Typhidot is 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. The test is based on the presence of specific IgM and IgG
antibodies to a specific 50Kd OMP antigen, which is impregnated on nitrocellulose
strips. IgM shows recent infection where as IgG signifies remote infection. The most
important limitation of this test is that it is not quantitative and result is only positive or
negative. Whereas a detailed Widal test can tell the titres of specific antibodies.
However both tests lack sensitivity and specificity. The Widal test is losing its value as it
is labor intensive and time consuming

The Typhidot test was developed by a Malaysian scientist for the quick diagnosis of
typhoid fever and has recently been introduced commercially. This test utilizes the
principle of antigen-antibody reaction. It costs less than a blood culture, and results are
much faster. they can be obtained within the same day as the examination.
Typhoid Fever - Presentation Transcript

1. Typhoid Fever Presented by: Dave Jay S. Manriquez, BSN, RN

2. Other names:
o Enteric Fever
o Bilious Fever
o Yellow Jack
3. Causative Agent Salmonella Typhi
4.
o 3 main antigenic factors:
o the O, or somatic antigen
o the Vi, or encapsulation antigen
o the H, or flagellar antigen
5. Epidemiology
o World: 17 million cases per year
o U.S.: 400 cases per year (70% in travelers)
o Philippines: (Nov 2006) 478 in Agusan del Sur; (May 2004) 292 in Bacolod
City
6.
o Incidence of Typhoid Fever
o red - strongly endemic; orange – endemic;
o gray - sporadic cases
7. Mode of Transmission
o Ingestion of contaminated food or water; rarely from person to person
transmission through fecal-oral route.
8. Incubation Period
o First 7-14 days after ingestion
9. Symptoms
o Diarrhea may occur
o Active infection
o Severe Headache
o Generalized Abdominal Pain
o Anorexia
10. Symptoms
o Fever [usually higher in the evening]
o - Intermittent Fever initially
o - Sustained Fever to high temperatures later
11. Symptoms
o Severe cases
o ulcers on the intestinal wall
o shock
o delirium
o stupor
12. Pathognomonic Sign
 o Rose Spots
o Blanching pink macular spots 2-3 mm over trunk
13. Complications
o Intestinal perforation, gastrointestinal hemorrhage and peritonitis may
occur in the 3rd and 4th week of illness; rarely pancreatitis, hepatic and
splenic abscesses, disseminated intravascular coagulation, myocarditis,
meningitis, encephalitis.
14. Pathophysiology
o Salmonella 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 and
survives bacteria spreads via the lymphatics while inside the macrophages

15. 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 rose spots Third week: necrosis of the
Peyer’s Patches leads to perforation, bleeding and, if left untreated, death is
imminent
16. Diagnostics
o CBC (normal WBC despite fever), platelet count
o Tourniquet Test
17. Diagnostics
o Typhi dot test (if illness is 4 days or longer)
o Interpretation:
o Ig M Ig G
o (+) (- ) Acute infection
o (+) (+) Recent infection
o (- ) (+) Equivocal: Past
o infection or acute
o infection
18. Diagnostics
o Malarial smear (Differential diagnosis)
o Chest X-ray
o Urinalysis
19. Diagnostics
o First Week of illness: Blood C/S
o Second Week of illness: Urine G/S, C/S
o Third Week of illness: Stool C/S
20. Management
o A. Prevention:
o Choose foods processed for safety
o Prepare food carefully
o Foods prepared by others (avoid if possible)
21. Management
 o Keep food contact surfaces clean
o Eat cooked food as soon as possible
o Maintain clean hands
22. Management
o Steam or boil shellfish at least 10 minutes
o All milk and dairy products should be pasteurized
o Control fly populations
23. Management
o B. Antibiotics
o For uncomplicated cases, use Conventional Therapy:
o 1. Chloramphenicol 3-4 gm per day PO in 4 divided doses x 14 days (50-
100 mg/kg BW) except it with low WBC.
o 2. Co-trimoxazole forte or double-strength tab BID PO x 14 days
o 3. Amoxicillin 4-6 gm per day PO in 3 divided doses x 14 days
24. Management
o For cases with complications, presence of severe symptoms, or clinical
deterioration despite conventional therapy, use Empiric Therapy for
Suspected Resistant Typhoid Fever:
o 1. Ceftriaxone (Rocephin) 3 gm IV infusion OD x 5-7 days
o Ceftriaxone may be used for pregnant women and children.
o 2. Fluoroquinolones:
o Ciprofloxacin (Ciprobay) 500 mg tab PO BID x 7-10 days
o Ofloxacin (Inoflox) 400 mg tab PO BID x 7-10 days
o Perfloxacin (Floxin) 400 mg tab PO BID x 7-10 days
25. Management
o C. Vaccines

5 years 1 capsule every other day, total of 3 capsules Oral 6 years Ty21 a, live 3
years 0.5 ml Subcutaneous 2 years Vi CPS 3 years 0.5 ml (0.25 ml for children <
10y) x 2 times, 4 weeks apart Subcutaneous 5 years Killed whole-cell vaccine
Revaccination Dosage Route Age Vaccine

26. Management
o D. Public Health Nursing
o Responsibility
o - Teach members of the family how to report all symptoms to the attending
physician especially when patient is being cared for at home.
27. Management
o - Teach, guide and supervise members of the family on nursing
techniques which will contribute to the patient’s recovery.
28. Management
o - Interpret to family nature of disease and need for practicing preventive
and control measures.
29. Management
o E. Nursing Care
 o - Demonstrate to family how to give bedside care, such as tepid sponge
bath, feeding, changing of bed linen, use of bedpan and mouth care.
30. Management
o - Any 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 be brought at once to the hospital.
31. Management
o - Take TPR, I&O and teach family members how to take and record same.
32. Historical Background Mary Mallon (September 23, 1869 – November 11, 1938)