Reported by: Rosevick Balaba Badoco

Communicable Disease:
TYPHOID FEVER

Definition:
Also known simply as typhoid is a common worldwide bacterial disease transmitted by
the ingestion of food or water contaminated with the feces of an infected person, which
contain the bacterium Salmonella Typhi or Salmonella Paratyphi.
o Typhoid fever is still a major problem with a reported global burden estimate of 26.9 million
cases in 2010 with a case fatality rate of 1%. The Philippines had 2,025 cases of typhoid and
paratyphoid fever in 2010, a marked decrease from the 2003 figure of 16,444 cases. Morbidity
is 30.5/100,000 population and mortality is 1.7/100,000 population.

Causative Agent:
 The main causative agent of typhoid fever is Salmonella typhi and Salmonella
paratyphi, both are members of the Enterobacteriaceae family. Salmonella is a
genus that has two species Salmonella enterica serovar and enteritidis classified
through extensive analysis by multiplex quantitative polymerase chain reaction
(PCR).
 Both Salmonella typhi and Salmonella paratyphi (A, B, C) are Salmonella
enterica serotypes.

Mode of Transmission:
These diseases are spread through sewage contamination of food or water and through
person-to-person contact. People who are currently ill and people who have recovered
but are still passing the bacteria in their poop (stools) can spread Salmonella Typhi and
Salmonella paratyphi.

Incubation Period:
CLINICAL MANIFESTATIONS OF TYPHOID FEVER:

Any individual who lives in or who has history of travel from tropical and subtropical
areas; who presents with fever of > 5 days of fever; fever documented at > 38 degree
celsius.
Signs & Symptoms:
SIGNS:
 Fever+ Abdominal pain
 Symptom onset occurs 5 to 21 days after ingestion
 Fever that starts low and increases daily, possibly reaching as high as 104.9 F
(40.5 C)
 1st week: “Stepwise” fever
 2nd week: Abdominal Pain, “Rose Spots”
 3rd week: Intestinal Bleeding, Hepatosplenomegaly, Intestinal Perforation
SYMPTOMS:
1. Headache
2. Diarrhea
3. Body malaise/ weakness
4. Abdominal distention/pain
5. Gastrointestinal bleeding and changes in orientation/ confusion should be
considered a suspected typhoid fever case (strong recommendation, high quality
of evidence)

Diagnostic Exams:
LABORATORY TESTS THAT CAN BE USED TO CONFIRM THE DIAGNOSIS OF TYPHOID FEVER

• Direct Detection Method

 Culture and Isolation(strong recommendation, high quality of evidence)
 Polymerase chain reaction (conditional recommendation, moderate quality of
evidence)

• Indirect Method
 Antibody detection (conditional recommendation, high quality of evidence)
 Tubex
 Typhidot
 TyphiRapid

Treatment:
 Antibiotic therapy is the only effective treatment for typhoid fever.

Uncomplicated Typhoid Fever

 Amoxicillin 500mg/cap 2 caps q6h for 14 days
 Chloramphenicol 500mg 2caps q6h for 14 days
  TMP-SMX 800/160 mg 1 tab q12h for 14 days
 Cefixime 200 mg 1 tab q12h for 7 days
 Azithromycin 500 mg 1-2 tab q24h for 7 days
 Ciprofloxacin 500mg q12h for 7 days
 Ofloxacin 400 mg 1 tab q12h for 7 days

Complicated Typhoid Fever

First-line treatment Step down antibiotics Duration of treatment
Ceftriaxone 2-3 g IV q24h Cefixime 200 mg 1 tab 14 Days
Azithromycin 1 g IV q24h Azithromycin 500 mg 1tab q24h 7 Days
Ciprofloxacin 400 mg IV q12h Ciprofloxacin 500-750 mg q12h 14 Days
Ofloxacin 400 mg IV q12h Ofloxacin 400 mg 1 tab q12h 14 Days
*Stepping down to an oral antibiotic may be done if patient is afebrile for 48hrs and is
able to tolerate oral medications.
 If intestinal perforation is suspected, surgical evaluation and coverage for
anaerobes must be considered.

Typhoid Fever in Pregnant Patients

First-line treatment Step down antibiotics Duration of treatment
Ampicillin 1-2 g IV q6h Amoxicillin 1 g q6h 10-14 days
Ceftriaxone 2-3 g IV q24h Cefixime 200 mg 1 tab q12h 7 days

Nursing Care:
 Observation of the client's body temperature
 Give compress with warm water (water) on axilla area, groin, temporal when heat
 Encourage families to put on clothing that can absorb sweat like cotton
 Collaboration with doctors in the provision of antipyretic
 Assess client's nutritional patterns
 Assess eating likes and dislikes
 Encourage bed rest / activity restrictions during the acute phase
 Measure weight every day
 Encourage clients to eat little but often
 Collaboration with a dietitian for a diet providing

Complications:
 Intestinal Bleeding
 Perforation
 Inflammation of the heart muscle (myocarditis)
 Inflammation of the lining of the heart and valves (endocarditis)
 Infection of major blood vessels (mycotic aneurysm)
 Pneumonia
 Inflammation of the pancreas (pancreatitis)
 Kidney or bladder infections
  Infection and inflammation of the membranes and fluid surrounding your brain
and spinal cord (meningitis)
 Psychiatric problems, such as delirium, hallucinations and paranoid psychosis

Prevention:
 Get vaccinated against typhoid fever.
 Ensure food is properly cooked and still hot when served.
 Avoid raw milk and products made from raw milk. Drink only pasteurized or
boiled milk.
 Avoid ice unless it is made from safe water.
 When the safety of drinking water is questionable, boil it or if this is not possible,
disinfect it with a reliable, slow-release disinfectant agent (usually available at
pharmacies).
 Wash hands thoroughly and frequently using soap, in particular after contact with
pets or farm animals, or after having been to the toilet.
 Wash fruits and vegetables carefully, particularly if they are eaten raw. If
possible, vegetables and fruits should be peeled.

SOURCES:
 The Philippine Clinical Practice Guidelines on the Diagnosis, Treatment and Prevention of
Typhoid Fever in Adults 2017 by: Philippine Society for Microbiology and Infectious Diseases;
http://thepafp.org/website/wp-content/uploads/2017/05/2017-Typhoid-fever-in-Adults.pdf
 https://www.cdc.gov/typhoid-fever/sources.html