Typhoid face

Introduction Typhoid face: apathy, unresponsiveness, and a state of no desire. Found in patients with high fever after typhoid fever, meningitis, encephalitis. Typhoid fever, also known as enteric fever, wet typhoid fever, intestinal typhoid fever, is a common infectious disease, usually originating from food or drinking water contaminated with the original manure, which is quickly caused Pandemic. Typhoid fever is an acute gastrointestinal infectious disease caused by Salmonella typhi, with persistent bacteremia and toxemia, proliferative response of the mononuclear phagocytic system, hyperplasia and swelling mainly in the lower ileum lymphoid tissue. Necrosis and ulcer formation are basic pathological features. Typical clinical manifestations include persistent high fever, systemic toxic symptoms and gastrointestinal symptoms, relatively slow pulse, rose rash, hepatosplenomegaly, and leukopenia.

Cause

Mostly, the face of patients with high fever and fever, such as typhoid fever, encephalitis, and meningitis.

The typhoid bacillus is transmitted through contaminated water or food, daily life contact, flies and cockroaches after being discharged from the dung or urine of the patient or the carrier. Among them, water pollution is an important way to spread the disease, and it is also the main cause of outbreaks. Food contamination can also cause the epidemic, and sporadic cases are generally spread in daily life.

Susceptibility to the population: People are generally susceptible to typhoid fever. Persistent immunity can be obtained after the disease, and there are very few people who are sick again.

an examination

Related inspection

Complement-binding test, fertilizer, Dar's reaction, Dar's reaction, rickettsia, complement fixation, rickettsia agglutination test

Routine inspection

Diagnostic method: Most of the typhoid blood leukocytes are 3×109/L~4×109/L with neutropenia and eosinophil disappearance, and the latter gradually rises with the improvement of the condition. Extremely eosinophils > 2% absolute count over 4 × 108 / L can be basically excluded from typhoid fever. Mild proteinuria in high fever. Fecal occult blood test was positive.

Bacteriological examination

1 Blood culture is the evidence for the diagnosis. It can be positive in the early stage of the disease. The positive rate of the 7th to 10th day can reach 90%, and the third week will be 30%~40%.

2 The positive rate of bone marrow culture is higher than that of blood culture, especially suitable for those who have been treated with antibiotics and those with negative blood culture;

3 Fecal culture can be positive from the incubation period, up to 80% in the third to fourth weeks, and the positive rate in the 6th week after the disease is rapidly decreased by 3%. The patient's bacteria can be more than one year;

4 urine culture: the positive rate in the late stage of the disease can reach 25%, but the fecal contamination should be avoided;

5 Scrapping or biopsy sections of rose rash can also be positively cultured.

Immunological examination

The fatda test typhoid serum agglutination test, that is, the fat-positive reaction, has an auxiliary diagnostic value for typhoid fever. The antigens used in the examination included typhoid bacillus (O) antigen, flagellar (H) antigen paratyphoid A, B, and propylene flagellin antigens. The five purposes were to determine the agglutination titer of various antibodies in the patient's serum by agglutination. There was not a positive reaction in the first week of the disease. Generally, the positive rate gradually increased from the second week to 90% in the fourth week, and the positive reaction lasted for several months after the recovery. In a small number of patients, antibodies are raised very late or even the whole course of antibody titer is very low (14.4%) or negative (7.8% to 10%), so this disease cannot be ruled out accordingly.

Differential diagnosis

Differential diagnosis of typhoid face :

1. Smiley face: Tetanus is a nervous system syndrome caused by Clostridium tetanus toxin. Patients with local or systemic muscles or tonic spasm, often affected by facial and neck muscles, closed jaws and "smiley face".

2, anemia face: pale and dull, eyelids, lips and tongue pale, expression tired and weak.

3, dementia face: head large neck short, small eye cracks, wide nose flat, nose hypertrophy, wide tongue and often stretch out of the mouth, common in patients with small patients.

4, cachexia quality face: face is extremely thin, pale complexion, skin elasticity is poor, more common in patients with chronic wasting diseases, such as tuberculosis, advanced cancer.

5, mask face: facial expression is dull, like wearing a mask, common in patients with encephalitis, tremor paralysis.

6, half of the face of the face: semi-lateral muscles irregular facial convulsions, sometimes only for the blink of the eye or mouth twitching, common in patients with facial nerve spasm sequelae and trigeminal neuralgia, central nervous system disorders.

7. Insular temperament, slow response, less gas lazy, called "no desire."

Typhoid fever: the heat lasts for more than 5 days, the body temperature continues to rise or the heat is retained or the heat is present. Zhang fever, typhoid face, headache, relatively slow pulse, typhoid tongue, liver spleen, epidemic cerebrospinal meningitis, epidemic meningitis Or the brain, this disease is a disease that children and young people are prone to. In a few severe cases, skin spots and ecchymoses are seen early, and they are rapidly progressively increased with a poisoned face.

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