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Typhoid Fever
Presented by: Paul Miranda
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Other names:
• Enteric Fever • Bilious Fever
• Yellow Jack
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Causative Agent
Salmonella Typhi
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Mode of
Transmission
Ingestion of contaminated food or
water; rarely from person
to person transmissionthrough fecal-oral route.
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Incubation Period
First 7-14 days after
ingestion
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Symptoms
• Diarrhea may occur
• Active infection• Severe Headache
• Generalized AbdominalPain
• Anorexia
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Symptoms
• Fever [usually higher in the
evening]
- Intermittent Fever initially
- Sustained Fever to high
temperatures later
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Symptoms
Severe cases
• ulcers on the intestinalwall
• shock
• delirium
• stupor
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Complications
Intestinal perforation,
gastrointestinal hemorrhage
and peritonitis may occur in the3rd and 4th week of illness;
rarely pancreatitis, hepatic and
splenic abscesses,disseminated intravascular
coagulation, myocarditis,
meningitis, encephalitis.
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PathophysiologySalmonella Typhi
survives the acidity of the stomach
invades the Peyer’s Patches of the intestinal wall
macrophages (Peyer’s Patches)
the bacteria is within the macrophages andsurvives
bacteria spreads via the lymphatics while insidethe macrophages
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Pathophysiology
access to Reticuloendothelial system, liver,spleen, gallbladder and bone marrow
First week: elevation of the body temperature
Second week: abdominal pain, spleen enlargement and rosespots
Third week: necrosis of the Peyer’s Patches
leads to perforation, bleeding
and, if left untreated, death is imminent
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Diagnostics
CBC (normal WBC despite
fever), platelet count
Tourniquet Test
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Diagnostics
Malarial smear (Differential diagnosis)
Chest X-ray
Urinalysis
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Diagnostics
First Week of illness: BloodC/S
Second Week of illness: UrineG/S, C/S
Third Week of illness: StoolC/S
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Management
A. Prevention:
• Choose foods processedfor safety
• Prepare food carefully
• Foods prepared by others
(avoid if possible)(
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Management
• Keep food contact surfacesclean
• Eat cooked food as soon aspossible
• Maintain clean hands
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Management
• Steam or boil shellfish at
least 10 minutes• All milk and dairy
products should be
pasteurized
• Control fly populations
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Management
B. Antibiotics
For uncomplicated cases, useConventional Therapy:
1. Chloramphenicol 3-4 gm per day PO in 4divided doses x 14 days (50-100 mg/kgBW) except it with low WBC.
2. Co-trimoxazole forte or double-strength
tab BID PO x 14 days
3. Amoxicillin 4-6 gm per day PO in 3divided doses x 14 days
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Management
For cases with complications, presence of severesymptoms, or clinical deterioration despiteconventional therapy, use Empiric Therapy for Suspected Resistant Typhoid Fever:
1. Ceftriaxone (Rocephin) 3 gm IV infusion OD x 5-7days
Ceftriaxone may be used for pregnant women andchildren.
2. Fluoroquinolones:
Ciprofloxacin (Ciprobay) 500 mg tab PO BID x 7-10days
Ofloxacin (Inoflox) 400 mg tab PO BID x 7-10 days
Perfloxacin (Floxin) 400 mg tab PO BID x 7-10 days
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Management
D. Public Health Nursing
Responsibility
- Teach members of the familyhow to report all symptomsto the attending physician
especially when patient isbeing cared for at home.
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Management
- Teach, guide and
supervise members of thefamily on nursing
techniques which will
contribute to thepatient’s recovery.
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Management
- Interpret to family nature
of disease and need for
practicing preventive and
control measures.
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Management
E. Nursing Care
- Demonstrate to familyhow to give bedside care,such as tepid sponge
bath, feeding, changing of bed linen, use of bedpanand mouth care.
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Management
- Any bleeding from therectum, blood in stools,
sudden acute abdominalpain, restlessness, falling of temperature should bereported at once to the
physician or the patientshould be brought at once tothe hospital.
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Management
- Take TPR, I&O and teach
family members how to
take and record same.
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Thank you!
