ph

TYPHOID
FEVEB
by spread
an initiating bacteremia ae ever u
Zltaprolonged, systeme nnes arked by a**

** Enterle
yilesn
nena through out the body.
of organisis m tetieune fever
Fever". Enterie
Caused
tever by seratype Typhi i s talled typhoid

etology:

It is caused by Salmonella typhi, it caused by any other serotYpe. t as

paratypho Tever
intectian s usuay spreau oy e w a e contaiinated water
1s
for theorganisms, so personal hygiene vety
an is e oniy natural nost ana e n y in
may i v e in the gallbladder of carriers for months
to years pa
ne Dacn
The incubation period of typhoid fever is about 10-14 days

Pathophysiology small bowel mucosa ana rapiaig ehierts the

period. the bacilli penetrate the
Ater incubation
lymphatics and nenet e througrout
ne renculendnthelial
P o y macrophages and monocytic cells
PE
vug
and
and destruction of macrophages leads to reeeener
u n
epiicaion within O' Dacteremia
nauction recurrent waves
O1
hone marruw ang
in terminal
ileum. spieen,
s m s tnen peyers patches
1ocalize in
at first, then ulcerate
and uitifmatesy rieal,
but
dufing this
mesenteriC
iymph nodes. These swell
o r bleed
sequence they may perforate

Clinical Features:
Signs and Symptoms:
irst usualy fever 40 C (104 F). headache, myalgia. relative bradytard
DurinR week
constipation, diarrhoca and vomitins ncaren cough abdounal distensica

Ar tme
o1 n r s t week
ena
rose SpDEs on tt% 5pienRmegaly.
diarrhoea.
At the end of second week, delirium. compiications, then corma and death (ir untreatedj

rvestigations:
Physical examnation; in tirst week the diagn0SIs may be ditticult. In
acuteiy patient
pritiariy o n the atrdomen
rythematous maculopapular Tasth kiown as rase spots appears
Blood; Leukopenta may ne retiective or a retative ecrease in poiyitiar phonuciear ieukocy t

Feces; contain the organisms more t r e q u e n t y curing tne second and t h i r d week.

oWidal test; the widal reaction detects antibodies to the causative organistia However it t
reliablediagnostic test and shoud be interpreted with caution, particulariy in yp
Vaccine patients.

Management
Antibiotic treatiment
everal antibiotics are etective in enteric fever
cist &Conceptual Clinical Pharmacy Typhoid Fena

dose of 300 mg 12-houriy

ouroquinolones: Ciprofloxacin is the antibacterial of choice in a

Aoxacin and levofloxacin a r e equally effective).

Broad spectrum anti-bacterials (ampicilhn, sulphonamides eg. co-gzimcyarie anu
gternatives; active strains of S typhi, but resistance is a m.ajor probiem
loramphenicol) are a,gainst some efftectve

Third Worid countries has led to the loss of prevtou

use in some Sivity
discriminate early diagnoSis
chloramphenicol. Thus treatment must be guided by
thnicrobials, e,g.
ting and local knowledge. when the organism
is

cefotaxime are useful

ceftriaxone and
cephalosporins:
hird generation contimued for 14 days.
ciprofloxacin. Treatment shouid be
to
sstant
400 oraily twice daily
hronic carriers: norficxacin mg
the drug of choice is
the chronic carrier state,
To alleviate
for 28 days in s o m e cases
may be
necessary
Cholecystectomy:

Prevention: conditions
reduce the
incidence
of typhaid
endemic
should be
inoculated

sanitation and living enteric

infections are
and one oral Iive
:Improved where injectable
countries inactivated
T r a v e l e r s to (two
Vaccines; typhoid
vaccines

availabie
of the three
with one
attenuated). (TYPHERIX)