through close contact with an infected person.
• Salmonella Paratyphi: This bacterium causes paratyphoid fever, which is similar to typhoid fever but has a milder course.
• Contaminated food and water: Food and water contaminated with Salmonella Typhi or Salmonella Paratyphi can cause enteric fever.
• Close contact with an infected person: Close contact with an infected person, such as through touching or sharing utensils, can also transmit the bacteria.

4. Types / Classification

• Typhoid fever: Caused by Salmonella Typhi, it is characterized by high fever, abdominal pain, and diarrhea.
• Paratyphoid fever: Caused by Salmonella Paratyphi, it is similar to typhoid fever but has a milder course.
• Typhoid carriers: Some people can become carriers of Salmonella Typhi, carrying the bacteria in their gallbladder without showing symptoms.

5. Pathophysiology / Pathology

1. Invasion: Salmonella Typhi enters the body through the gastrointestinal tract.
2. Colonization: The bacteria multiply in the intestinal tract, causing inflammation and damage to the intestinal lining.
3. Systemic infection: The bacteria enter the bloodstream, causing a systemic infection that affects multiple organs.
4. Fever and inflammation: The body's immune response causes fever, inflammation, and damage to various organs.

6. Clinical Features

• Acute typhoid fever:
  • High fever (up to 104°F)
  • Abdominal pain and tenderness
  • Diarrhea or constipation
  • Headache and fatigue
• Chronic typhoid fever:
  • Prolonged fever and illness
  • Weight loss and fatigue
  • Abdominal pain and tenderness

7. Complications

• Acute complications:
  • Intestinal perforation
  • Sepsis
  • Meningitis
• Chronic complications:
  • Chronic carrier state
  • Intestinal obstruction

8. Investigations / Diagnosis

• Routine tests: Complete blood count (CBC), blood culture, and urine culture.
• Specific tests: Salmonella Typhi or Salmonella Paratyphi antigen detection in stool or urine.
• Confirmatory tests: Salmonella Typhi or Salmonella Paratyphi isolation from stool or blood culture.

9. Differential Diagnosis

1. Malaria: Similar symptoms, but with a different epidemiology and treatment.
2. Urinary tract infection: Similar symptoms, but with a different epidemiology and treatment.
3. Gastroenteritis: Similar symptoms, but with a different epidemiology and treatment.
4. Rickettsial infections: Similar symptoms, but with a different epidemiology and treatment.

10. Management / Treatment

• General management: Rest, hydration, and nutrition.
• Modern medicine treatment:
  • Antibiotics (e.g., ciprofloxacin, ampicillin)
  • Supportive care (e.g., fluids, electrolytes)
• Diet and lifestyle advice:
  • Avoid contaminated food and water
  • Practice good hygiene (e.g., handwashing)
  • Get plenty of rest and nutrition

11. Homeopathic Therapeutics

1. Aconitum napellus:

• Causation: Sudden onset of symptoms
• Characteristic symptoms: High fever, abdominal pain
• Modalities: Worsening with touch, movement
• Mental state: Anxiety, restlessness
• Thirst and appetite: Increased thirst, loss of appetite
• Nature of discharges or secretions: Diarrhea, mucus
• Physical generals: Headache, fatigue
• Suitable constitution or patient type: Sensitive, restless individuals
• Helps in the disease: Eases symptoms, reduces fever

2. Bryonia alba:

• Causation: Dry, hot weather
• Characteristic symptoms: Abdominal pain, dry mouth
• Modalities: Worsening with movement, touch
• Mental state: Irritability, anxiety
• Thirst and appetite: Decreased thirst, loss of appetite
• Nature of discharges or secretions: Constipation, mucus
• Physical generals: Dry skin, fatigue
• Suitable constitution or patient type: Dry, irritable individuals
• Helps in the disease: Eases abdominal pain, reduces fever

3. Arsenicum album:

• Causation: Contaminated food and water
• Characteristic symptoms: Diarrhea, abdominal pain
• Modalities: Worsening with movement, touch
• Mental state: Anxiety, restlessness
• Thirst and appetite: Increased thirst, loss of appetite
• Nature of discharges or secretions: Diarrhea, mucus
• Physical generals: Fatigue, weakness
• Suitable constitution or patient type: Sensitive, anxious individuals
• Helps in the disease: Eases symptoms, reduces fever

4. Belladonna:

• Causation: Sudden onset of symptoms
• Characteristic symptoms: High fever, headache
• Modalities: Worsening with touch, movement
• Mental state: Anxiety, restlessness
• Thirst and appetite: Increased thirst, loss of appetite
• Nature of discharges or secretions: Mucus, diarrhea
• Physical generals: Headache, fatigue
• Suitable constitution or patient type: Sensitive, restless individuals
• Helps in the disease: Eases symptoms, reduces fever

5. Digitalis purpurea:

• Causation: Cardiac problems
• Characteristic symptoms: Abdominal pain, nausea
• Modalities: Worsening with movement, touch
• Mental state: Anxiety, restlessness
• Thirst and appetite: Decreased thirst, loss of appetite
• Nature of discharges or secretions: Diarrhea, mucus
• Physical generals: Fatigue, weakness
• Suitable constitution or patient type: Cardiac problems, sensitive individuals
• Helps in the disease: Eases abdominal pain, reduces fever

6. Gelsemium:

• Causation: Weakened immune system
• Characteristic symptoms: Abdominal pain, fatigue
• Modalities: Worsening with movement, touch
• Mental state: Anxiety, restlessness
• Thirst and appetite: Decreased thirst, loss of appetite
• Nature of discharges or secretions: Mucus, diarrhea
• Physical generals: Fatigue, weakness
• Suitable constitution or patient type: Weakened immune system, sensitive individuals
• Helps in the disease: Eases symptoms, reduces fever

7. Hydrastis:

• Causation: Contaminated food and water
• Characteristic symptoms: Diarrhea, abdominal pain
• Modalities: Worsening with movement, touch
• Mental state: Anxiety, restlessness
• Thirst and appetite: Increased thirst, loss of appetite
• Nature of discharges or secretions: Diarrhea, mucus
• Physical generals: Fatigue, weakness
• Suitable constitution or patient type: Sensitive, anxious individuals
• Helps in the disease: Eases symptoms, reduces fever

8. Lycopodium:

• Causation: Weakened immune system
• Characteristic symptoms: Abdominal pain, fatigue
• Modalities: Worsening with movement, touch
• Mental state: Anxiety, restlessness
• Thirst and appetite: Decreased thirst, loss of appetite
• Nature of discharges or secretions: Mucus, diarrhea
• Physical generals: Fatigue, weakness
• Suitable constitution or patient type: Weakened immune system, sensitive individuals
• Helps in the disease: Eases symptoms, reduces fever

12. Prognosis

The prognosis of enteric fever depends on the promptness and effectiveness of treatment. If left untreated, enteric fever can lead to serious complications, including:

• Intestinal perforation
• Sepsis
• Meningitis
• Chronic carrier state

Prompt treatment with antibiotics can reduce the risk of complications and improve the prognosis.

13. Prevention

Prevention of enteric fever involves:

• Avoiding contaminated food and water
• Practicing good hygiene (e.g., handwashing)
• Getting plenty of rest and nutrition
• Avoiding close contact with an infected person
• Getting vaccinated against Salmonella Typhi

14. Diet

Recommended foods:

• Bananas
• Rice
• Applesauce
• Toast (BRAT diet)
• Clear broths
• Electrolyte-rich beverages

Avoided foods:

• High-fiber foods
• Spicy foods
• Fatty foods
• Greasy foods
• High-sugar foods