GB 16001-1995 Diagnostic criteria and treatment principles for typhoid and paratyphoid
Some standard content:
GB 16001--1995
Typhoid and paratyphoid are acute intestinal infectious diseases and are Class B infectious diseases that must be reported in the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases. Since the discovery of the pathogens of typhoid and paratyphoid, the disease has made great progress in both clinical and etiology, and the total incidence rate is on a downward trend. However, my country has a vast territory, a large population, and uneven economic and cultural development in various regions. There are still a considerable number of cases each year, and small-scale outbreaks occur from time to time. Formulating diagnostic standards and treatment principles for typhoid and paratyphoid applicable to the whole country is of practical significance for guiding diagnosis, rational use of antimicrobial drugs, and prevention and control of disease. In the process of compiling this standard, we will make full use of my country's achievements in the prevention and control of typhoid and paratyphoid, and make them reflected in the relevant items.
Appendix A and Appendix B of this standard are both standard appendices; Appendix C of this standard is a suggestive appendix.
This standard is proposed by the Ministry of Health of the People's Republic of China. The drafting unit of this standard: Department of Infectious Diseases, Huashan Hospital, Shanghai Medical University. The main drafters of this standard are Wang Fu and Weng Xinhua. The Ministry of Health entrusted the technical unit, the Office of Supervision and Administration of Communicable Disease Prevention and Control of the Ministry of Health, to interpret this standard. 129Www.bzxZ.net
1 Scope
National Standard of the People's Republic of China
Diagnostic criteria and principles of management of typhoid and paratyphoid GB16001—1995
This standard specifies the diagnostic principles (including clinical diagnostic criteria and confirmation criteria), diagnostic criteria and prevention and treatment principles of typhoid and paratyphoid. This standard is applicable to all medical care and health and epidemic prevention institutions at all levels in cities and rural areas of my country. 2 Definition
Typhoid and paratyphoid are acute gastrointestinal infectious diseases caused by Salmonella typhi and Salmonella paratyphi A, B, and C. Clinically, they are characterized by persistent high fever, relatively slow pulse, characteristic poisoning symptoms, splenomegaly, roseola and leukopenia. Intestinal bleeding and intestinal perforation are the main complications.
3 Diagnostic principles
Typhoid and paratyphoid fever can be clinically diagnosed based on epidemiological data, clinical course and immunological examination results, but the diagnosis is based on the detection of pathogenic bacteria.
4 Diagnostic criteria
4.1 Clinical diagnostic criteria
In typhoid fever seasons and areas, 4.1.1, 4.1.2 and 4.1.3 can be used for clinical diagnosis. 4.1.1 Continuous high fever (up to 40-41°C) for more than 1-2 weeks. 4.1.2 Special poisoning face, relatively slow pulse, rose rash on the skin, hepatosplenomegaly. 4.1.3 Peripheral blood count is low, eosinophils disappear, and typhoid cells (ring cells) are present in the bone marrow. 4.2 Diagnostic criteria
Clinical diagnosis cases can be diagnosed if any of the following items are present [see Appendix A (Standard Appendix)}. 4.2.1 From blood, bone marrow, urine, feces, roseola scrapings, any specimen is isolated from Salmonella typhi or Salmonella paratyphi. 4.2.2 Serum specific antibody is positive. The agglutination titer of Widal reaction "0" antibody is ≥1:80, the agglutination titer of typhoid or paratyphoid flagella antibody is ≥1:160, and the titer increases by more than 4 times during the recovery period. 5 Principles of prevention
Typhoid and paratyphoid are infectious diseases of the digestive tract. The prevention focus is to strengthen drinking water, food hygiene and feces management, prevent and kill flies, eliminate fly habitats, cut off the transmission route, strengthen health education, and improve the public's health level and self-protection awareness [see Appendix B (Standard Appendix). 5.1 Control the source of infection
5.1.1 Timely identify patients and carriers and isolate the intestines. Mix feces and urine with an equal amount of 20% bleaching powder clarified liquid for 2 hours, soak the toilet with 3% bleaching powder for 1 hour, and boil the tableware for disinfection. One week after the patient stops taking antibacterial treatment, urine and feces culture should be performed weekly. Only those with two consecutive negative results can be released from isolation.
GB16001—1995
5.1.2 Nursery workers and catering industry personnel should undergo fecal culture and Vi antibody testing regularly. Chronic carriers should not engage in the above work. 5.1.3 Close contacts should be placed under medical observation for at least three weeks from the time of cessation of contact. 5.2 Cutting off the transmission route
Strengthen the hygiene of food and drinking water, protect water sources, manage and handle feces, sewage and garbage, pay attention to washing hands before and after meals, and cutting off the transmission route is the focus of the prevention measures for this disease.
5.3 Protecting susceptible people
5.3.1 Residents of epidemic areas, travelers to epidemic areas, cleaners, laboratory staff and other medical workers, and family members of carriers are the targets of active immunization. The triple mixed killed bacteria vaccine of typhoid, paratyphoid A and B is used in China. It is injected subcutaneously three times with an interval of 7 days. Immunity can be generated 2 to 3 weeks after vaccination, and it is strengthened once a year thereafter. Severe heart disease, kidney disease, hypertension, active tuberculosis, fever and pregnant women are contraindicated.
5.3.2 Oral attenuated bacteria vaccine is in trial use, and its effect needs further verification. 6 Treatment principles
Pathogen treatment is the key, fluoroquinolones are the first choice, and ofloxacin and ciprofloxacin are commonly used, but they are contraindicated for children, pregnant women and lactating women. The latter can use ceftriaxone or ceftriaxone. However, for patients who are not suitable for fluoroquinolones or are allergic to cephalosporins, chloramphenicol can still be used as an alternative drug, but its indications and side effects should be noted. Patients with intestinal bleeding should temporarily fast, and patients with massive bleeding should receive blood transfusions. If there is intestinal perforation, surgical treatment should be performed as soon as possible [see Appendix C (Suggested Appendix)]. [3]
A1 Methods for etiological diagnosis
A1.1 Bacterial culture
A1.1.1 Specimen collection
Different types of specimens should be collected according to different stages of the disease. GB16001—1995
Appendix A
(Standard Appendix)
Experimental diagnostic methods
A1.1.1.1 Blood specimens should be collected in the first 1~2 weeks of the disease, but as long as the fever has not subsided, positive results can still be obtained after two weeks. The blood volume should not be less than 5~10mL. For patients who have used chloramphenicol, blood clots should be taken for culture. A1.1.1.2 Bone marrow culture should be sent for examination in the first 1-2 weeks of the course of the disease. A1.1.1.3 Stool specimens should be sent for examination in the third to fourth weeks of the course of the disease. A1.1.1.4 Urine specimens should be sent for examination in the third to fourth weeks of the course of the disease. The positive rate is low, and fecal contamination should be avoided when collecting. A1.1.1.5 Scrapings or biopsy sections of roseola. A1.1.2 Culture
Blood and bone marrow puncture fluid should be cultured for bacterial enrichment first. Feces and urine (sediment) can be directly inoculated into identification culture medium. After culturing at 37℃ for 24h, suspicious colonies are selected for further biochemical reaction and serological identification. A1.1.3 Identification
A1.1.3.1 Colony morphology: Salmonella typhi forms medium-sized, colorless and translucent colonies with smooth surfaces on ordinary culture medium, and the colony edges are neat.
A1.1.3.2 Morphological staining: Salmonella typhi is a Gram-negative bacillus belonging to the D group of Salmonella. It has no spores, no membrane, and is motile. It is a flagellated fungus with pili.
A1.1.3.3 Biochemical reaction: It does not decompose lactose, sucrose, and rhamnose, but can decompose glucose, produce acid but not gas, is positive for lysine decarboxylase, negative for glutamic acid decarboxylase, and positive for methyl red test. Paratyphoid morphology is similar to that of Salmonella typhi, and can decompose glucose, produce acid and gas. A2 Serological diagnosis method
The classic serological diagnosis method for typhoid fever is the Widal reaction (test tube method), and microagglutination test has been adopted. A2.1 Principle
Use standard typhoid, paratyphoid A, B, and C bacterial solutions to react with the diluted serum to be tested, and judge whether there are antibodies against Salmonella typhi in the serum to be tested based on the agglutination titer. Unlike the traditional Widal reaction, this test is performed on a micro-hemagglutination reaction plate. A2.2 Reagents
Take the diagnostic bacterial solution of Typhoid O and H (7 billion bacteria/mL) and dilute them to 1 billion bacteria/ml with physiological saline. For easy observation, add 10μI of carbofusin (acid-fast staining dye) or 50μl of 20.0g/l methylene blue solution to each 10ml of this diluted bacterial solution. A2.3 Operation
A2.3.1 Dilute the serum to be tested in the wells of the hemagglutination reaction plate, use a 25uL calibration dropper to drop 9 drops of physiological saline into the wells, and then add 1 drop of the serum to be tested and mix well (1:10 dilution). A2.3.2 Operate on an 8×12 well U-shaped well hemagglutination reaction plate. Use 5 rows of wells for each serum to be tested, marked with O, H, A, B, and C respectively. Add 25μL of physiological saline to each well from the second well in each row to the eighth well. A2.3.3 Take the 1:10 diluted serum to be tested and drop 1 drop (25uL.), use a dilution stick to make double continuous dilutions from the 2nd well to the 7th well. No serum is added to the 8th well, which is reserved as a bacterial solution control. Typhoid and paratyphoid diagnostic serum can be used as a positive control for each batch of tests, and the dilution is performed in the same way. 432
GB16001—1995
A2.3.4 Drop the corresponding dyed bacterial solution into each row, 1 drop (25μL) per well. At this time, the total liquid volume of each well is 50μL, and the final dilution of the serum in the 1st to 7th wells is 1:20 to 1:1280. A2.3.5 Mix on a mixer for 1min, cover the hemagglutination reaction plate, and observe the results after 37C6h. A2.4 Result judgment
A positive result is a clear liquid with red or blue fine particles, evenly spread on the bottom of the well; a negative result is a concentration of blue or red bacteria at one point, which is deposited at the bottom of the well, which is the same as the bacterial solution control. The reciprocal of the maximum dilution of serum that produces 50% (2+) agglutination is the titer of the serum to be tested.
A2.5 Reference value
The same as the traditional Widal reaction, that is, under normal circumstances, .0 agglutination titer ≥1:80, H agglutination titer ≥1:160 is of diagnostic value. However, in high-incidence areas, many normal people may also have higher titers due to previous infections. At this time, it is best to first check the local population's immune level and determine the normal value. If the titer of the double serum increases by more than 4 times, it is more meaningful. Appendix B
(Standard Appendix)
Prevention of typhoid and paratyphoid
B1 Monitoring
B1.1 Comprehensively and systematically collect general information on geography, topography, meteorology, economy, culture, transportation, population flow, customs and habits. B1.2 Collect, organize and analyze basic information on population, diseases, causes of death, typhoid vaccination status, population immunity level, etc. B1.3 Keep track of the epidemic data of previous years, analyze the time, space, and human distribution of the epidemic, as well as the mutual influence and dynamic trend of the three.
B1.4 Monitoring of fever patients: In the early stage of the epidemic, patients with unexplained fever for more than 3 days and suspected typhoid patients are registered, and blood or stool specimens are collected for culture and serological examination, in order to detect typhoid patients early. B1.5 Monitoring of key populations: Key populations include: close contacts, fishermen, boat people, students, catering industry practitioners, medical and health personnel, fecal management personnel, cleaners, etc. Key personnel are mainly tested by pathogen culture, and serological methods are used for monitoring when necessary. B1.6 Monitoring of carriers: For patients in the recovery period of typhoid fever, fecal examinations are performed 3 times at 1 month and 3 months after the onset of the disease, with an interval of 1 to 2 days each time, so as to timely detect carriers; typhoid patients in previous years can be regularly tested for carriers, and fecal examinations are performed 3 times a year to detect chronic carriers. B1.7 Etiological monitoring: Phage typing, plasmid analysis and drug sensitivity test of typhoid pathogens in monitoring points are carried out to observe their dynamic changes. B1.8 Water source monitoring: Focus on monitoring the surrounding and related water sources of the epidemic point; strengthen monitoring of other water sources that are easily contaminated. B1.9 Food, feces and fly monitoring.
B1.10 Evaluation of the effectiveness of epidemic prevention measures: Scientific evaluation can be made on the implementation of water improvement, feces management and other epidemic prevention measures in the typhoid monitoring points.
B2 Regular preventive measures
B2.1 Carry out in-depth health education
B2.2 Strengthen the management of drinking water hygiene and sewage treatmentB2.3 Do a good job in feces management and sewage treatment
B2.4 Strengthen food hygiene management
B2.5 Fly control
B2.6 Strengthen the management of fishermen, boat people and floating populationB2.7 Management of carriers
B2.8 Vaccination
GB 16001-1995
The typhoid and paratyphoid A and B triple vaccine currently in use contains 500 million typhoid bacilli and 250 million paratyphoid A and B bacilli per milliliter. The initial vaccination is subcutaneously injected three times, with adult doses of 0.5, 1.0, and 1.0 mL, children aged 1 to 6 years old are 0.2, 0.3, and 0.3 ml, and children aged 7 to 14 years old are 0.3, 0.5, and 0.5 mL, respectively. Each injection is 7 to 10 days apart, and the immunization period is one year. After that, booster injections are given once a year for three consecutive years. The adult dose is 1.0 mL, children aged 1 to 6 years old are 0.3 mL, and children aged 7 to 14 years old are 0.5 mL. The use of this vaccine must be sufficient throughout the whole process, otherwise it will affect the immune effect.
Typhoid Vi polysaccharide vaccine (unit price, excluding paratyphoid A and B) has been successfully trial-produced, with a protection rate of about 70% and a mild reaction. The adult dose is 0.5 mL (containing 30 μg of polysaccharide vaccine), injected intramuscularly on the outer side of the forearm, once a year. B3 Measures when an epidemic occurs
B3.1 General epidemic treatment
B3.1.1 Prepare an epidemic report
B3.1.2 Epidemiological investigation
B3.1.3 Isolate and treat patients
All typhoid patients or suspected patients must be isolated and treated in time. Patients can be released from isolation only after 2 weeks of complete disappearance of clinical symptoms after regular treatment or 2 weeks after disappearance of clinical symptoms and discontinuation of medication, and 2 negative stool tests (2 to 3 days apart). B3.1.4 Disinfection of epidemic sites
B3.1.5 Medical observation
B3.2 Treatment of epidemic outbreaks
B3.2.1 Verify the epidemic report to determine whether there is an outbreak. B3.2.2 Understand the distribution characteristics of outbreak cases B3.2.3 Find out the cause of the outbreak and implement measures to control the outbreak. B3.2.3.1 Establish a temporary prevention and control leading group. B3.2.3.2 Vigorously carry out health education to make the masses understand the causes and prevention methods of typhoid fever and do a good job of prevention. B3.2.3.3 When it is difficult for hospitals to treat patients, temporary isolation treatment points should be set up to isolate patients on the spot. B3.2.3.4 Comprehensively carry out drinking water disinfection and management. B3.2.3.5 Contaminated toilets, floors, tableware, clothing, supplies, etc. in patients' homes and temporary isolation treatment points should be disinfected at any time, and the feces and urine excretions of patients should be strictly disinfected.
B3.2.3.6 Carry out hygienic management of the catering industry and food stalls. B3.2.3.7 Emergency preventive medication, 2 tablets of compound sulfamethoxazole can be used, twice a day, for 3 to 5 days. B3.2.3.8 Vaccinate key populations in the outbreak area and its adjacent areas with typhoid vaccine. Appendix C
(Suggested Appendix)
Treatment of Typhoid and Paratyphoid
C1 Etiological Treatment
C1.1 Choice of Antimicrobial Drugs for Typhoid Patients
C1.1.1 Fluoroquinolones are the First Choice
Fluoroquinolones have the following common characteristics: a) They have a broad antibacterial spectrum, especially high activity against Gram-negative bacilli; 434
GB 16001--1995
b) The incidence of bacterial mutation resistance is low; c) They are widely distributed in the body, with high drug concentrations in tissues and body fluids, which can reach effective antibacterial or bactericidal levels; d) Most varieties are oral preparations, which are easy to use; e) Because they affect bone development, they should be used with caution in pregnant women, children, and lactating women. C1.1.1.1 Ofloxacin
C1.1.1.1.1 Dosage: 300 mg BID orally or 200 mg Q8-12H intravenously. C1. 1. 1. 1.2 Course of treatment: 14 days.
C1.1.1.2 Ciprofloxacin
C1.1.1.2.1 Dosage: 500 mg BID or Q8H, orally or intravenously. C1.1. 1. 2.2 Course of treatment: 14 days.
C1.1.2 Cephalosporins
The second and third generation cephalosporins have strong antibacterial activity against Salmonella typhi in vitro, with low toxicity and side effects, and are particularly suitable for pregnant women, children, lactating women, and typhoid fever caused by chloramphenicol-resistant bacteria. C1.1.2.1 Ceftriaxone
C1.1.2.1.1 Dosage: 1gQ12H for adults, 100mg/(kg·d) for children. C1.1.2.1.2 Course of treatment: 14 days.
C1.1.2.2 Ceftriaxone
C1.1.2.2.1 Dosage: 1~～2gQ8～~12H for adults, 100～~150mg/(kg·d) for children. C1.1.2.2.2 Course of treatment: 14 days.
C1.1.3 Chloramphenicol
C1.1.3.1 Dosage: 25mg/(kg·d), divided into 24 times for oral administration or intravenous drip. After the body temperature returns to normal, the dose is halved. C1.1.3.2 Course of treatment: two weeks.
C1.1.3.3 Precautions:
a) Do not use in newborns, pregnant women, or patients with significant liver damage; b) Pay attention to toxic side effects, check blood counts regularly, and stop taking the drug when the white blood cell count is less than 2.5×10°/l. C1.1.4 Ampicillin (or Amoxicillin)
C1.1.4.1 Dosage: 2-6g/d for adults, 100-150mg/(kg·d) for children, divided into 3-4 times orally or intravenously. Amoxicillin for adults 2-4g/d, divided into 3-4 times orally
C1.1.4.2 Treatment course: 14 days.
C1.1.4.3 Notes:
a) The effect of this drug is not ideal, so the treatment course should be long to reduce recurrence and excretion of bacteria. b) - If drug rash occurs, the drug should be stopped immediately. C1.1.5 Co-trimoxazole
C1.1.5.1 Dosage: 2 tablets for adults (each tablet contains SMZ 400 mg, TMP80 mg) BID. Children SMZ 40-50 mg/(kg*d), TMP10 mg/(kg · d), BID.
C1. 1.5.2 Treatment course: 14 days.
C1.2 Treatment of carriers
C1.2.1 Ampicillin (or amoxicillin) C1.2.1.1 Dosage: 4-6 g/d of ampicillin or 6 g/d of amoxicillin plus 2 g/d of probenecid for adults, divided into 3-4 oral doses. C1.2.1.2 Course of treatment: 6 weeks.
C1.2.2 Ofloxacin or ciprofloxacin
C1.2.2.1 Dosage: 300 mg BID of ofloxacin, 500-750 mg BID of ciprofloxacin orally. C1.2.2.2 Course of treatment: 6 weeks.
General treatment, symptomatic treatment and nursing measures C2.1
Rest in bed.
Supplement adequate water and electrolytes.
Cooling down in case of high fever.
GB 16001
Diet: soft food with little residue, small and frequent meals, provide sufficient calories and vitamins, always eat beans and dairy products when abdominal distension and diarrhea C2.5
Pay attention to oral hygiene and keep the skin clean. Keep bowel movements smooth.
Abdominal distension and diarrhea should be treated symptomatically.
C2.8Prevent bedsores.
C2.9High fever accompanied by neurological symptoms, drug rash after antibiotic use, or severe poisoning symptoms (toxic myocarditis, severe liver and kidney damage), adrenal glucocorticoids can be used in combination with effective antibiotics to improve the body's immune function.
C2.11Fresh blood can be transfused when intestinal bleeding occurs. 4.36
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