Title: Typhoid Fever
题目：伤寒热
Author 作者: Walid Hammad

General information 一般资料:
Salmonella typhi – transmission through fecal-oral, contaminated food, human carriers
伤寒沙门氏菌 - 通过粪 - 口，受污染的食物，和人携带者传播
Most cases in the US acquired abroad – Africa, Latin American, Asia
美国的大多数病例都是在国外获得 - 非洲，拉丁美洲，亚洲
Vaccine available – not life-long immunity, need 1-2 weeks to take effect
有疫苗 - 不是终身免疫，需要1-2周才能生效
Clinical Presentation 临床表现:
sustained high fever (103-104)
持续高热（103-104）
Faget sign: fever and bradycardia (also seen in yellow fever, atypical pneumonia, tularemia, brucellosis, Colorado tick fever)
费格特（Faget）征：发烧和心动过缓（也可见于黄热病，非典型性肺炎，土拉菌病，布氏杆菌病，科罗拉多蜱热）
Abdominal pain, GI bleed/perforation, hepatosplenomegaly, delirium
腹部疼痛，消化道出血/穿孔，肝脾肿大，神志昏迷
“Rose spots” – erythematous macular rash over chest and abdomen
“玫瑰斑” - 胸部和腹部红斑疹
Without treatment sx can resolve after 3-4 weeks, mortality from secondary infections 12-30%
如果不进行治疗症状可在3-4周后消失，因继发感染而死亡的约占12-30％
Diagnosis 诊断:
Pan-culture for S. typhi
伤寒沙门氏菌的全部培养
Serologic: Widal test (negative for 1st week of symptoms, 7-14 days to result)
血清：肥达氏试验（第一周内可成阴性,7-14天才能出结果）
Treatment 治疗方法:
Abx: amoxicillin, trimethoprim-sulfamethoxazole, and ciprofloxacin
抗菌素：阿莫西林，复方新诺明，环丙沙星
MDR typhoid: ceftriaxone or Azithromycine 1st line
多药物耐药（MDR）伤寒：1线药为头孢曲松，阿奇霉素
 
Bottom Line 要点:
Get vaccinated if travelling to endemic areas 1-2 weeks before travel
要在前往流行地区前1-2周接种疫苗
Suspect in travelers to endemic areas with sustained high fevers
如发现到流行地区的旅客有持续高烧，要怀疑此病
Spontaneous resolution does occur but may become carriers without abx
可自愈，但如果没用抗菌素有可能成为携带者