Typhoid Fever (Enteric Fever)

7/29/2019 Typhoid Fever (Enteric Fever)

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TYPHOID FEVER (ENTERIC

FEVER)By: Ma. Noela Jessette L. Arcega

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ETIOLOGY

Typhoid fever, also known as typhoid, is acommon worldwide bacterial disease, aninfection, and an acute illness accompanied byfever caused by gram negative bacilli called asSalmonella typhi (S. typhi) which is the mostvirulent serotype ofSalmonella.
http://rnspeak.com/community-health-nursing/public-health-nursing-in-the-philippines-10-edition-typhoid-fever-its-cause-transmission-and-prevention-by-s-n-khosla/http://rnspeak.com/community-health-nursing/public-health-nursing-in-the-philippines-10-edition-typhoid-fever-its-cause-transmission-and-prevention-by-s-n-khosla/http://rnspeak.com/community-health-nursing/public-health-nursing-in-the-philippines-10-edition-typhoid-fever-its-cause-transmission-and-prevention-by-s-n-khosla/http://rnspeak.com/community-health-nursing/public-health-nursing-in-the-philippines-10-edition-typhoid-fever-its-cause-transmission-and-prevention-by-s-n-khosla/


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EPIDEMIOLOGY

With an estimated 1633 million cases oftyphoid fever annually resulting in 216,000

600,000 deaths in endemic areas, theWorld HealthOrganization identifies typhoid as a serious publichealth problem. Its incidence is highest in childrenand young adults between 5 and 19 years old.

In the Philippines recent outbreak declared inTuburan, Cebu City after recording 924 cases oftyphoid and three deaths. The Department of Healthpresumed that the residents contaminated water wasthe source of the disease.
http://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/World_Health_Organizationhttp://en.wikipedia.org/wiki/World_Health_Organization


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MODE OF TRANSMISSION

Fecal-oral route

Those carriers can then be a cause for futureoutbreaks of typhoid fever especially if there isimproper sanitation and handling of food andpoor hygiene. Furthermore, flying insects that

feed in feces can spread the bacteria inunhygienic places such as public areas.


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MODE OF TRANSMISSION

Many carriers of typhoid were locked into anisolation ward never to be released to preventfurther typhoid cases. These people oftendeteriorated mentally, driven mad by theconditions they lived in.

TYPHOID MARY


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INCUBATION PERIOD

Average of 2 weeks (14 days); usual range 1 to 3weeks

May persist as long as 60 days


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PATHOGENESIS

The pathogenesis of enteric fever depends on anumber of factors including the infecting speciesand infectious dose. Ingested organisms surviveexposure to gastric acid before gaining access tothe small bowel, where they penetrate the

epithelium, enter the lymphoid tissue, anddisseminate via the lymphatic or hematogenousroute. A chronic carrier state is established in anestimated 1 to 5 percent of cases.


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1. Ingestion of food or water contaminated withSalmonella typhi

2. The bacteria adheres and invades the gut wallof the gastrointestinal tract

3. It enters the distal ileum (Peyers patches)

4. S.typhihas a Vi capsular antigen that avoidsneutrophil- based inflammation. It induceshost macrophages to attract moremacrophages.

5. The bacteria enters the macrophages cellularmachinery for their own reproduction which iscarried through the mesenteric lymph nodes.


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6. It enters the thoracic duct then the lymphaticsystem and then through the tissues of the liver,

spleen, bone marrow, and lymph nodes.7. The bacteria continue to multiply until itreached a critical density (1,000,000 to cause an

infection).8. It then induces apoptosis of the macrophagesand leaking into the blood stream (bacteremia)and to the rest of the body.


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PATHOPHYSIOLOGY

TYPHOID FEVER The gallbladder isinfected through extension of infection of bacteria

or via bacteremia S.typhireinvades thegastrointestinal tract as well as the Peyers patches

The bacteria that does not re- infect thehost is shed into the stool

The bacteria that remained present in thesystem of the host pauses and continuos tomultiply which makes the host as carrier for along time.


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PATHOGNOMONIC SIGNS

1. ladder like fever

2. rose spots

3. splenomegaly


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MANIFESTATIONS

a. Gradual Onset

Headache, malaise, poor appetite

Chills and fever

Rose spots- skin eruptions seen on abdomen,chest, back (within 3-4 days)

Splenomegaly in some cases


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b. Second week

Fever remains consistently high

Abdominal distention

Constipation and later on diarrhea

Lethargy

Intestinal bleeding and perforation (after 2-3weeks)

c. Gradual decline in fever and symptomssubsides, too.
http://rnspeak.com/pathophysiology/typhoid-fever-pathophysiology-schematic-diagram/rnspeak.com/nursing-care-plan/fever-hyperthermia-nursing-care-plan/http://rnspeak.com/pathophysiology/typhoid-fever-pathophysiology-schematic-diagram/rnspeak.com/nursing-care-plan/fever-hyperthermia-nursing-care-plan/


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SIGNS AND SYMPTOMS

Fever as high 40 C (104 F)

Headache

Stomach pain

Weakness

Diarrhea or constipation

Loss of appetite and severe weigh lossRash with flat rose-colored spots


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TESTS

Acomplete blood count (CBC) will show a highnumber of white blood cells.

Ablood culture during the first week of the fevercan showS. typhibacteria.

A stool culture on the second week
http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003642/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003744/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003744/http://www.ncbi.nlm.nih.gov/pubmedhealth/n/pmh_adam/A003642/


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NURSING INTERVENTIONS

Health Teaching

Teach members of the family how to report allsymptoms to the attending physician especiallywhen patient is being cared for at home

Teach, guide and supervise members of the

family on nursing techniques which willcontribute to the patients recovery

Interpret to family nature of disease and needfor practicing preventive and control measures.


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ManagementDemonstrate to family how to give bedside care

such as tepid sponge, feeding changing of

bedlinen,use of bedpan and mouth careAny bleeding from the rectum, blood in stools

sudden acute abdominal pain restlessness,falling of temperature should be reported at

once to the physician or the patient should bebrought at once to the hospital.Take vital signs and teach patient family

member how to take and record same.


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MEDICAL TREATMENT

Chlorampenicol 3-4 gm per day PO in 4 divideddoses for 14 days or

Co-Trimoxazoleforte or double -strength tabtwice a day PO for 14 days or

Amoxyxillin 4-6 gm per day PO in 3 divided

doses for 14 daysThe most effective antityphoidal drugs are

quinolones or third generation cephalosphorins.


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PREVENTION

Vaccines

Water treatment

Waste disposal

Protecting the food supply from contamination

Carriers of typhoid must not be allowed to work

as food handlers.


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FIGURES


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FIGURES


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REFERENCES

Public Health Nursing in the Philippines 10thedition

Typhoid fever, its cause, transmission andprevention by S.N. Khosla http://www.uptodate.com/contents/pathogenesis-

of-typhoid-fever RNSpeak.com

Tortora, G.J., Funke, B.R., Case, C.L. (2007).Microbiology: An introduction. 9th edition.Singapore: Benjamin Cummings

Mosbys Pocket Dictionary of Medicine, Nursing andHealth Professions 6th edition
http://www.uptodate.com/contents/pathogenesis-of-typhoid-fever?source=see_linkhttp://www.uptodate.com/contents/pathogenesis-of-typhoid-fever?source=see_linkhttp://www.uptodate.com/contents/pathogenesis-of-typhoid-fever?source=see_linkhttp://www.uptodate.com/contents/pathogenesis-of-typhoid-fever?source=see_linkhttp://www.uptodate.com/contents/pathogenesis-of-typhoid-fever?source=see_linkhttp://www.uptodate.com/contents/pathogenesis-of-typhoid-fever?source=see_linkhttp://www.uptodate.com/contents/pathogenesis-of-typhoid-fever?source=see_linkhttp://www.uptodate.com/contents/pathogenesis-of-typhoid-fever?source=see_linkhttp://www.uptodate.com/contents/pathogenesis-of-typhoid-fever?source=see_link


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