伤寒和副伤寒演示教学.ppt

Bacteriological examinations: Blood culture: the most common use80~90% positive during the first 2 weeks of illness 50% in 3 weeks not easy in 4 weekre-positive when relapse attention to the use of antibiotics The bone marrow culture the most sensitive testspecially in patients pretreated with antibiotics. Urine and stool culturesincrease the diagnostic yieldpositive less frequentlystool culture better in 3~4 weeks The duodenal string test to culture bile useful for the diagnosis of carriers. Rose spots: Not use routinely Serological tests(Vidal test): five types antigen:somatic antigen(O),flagella(H) antigen, and paratyphoid fever flagella(A,B,C) antigen. Antibody reaction appear during first week 70% positive in 3~4 weeks and can prolong to several months in some cases, antibodies appear slowly, or remain at a low level, some(10~30%) not appear at all. O agglutinin antibody titer ≥1:80 and H ≥1:160 or O 4 times higher supports a diagnosis of typhoid fever O rises alone, not H, early of the disease.Only H positive, but O negative, often nonspecifically elevated by immunization or previous infections or anamnestic reaction. Antibody level maybe lower when have used antibiotics early. Some cross reaction between group “D” and “A”. False positive in some infectious diseases. Some positive in blood culture ,but negative in vidal test. Vi often useful for carrier  molecular biological tests:  DNA probe or polymerase chain reaction (PCR) Complications Intestinal hemorrhageCommonly appear during the second-third week of illnessdifference between mild and greater bleedingoften caused by unsuitable food, diarrhea et al serious bleeding in about 2~8%a sudden drop in temperature、 rise in pulse、and signs of shock followed by dark or fresh blood in the stool. Intestinal perforation: The more serious .Incidence,1-4% Commonly appear during 2-3 weeks. Take place at the lower end of ileum. Before perforation,ab