COMMUNICABLE

DISEASE
TYPHOID FEVER
INTRODUCTION

 Enteric fever, also known as typhoid fever.

Typhoid fever is an acute illness associated with
fever caused by the Salmonella typhi bacteria. It
can also be caused by Salmonella paratyphi, a
related bacterium that usually causes a less severe
illness.
 Major cause morbidity and mortality.
 Food water borne disease.
 The bacteria are deposited in water or food by a
human carrier and then spread to other people.
DEFINITION

 An acute illness with fever caused by infection with the

Salmonella typhi bacteria contracted from contaminated water
and food. Also called enteric fever, bilious fever and yellow
jack .
ETIOLOGY

 Bacteria :- Virulent bacteria that cause illness

called Salmonella Typhi.

 Fecal oral route :- spread through contaminated

food or water and occasionally through direct
contact with someone who is infected.

 Typhoid Carriers :- these people, called chronic

carriers, shed the bacteria in their faeces and are
capable of infecting others.
RISK FACTORS

 Work in or travel to areas where typhoid fever is

endemic.
 Work as a clinical microbiologist handling
Salmonella typhi bacteria
 Have close contact with someone who is infected or
has recently been infected with typhoid fever.
 Have an immune system weakened by medications
such as corticosteroids or diseases such as
HIV/AIDS.
 Drink water contaminated by sewage that contains S.
typhi.
 Typhoid fever is highly contagious. An
infected person can pass the bacteria
out of their body in their stools
(faeces) or, less commonly, in their
urine.
 Contamination of the water supply
can, in turn, taint the food supply.
The bacteria can survive for weeks in
water or dried sewage.
PATHOPHYSIOLOGY
 Salmonella typhi contracted from contaminated water and
food

 Ingested by human.The S.typhi survives the acidity of the

stomach

 It will invades the payer’s patches of the intestinal wall

 The bacteria is within the macrophages and survives

 Bacteria spreads via the lymphatics while inside the

macrophages
 Access to reticuloendothelial system, liver, spleen,
gallbladder and bone marrow.

1 st week: elevation of the body temperature

2 nd week: abdominal pain, spleen enlargement and

rose spot

3 rd week: necrosis of the payer’s patches

 Leads to perforation, bleeding .And if left

untreated, death is imminent
CLINICAL FEATURES

 Incubation period is typically about 10-14 days but can be

longer, and the onset may be insidious.
 Symptoms are often nonspecific and clinically non
distinguishable from other febrile illnesses. However, clinical
severity varies and severe cases may lead to serious
complications or even death.
Stage 1 (1ST WEEK)
 Slowly rising (stepladder fashion) of temperature for 4-
5 days
 Abdominal pain & myalgia
 Malaise
 Headache
 Constipation
 Relative bradycardia
End of 1ST WEEK
 Rose spots may appear on the upper abdomen
 Cough
 Splenomegaly
 Abdominal distension with tenderness
Stage 2 (2ND WEEK)
 Signs and symptoms of 1st week
progress •
End of 2ND WEEK
 Delirium, complications, then coma
& death (if untreated)
Stage 3 (3RD WEEK)
 Febrile become toxic & anorexic
 Significant weight loss
 Typhoid state (Apathy, confusion & psychosis)
 High risk (5-10%) of hemorrhage and perforation may
cause death.
Stage 4 (4 TH WEEK)
 Recovery period
 If the individual survives to the fourth week, the fever, mental
state, and abdominal distension slowly improve over a few days.
 Intestinal and neurologic complications may still occur in surviving
untreated individuals.
 Weight loss and debilitating weakness last months.
 Some survivors become asymptomatic S typhi carriers and have the
potential to transmit the bacteria indefinitely.
DIAGNOSTIC FINDINGS

 Blood culture (C&S):- A blood culture during the first week

of the fever can show S. typhi bacteria.
 Complete blood count (CBC) :-A complete blood count
(CBC) will show a high number of white blood cells.
DIAGNOSTIC FINDINGS

 Stool C&S :- stool culture may be positive for S.typhi several

days after ingestion of the bacteria.
 Widal test :- Test where by bacteria causing typhoid fever are
mixed with serum containing specific antibodies obtained from
an infected individual.
Other non- specific lab studies
 Moderate anemic, increased ESR, thrombocytopenia, lymphopenia
 Slightly elevated PT and aPTT, decreased fibrinogen level
 Liver transaminases & bilirubin – increased 2x normal
 Mild hyponatremia & hypokalemia
 Serum ALT: LDH > 9:1 = viral hepatitis
< 9:1 = typhoid hepatitis
COMPLICATIONS
BOWEL
 Perforation
 Hemorrhage
SEPTICAEMIC FOCI
 Bone and joint infection
 Meningitis
 Cholecystitis
TOXIC PHENOMENA
 Myocarditis
 Nephritis
CHRONIC CARRIAGE
 Persistent Gallbladder Carriage
TREATMENT

 Activity – rest is helpful

 Medical care
 Antibiotic
 Corticosterois ( for severe typhoid fever)
 Antipyretics
 Diet - fluid and electrolytes should be
monitored. Soft digestible diet is preferable in
absence of abdominal distension and ileus.
 Surgical care – in cases of intestinal perforation
AntibioticTherapy
 Chloramphenicol (500mg qid)
 Ampicillin ( 750mg qid)
 Co-trimoxazole ( 2 tablets/ iv bds)
 Fluoroquinolone (Drug of choice) – ciprofloxacin (500mg
bds)
 3rd generation cephalosporin – ceftriaxone, cefotaxime
(alternative)
 Azithromycin ( 500mg once daily) alternative when
fluoroquinolone resistant is present.
 Treatment should be continued for 14 days.
 Chronic carriers were formerly treated for 4 weeks with
ciprofloxacin but may require an alternative agent and
duration, as guided by antimicrobial sensitivity testing.
NURSING MANAGEMENT
Nursing Diagnosis :Hyperthermia related to increased
metabolic rate, illness.

Nursing Intervention
 Monitor patient temperature degree and patterns Fever
pattern may aids in diagnosing underlying disease.
 Observe for shaking chills and profuse diaphoresis Chills
often precede during high temperature and in presence of
generalized infection.
 Wash hands with anti-bacterial soap before and after each
care of activity and encourage proper hygiene. Reduces cross
contamination and prevents the spread of infection.
 Provide tepid sponge baths and avoid the
use of ice water and alcohol.
 May help reduce fever .Use of ice water and
alcohol may cause chills and can elevate
temperature.
 Monitor for signs of deterioration of
condition or failure to improve with
therapy.mMay reflect inappropriate
antibiotic therapy.
Nursing Diagnosis : Increase frequency of bowel movement
related to disease process.
Nursing Intervention
 Monitor the vital sign such as pulse and respiration To monitor
patient from over dehydration.
 Monitor the Input & Output chart. To maintain the fluid
balance in patient body.
 Encourage the patient to eat more nutritious food such as fruit
& vegetable. To prevent patient from get constipation.
 Encourage pt to drink plenty of water at least 2.5 liters / 24
hours. To maintain hydration status of patient
 Observe the drip infusion & administer the medication as
ordered by doctor. To prevent infection and maintain fluid
balance
Nursing Diagnosis : Imbalance nutrition less than body
requirement related to disease process.
Nursing Intervention
 Monitor the Input & Ouput Chart To maintain nutrient status
of patient
 Assess client’s nutritional patterns . Offer client their favorite
food to ensure patient taken the diet
 Recommend bed rest / activity restrictions during the acute
phase, balanced body weight each day. To minimize the pain
and to maintain patient weight
 Record or report such things as nausea, vomiting, stomach
pain and distension. To do further management to reduce the
symptom.
 Collaboration with a nutritionist for dietary administration
To maintain patient taken diet well.
PREVENTION
 Wash hand before and after handling something.
 Avoid drinking untreated water
 Avoid raw food and vegetables
 Choose well-cooked food
 Avoid popsicles and flavored ices that may have been made
with contaminated water.
 Avoid eat the foods and beverages from the street vendor
 Remember taking antibiotics injection as doctor orders
 Getting vaccinated before travelling to another country where
common gets the typhoid.
 Follow up with the doctor