Typhoid fever

Presented TO:
SIR SUBHAN ARSHAD
PRESENTED BY:
Warda Irfan
 Typhoid fever
 Typhoid is a bacterial infection that leads to a high fever, diarrhea and vomiting. It can be fatal. It is caused
by Salmonella typhi.

 It is also known as Enteric fever, Gastric fever, Abdominal typhus, drain fever.

 Typhoid fever is particularly high grade fever, gradually increasing over several days up to 104°F & 39-40°C
Etiology:
 Typhoid is caused by S. typhi;
S. enterica, subspecies enterica (serotype Typhi & Paratyphi A & B)

 It is gram negative bacilli, facultative, aerobic, non spore forming organism.

 S. Typhi contain 3 main antigens
--- Oligosaccharide somatic “O” antigen
--- Flagella “H” antigen
--- Virulence “Vi” antigen

 Although typhoid fever is now a rare disease but this infection causes an estimated 30 million
cases and 215,000 deaths annually worldwide.
Environmental & Social factor:
 Enteric fever is observed throughout year . The peak incidence is reported during July – September.
 Some social factors include pollution of drinking water, open air defecation & urination, low standard
food and health ignorance.
 The incubation period is 6 to 30 days; illness onset is insidious with gradually increasing fatigue and
fever

Pathophysiology:
 Its pathophysiology is subject ingest the contaminated food or bacilli enters the body that invade
small intestine mucosa , taken up by microphage & transport to regional lymph node.
 The S.typhi multiply in the intestinal lymphoid tissue which intact with enterocytes & M cells during
1-3 week of incubation period. after the incubation period bacilli enters blood stream . Then it
invade the gallbladder, biliary system and lymphatic tissue of bowl and multiply in number and then
pass into intestinal tract (stools)
Symptoms:
Common symptoms includes
• Headache
• Fever
• Rash or itching
• Sweating
• Diarrhea or constipation
• Cough
• Sore throat
• Abdominal pain
• After 7-10 days, fever reaches plateau.
Clinical manifestation:

 Febrile illness 5 to 21 days after ingestion of contaminated food or water, which may be persistent
and high-grade. A relative bradycardia may be noted at the fever peak.
 Chills, diaphoresis, headache, anorexia, cough, weakness, sore throat, dizziness, muscle pain, and
diarrhea may be present before onset of fever.
 Rose spots, a coated tongue, and/or hepatosplenomegaly may be noted.
 Intestinal hemorrhage or perforation, leukopenia, anemia, and subclinical disseminated
intravascular coagulopathy may occur.
Diagnosis:
For lab diagnosis, specimen and diagnostic tests are according to the duration of fever.

 Blood culture
 Stool culture
 Widal test (authentic test in which O & H antigens appears to confirm test)
 Urine culture
 Bone marrow
Vaccine:
Vaccination is increasingly important for travelers to consider since the growth of multidrug-resistant
strains of Salmonella serotype.

 Vi capsular polysaccharide vaccine (inactivated typhoid vaccine): Typhim VI (Sanofi Pasteur);

Typherix (GSK)
Given as single injection. It may be given to people 2 years and older.
 Ty21a oral vaccine (Live typhoid vaccine): Vivotif (PaxVax)
Given as 3 capsules to take on alternative days.
 Combined hepatitis A and Vi polysaccharide vaccine: ViVaxim and ViATIM (Sanofi Pasteur);
Hepatyrix (GSK)
Available for people aged 15 or over. Protection against Hepatitis last for 1 year & for
typhoid 3 years.
 Conjugate Vaccine (TCV):
It is given to the age of 9 to 12 months . Pakistan introduce this vaccine on the
recommendation of WHO
Treatment:
 General: Supportive care include
--- Maintenance of adequate hydration
--- Appropriate nutrition
--- Antipyretic (Paracetamol)
 Specific: Antimicrobial therapy is main stay treatment
o Antibiotics:
--- Fluoroquinolone (e.g , levofloxacin, ciprofloxacin)
Dose: (oral 500mg BD or IV 400mg BD for 5-7 days)
--- 3rd generation cephalosporin (e.g, ceftriaxone)
Dose: (oral 1g OD for 7-14 days)
--- Chloramphenicol: (oral 2-3g in 4 divided dose for 14-21 days)
o Corticosteroids:
--- Hydrocortisone
--- Dexamethasone

o Azithromycin or ceftriaxone are preferred in children.

Chronic Carrier State:
Chronic carrier state, defined as positive stool or urine cultures for more than 12 months,
develops in 1% to 4% of adults with typhoid fever.
 Amoxicillin (3 g orally divided three times a day in adults for 3 months),
 Trimethoprim-sulfamethoxazole (one double-strength tablet orally twice a day for 3 months),
 Ciprofloxacin (750 mg orally twice daily for 4 weeks).
 Surgery in combination with antibiotic therapy is indicated in patients with biliary tract
abnormalities