AN IMPORTED CASE OF TYPHOID FEVER IN CHUVASHIA

Abstract

Typhoid fever and paratyphoids are still a widespread topical problem, especially in connection with the possibility of imported cases from regions that are epidemically disadvantaged by the disease. The current relevance of typhoid fever problem in the Russian Federation is determined by its persistent sporadic morbidity. Reduced control over the sanitary and hygienic state of the environment, deterioration of the quality of water treatment in water supply and sewerage systems, and a number of other reasons can still result in an increase in the number of patients with typhoid-paratyphoid diseases. At the same time, a mild and subtle course of typhoid fever is a common cause of late disease diagnosis and late start of the patient's treatment. Methods of modern diagnosis and treatment of typhoid-paratyphoid disease are considered. The article describes a case of typhoid fever that was diagnosed in the Chuvash Republic in 2017 after a long period of epidemiological welfare. The aim of the study is to analyze an imported case of typhoid fever and characterize the current course of the disease in the period of sporadic morbidity. A retrospective analysis of the patient's history of typhoid fever was performed. The diagnosis was made on the basis of clinical, epidemiological and laboratory data. To confirm the diagnosis of typhoid fever, bacteriological methods to study blood, urine and feces were used. The study of this female patient's medical history showed that there were no typical symptoms characteristic of typhoid fever: subcutaneous fat was moderately expressed, on palpation submandibular lymph nodes were painless, mobile, of soft-elastic consistency up to 0.6 cm. Nasal breathing was not disturbed, breathing was vesicular, the RR was 16 movements per 1 min., heart tones were muted, rhythmic, the heart rate was 100 beats / min, BP – 120/75 mm Hg, temperature – 39°C. The tongue was dry, coated with a grayish-brown plaque with tooth marks on the edges. The pharynx was moderately hyperemic. The stomach was soft, painless, the liver and the spleen were not enlarged, Padalka’s symptom was negative. The patient reported fecal excretion with a tendency to constipation. There was no CVA tenderness on both sides. Thus, it is difficult to make a diagnosis of typhoid fever with sporadic morbidity. Modern clinical presentation of typhoid fever in moderate severity differs from the classic one. The patient had an atypical course of typhoid fever. Typhoid status was absent. The cutaneous coverings were normal, there was no rash. There was no congestive splenomegaly or Padalka's symptoms. No complications or relapses developed. The diagnosis was made only when the pathogen was seeded from the blood (hemoculture) and basing on clear epidemiological data.