TYPHOID FEVER

Prepared by: Roxanne Mae E. Birador

Is there any difference between Typhus and Typhoid Disease?

YES

Typhus and Typhoid Fever were two different diseases which tended to confuse

people

TYPHUS

Caused by bacteria spreading through the bites of lice and fleas

Rickettsia typhi

Flea-borne infection

TYPHOID

Caused spread by consuming contaminated food or water

Salmonella typhi

Food-borne infection

TYPHOID FEVER(Enteric Fever)

Bacterial infection transmitted by contaminated water, milk, shellfish and other foods.

TYPHOID FEVER(Enteric Fever)

GIT infection affecting the lymphoid tissues of the small intestines called “PEYER’S PATCHES.”

Peyer’s patches detect antigens such as bacteria or toxins in small intestines and mobilize highly WBC termed B-cells to produce an antibody.

PEYER’S PATCHES

Etiologic agent: Salmonella typhosa/typhi

Incubation period: 5-40 days;with a mean of 10-20 days

Period of communicability: It is variable. As long as the patient is excreting microorganism, he is

capable of infecting others.

SOURCES OF INFECTION:

Stools & vomitus of an infected individual.

Ingestion of shellfish (oysters) taken from waters contaminated with sewage disposal.

SOURCES OF INFECTION:

A person who has just recovered from the disease or has recently taken care of a patient with typhoid and was infected is considered a potential carrier.

MODE OF TRANSMISSION:

Fecal - oral routeIngestion of contaminated food, water and milkThrough the 5 F’s

Flies Finger Feces Food Fornication

CLINICAL MANIFESTATIONS: Onset

Head ache Chilly sensation Aching all over the body Nausea Vomiting Diarrhea

During the 4th and 5th days, all symptoms are at their worst

Fever is higher in the morning than in the afternoon

Breathing is accelerating Skin dry and hot

Tongue furred Abdomen distended and tender Rose spots appear on the abdominal wall on the 7th

to 9th days

Typhoid State Tongue protrudes (dry and brown) Patient seems to be staring blankly (coma vigil)

Teeth and lips accumulate a dirty-brown collection of dried mucus and bacteria known as ‘SORDES’ (preventable by nursing good care)

Twitching of the tendon sets in, especially those of the wrist (subsultus tendinum)

Patient mutters deliriously and picks up aimlessly at bedclothes with his finger in a continuous fashion (carphologia)

In severe cases rambling delirium sets, often ending in death

COMPLICATIONS:

2 most dreaded complications; Hemorrhage & Perforation

Peritonitis Bronchitis & Pneumonia Meteorism or excessive distention of the bowels

(TYMPANITES)

Early Heart Failure Septicemia

Typhoid Spine or Neuritis

Reiter’s Syndrome - joint pain, eye irritation and painful urination that can lead to Chronic Arthritis

DIAGNOSTIC TESTS:Typhidot – confirmatory

A medical test consisting of a dot ELISA kit that detects IgM and IgG antibodies against the outer

membrane protein (OMP) of the Salmonella typhi.

The typhidot test becomes positive within 2–3 days of infection and separately identifies IgM and

IgG antibodies.

Widal test

Serological test for enteric fever whereby bacteria causing typhoid fever are mixed with a serum

containing specific antibodies obtained from an infected individual.

ELISA (Enzyme-Linked Immunosorbent Assay)

A technique used to detect antibodies or infectious agents in a sample

Rectal swab

A cotton swab is inserted into the rectum. The swab is rotated gently, and removed.

MODALITIES OF TREATMENT:

Chloramphenicol (drug of choice) Ampicillin Co-trimoxazole Ciprofloxacin or Ciftriaxone If the patient does not respond to

Chloramphenicol, 3rd and 4th generation drugs are administered.

NURSING MANAGEMENT:

Isolation by the medical aseptic technique

Maintain or restore fluid and electrolyte balance by giving nourishing fluids in small quantities at frequent intervals

Monitor Vital signs

Prevent further injury (such as falls) of patient with Typhoid psychosis

Maintain good personal hygiene and mouth care

Cooling measures are necessary during febrile state

Watch out for signs of intestinal bleeding

PREVENTION:

Sanitary and proper disposal of excreta

Proper supervision of food handlers

Enteric isolation

Provision of adequate amounts of safe drinking water supply

Reporting of cases to health authorities

Detection and monitoring of typhoid carriers

Education of the general public on the mode of transmission

PREVENTION:

2 Types of Typhoid Vaccines:

1. The oral vaccine based on the live, attenuated mutant strain of S. typhi Ty21a (Ty21a vaccine), is supplied in enteric coated capsules.

2. The injectable Vi capsular polysaccharide vaccine (ViCPS vaccine) is given intramuscularly in a single dose.

To maintain protection, revaccination is recommended every 3 years