Fiebre tifoidea-

Salmonelosis
Maria Gabriela Cristancho
Estudiante X semestre Medicina
Universidad del Rosario
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 SALMONELOSIS-
ENTEROBACTERIA MOVIL-
2300 SEROTIPOS

INFECCION QUE SOLO AFECTA ADQUIRIDA POR INGESTION DE

AL SER HUMANO ALIMENTOS

RESPUESTA FEBRIL SISTEMICA

AFECCIONES INTESTINALES

ENFERMEDAD ENTERICA
 BACTERIA NEGATIVA
FACIL MULTIPLICACION

01 ANTIGENO O 02 ANTIGENO H 03 ANTIGENO VI

SALMONELA
SALMONELLA SALMONELLA ENTERICA O
TYPHI PARATYPHI ENTERITIDICA
 FIEBRE
TIFOIDEA
 DE ORIGEN
ENTERICO

ENFERMEDAD INFECCIOSA
BACTERIANA, AGUDA, SISTEMICA
CAUSADA POR LA SALMONELLA
TYPHI
EL SER HUMANO ES EL
RESERVORIO UNICO 
PORTADOR O ENFERMO
EXCRETA EN HECES
INFECTA POR AGUA O
ALIMENTOS
CONTAMINADOS
 PATOGENIA

1 2 3 4

SUPERA BARRERAS DEBE ALCANZAR

ACIDEZ GASTRICA FLORA INTESTINAL
DE PROTECCION INOCULO EFECTIVO
PATOGENIA
INFLAMACION-DIARREA
01 SECRETORA
ETAPA INVASIVA
02
ATRAVIESA MUCOSA, SE ALOJA EN LOS
LINFATICOS E LAS PLACAS DE PEYER 
03 INVADE SISTEMA LINFATICO
INVASION TORRENTE SANGUINEO
04 ALCANZANDO EL HIGADO 
DISEMINACION

BACTEREMIA GENERALIZADA
05
 ANATOMIA PATOLOGICA

Periodo inicial

Intestino Delgado con

inflamación exudativa y
eventualmente hemorragia

ETAPAS

• Ulcera sucia  3ra semana

• Tumefaccion medular  1ra
semana
• Ulcera limpia  4ta semana
• Necrosis con peligro de
perforacion  2da semana
 CLINICA

Niños > 6 años Cuadro de 1-4 semanas Sintomatologia febril

inicial y enterica que
progresa a cuadro
sistemico

EL CONTAGIO PUEDE DARSE EN EL PERIODO

CLINICO Y EN EL POS INFECCION
 PRIMERA SEMANA

• Comienzo insidioso
• Curva febril de intensidad variable
• Cursa con diarrea, comitos
• Dolor abdominal
• Anorexia
• Escalofrios

• Lengua saburral con halitosis

 SEGUNDA SEMANA
Se establece la bacteremia

• Fiebre elevada sin respusta a farmacos

• Cefalea continua
• Tos
• Alterna diarrea y constipacion
• Estados de conciencia pueden alterarse
• Compromiso medular
• Epistaxis
 EXAMEN FISICO

• Lengua saburral con halitosis

• Roseola tifica en torax
• Bradicardia
• Disociaicion pulso-temperature (signo de
Faget)
• Borborismo en abdomen
• Alteracion del estado de conciencia
• ETAPA DE NECROSIS
 TERCERA SEMANA

• Prolongacion del S. Febril

• Clinica multi sistemica
• Mayor compromiso del estado general y de
conciencia
 COMPLICACIONES
En la segunda y tercera semana

• Perforacion intestinal
• Hemorragia intestinak
• Comrpomiso del SNC
• Compromiso cardiovascular
• Aplasia medular  anemia, purpura
trombocitopenixa, coagulacion
intravascular diseminada
• Shock endotoxico
 CUARTA SEMANA

• Fiebre declina
• Mejora el estado de conciencia
• Mejora la cefalea
• No hay siontomatologia gastrointestinal

• RIESGO DEL PORTADOR CRONICO

 FORMAS CLINICAS

• Fiebre tifoidea fulminante: fatal

• Estado tifico prolongado  SNC alterado
• Fiebre tifoidea con manifestaciones
purpuricas o medulares  insifuciencia
medular, anemia, pancitopenia, leucopenia
• Fiebre tifoidea del lactante  inespecifico
 DIAGNÓSTICO

• Clinico
Laboratorio
• Hemograma leucopenia relativa con
neutropenia y eosinopenia (pancitopenia)
Anemia y trombocitopenia leve-moderada
• Transaminitis leve (2-3 veces valor normal)
• Bilirrubinas aumento leve a moderado
 DIAGNÓSTICO

Hemograma diferente entre la 1ra y segunda

semana

• Reacción de Widal positive

• Inmunologia especifica  ELISA
• Cultivo  Hemocultivo, mielo cultivo,
coprocultivo, cultivo de bilis duodenal y/o
urocultivo
 DX DIFERENCIAL

• Meningitis
• Pielonefritis  Patron ascendente no es
tifoidea
• Enf. Inflamatorias intestinalis
• Apendicitis
 TRATAMIENTO

• Aislameinto  enterico
• Reposo
• Regimen alimentario blando blanco
HOSPITALARIO
• Cefotaxima
• Ceftriaxona
AMBULATORIO
• Amoxicilina
• Cotrimoxazol
 OBJETIVOS TRATAMIENTO

1. Evitar formas graves o complicadas

2. Conseguir una rapida defervescencia
3. Disminuir los por tadores cornicos al
minimo
4. Conseguir el menor porcentaje de recaidas
 SALMONELAS ENTERITIDICAS

Producidas pro salmonellas no tificas

EPIDEMIOLOGIA
• Distribucion mundial
• P de incubacion de 7 a 14 dias
• Se adquiere por alimentos contaminados
PATOGENIA
• Se asocial a diarrea por la produccion de
enterotoxinas y producen diarreas inflamatorias
• Migracion y afectacion al intestino grueso
 CLINICA

• Fiebre
• Sx gastroenterico  diarrea aguda inflamatoria
sin bacteremia que progresa a diarrea secretora.
• Portador cronico asintomatico
 DIAGNOSTICO

• Clinica
• Hemograma
• Cultivo
 TRATAMIENTO

• Sintomatico – hidroterapia
• Antibioticoterapia ambularoria  amoxicilina
 S. PARATYPHI
• Considerada fiebre enterica
• Periodo de incubación de 3-4 días
• Con serotipos A,B,C siendo mas frecuente A y B
• Clinica con cuadro similar a la tifoidea con mucha
menor intensidad
• Tratamiento de reposo, dieta e hiratacion
• Antibioticoterapia si es hospitalario con
cefalosporinas de tercera generacion o si es
ambulatorio con azitromicina
 Buyer Persona
Skills:
Internet Influences
Software Venus has a
Social beautiful name

Must Do Frequency
Angelina Doe Despite being red, Earth is the third
Mars is a cold place planet from the Sun
Age: 35
Occupation: IT Must Never Relationship
Education: University Saturn is a gas giant Mercury is the
Personality: Extrovert and has rings smallest planet
 Buyer Journey

01 02 03

Awareness Consideration Decision

Mercury is the closest Despite being red, Mars Jupiter is a gas giant and
planet to the Sun is a cold place the biggest planet
 Competitor Analysis

20% 10% 50% 25%

Mercury Mars Venus Jupiter

It’s the closest planet Despite being red, Venus has a A gas giant and the
to the Sun Mars is a cold place beautiful name biggest planet
 Our SWOT Analysis

Weaknesses Opportunities

Strengths Jupiter is the biggest Neptune is the Threats

planet in the entire farthest planet from
Despite being red, Solar System the Sun Saturn is composed
Mars is actually a mostly of hydrogen
very cold place and helium
 Goals

Goal 1 Goal 3

Venus has a beautiful Jupiter is a gas giant

name, but also very and the largest planet
high temperatures in the Solar System

Goal 2 Goal 4

Saturn is composed Mercury is the smallest

mostly of hydrogen and innermost planet
and helium in the Solar System
A Picture Is Worth a Thousand Words
 Strategy

Key Action 1 Mars

Neptune is far Despite being red,
away from Earth Mars is cold

Goals
It is named after
a Roman goddess
Key Action 2 Saturn
Earth is where we It’s a gas giant and
all live on has several rings
 Key Action Items

First Quarter Second Quarter Third Quarter

Here you can describe Here you can describe Here you can describe
Key Action 1 your items for the your items for the your items for the
quarter quarter quarter

Here you can describe Here you can describe Here you can describe
Key Action 2 your items for the your items for the your items for the
quarter quarter quarter

Here you can describe Here you can describe Here you can describe
Key Action 3 your items for the your items for the your items for the
quarter quarter quarter
 Timeline

Mars Jupiter Saturn

Despite being red, It’s the biggest Saturn is the sixth
Mars is cold planet of them all planet from the Sun

Mercury Neptune
It’s the closest planet It’s the farthest
to the Sun planet from the Sun
 Budget

Jupiter Neptune
Jupiter is a gas giant 40% Neptune is the fourth-
and the biggest planet largest planet in the
in the Solar System 60% Solar System

To modify this graph, click on it, follow the link, change the data and paste the new graph here
 KPI Overview

Paid Search €1.5

25% 50%

Organic Search €2.7

Jupiter Venus
A gas giant and the Planet Venus has a Referral €3.2
biggest planet beautiful name

Productivity CPC by traffic

To modify this graph, click on it, follow the link, change the data and paste the new graph here
 Our Team

David James Keanu Doe

You can replace the image on You can replace the image on
the screen with your own the screen with your own
Project Vision Deliver Value

Venus has a beautiful The second planet from

name, but also a the Sun. It is named after
poisonous atmosphere a Roman goddess

Guiding
Principles
Effective Efficiency Teamwork

The fifth planet from the Saturn is the sixth planet

Sun and the largest in the from the Sun and the
Solar System second-largest
Awesome Words
 Maybe You Need More Columns

Venus Mercury Saturn

Planet Venus has a It’s the closest planet to It’s composed of
beautiful name the Sun hydrogen and helium

Jupiter Mars Earth

It’s the biggest planet in Despite being red, Mars It’s the third planet from
the Solar System is a cold place the Sun
 3,235.00
Big numbers catch your audience's attention
 Active Marketing List

● Accessory Buyers: Venus has a beautiful name, but also high temperatures
● Bloggers: Mercury is the smallest and innermost planet in the Solar System
● Computer Buyers: Saturn is the sixth planet from the Sun and the second-largest
● Current Customers: Jupiter is the biggest planet in the entire Solar System
● Home Appliance Buyers: Neptune is the farthest planet from the Sun
● Online Reviewers: Earth is the third planet from the Sun and where we all live on
 Map

Venus
Planet Venus has a
beautiful name

Mars
Despite being red,
Mars is a cold place
 Market Share
Venus
Planet Venus has a
beautiful name
Saturn
Mars
To modify this graph, 859 1000 Despite being red,
click on it, follow the Mars is a cold place
link, change the data
and paste the new
graph here
Jupiter
541
It’s a gas giant and
the biggest planet
 Sneak Peek
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