Typhoid fever, also known as Salmonella typhi or commonly just typhoid, is a common worldwide illness, transmitted by the ingestion of food or water contaminated with the feces of an infected person. The bacteria then perforate through the intestinal wall and are phagocytosed by macrophages. It is caused by the bacterium Salmonella typhi The organism is a Gram-negative short bacillus that is motile due to its peritrichous flagella. The bacterium grows best at 37 °C/99 °F ± human body temperature. This fever received various names, such as gastric fever, abdominal typhus, infantile remittant fever, slow fever, nervous fever, pythogenic fever, etc. The name of ³typhoid " was given by Louis in 1829, as a derivative from typhus.
There are rhonchi in lung bases. green with a characteristic smell. This delirium gives to typhoid the nickname of "nervous fever".
. there is a slowly rising temperature with relative bradycardia. By the end of third week the fever has started reducing (defervescence). Intestinal perforation in the distal ileum: this is a very serious complication and is frequently fatal. each lasting approximately one week. The spleen and liver are enlarged (hepatosplenomegaly) and tender. There is leukopenia. comparable to pea soup. This carries on into the fourth and final week. with eosinopenia and relative lymphocytosis. a rash of flat. Diarrhea can occur in this stage: six to eight stools in a day. frequently calm. a number of complications can occur:
Intestinal hemorrhage due to bleeding in congested Peyer's patches. (The major symptom of this fever is the fever usually rises in the afternoon up to the first and second week. rosecolored spots may appear. profuse sweating. However. the course of untreated typhoid fever is divided into four individual stages.) In the third week of typhoid fever. the patient lies prostrate with high fever in plateau around 40 °C (104 °F) and bradycardia (sphygmothermic dissociation). classically with a dicrotic pulse wave. In the first week. Dehydration ensues and the patient is delirious (typhoid state). this can be very serious but is usually not fatal. a decrease in the number of circulating white blood cells. Less commonly. It may occur without alarming symptoms until septicemia or diffuse peritonitis sets in. headache and cough. A bloody nose (epistaxis) is seen in a quarter of cases and abdominal pain is also possible. cholecystitis. In the second week of the infection. Rose spots appear on the lower chest and abdomen in around a third of patients. malaise. Blood cultures are sometimes still positive at this stage. but sometimes agitated. gastroenteritis. endocarditis and osteitis
The fever is still very high and oscillates very little over 24 hours. Classically. constipation is also frequent. and nonbloody diarrhea. The Widal reaction is strongly positive with antiO and antiH antibodies. a positive diazo reaction and blood cultures are positive for Salmonella typhi or paratyphi. The abdomen is distended and painful in the right lower quadrant where borborygmi can be heard.Signs and symptoms
Typhoid fever is characterized by a slowly progressive fever as high as 40 °C (104 °F). The classic Widal test is negative in the first week. Encephalitis Metastatic abscesses. and there is elevation of liver transaminases. Delirium is frequent.
Public education campaigns encouraging people to wash their hands after defecating and before handling food are an important component in controlling spread of the disease. a young cook who was responsible for infecting at least 53 people with typhoid.S.
. Many carriers of typhoid were locked into an isolation ward never to be released in order to prevent further typhoid cases. The most famous asymptomatic carrier was Mary Mallon (commonly known as "Typhoid Mary"). A person may become an asymptomatic carrier of typhoid fever. the chlorination of drinking water has led to dramatic decreases in the transmission of typhoid fever in the U. suffering no symptoms. According to statistics from the United States Center for Disease Control. driven mad by the conditions they lived in. three of whom died from the disease. but capable of infecting others. According to the Centers for Disease Control approximately 5% of people who contract typhoid continue to carry the disease after they recover.Cause
Flying insects feeding on feces may occasionally transfer the bacteria through poor hygiene habits and public sanitation conditions. These people often deteriorated mentally. Mallon was the first apparently perfectly healthy person known to be responsible for an "epidemic".
bone marrow or stool cultures and with the Widal test (demonstration of salmonella antibodies against antigens O-somatic and H-flagellar).Heterozygous advantage
It is thought that cystic fibrosis may have risen to its present levels (1 in 1600 in UK) due to the heterozygous advantage that it confers against typhoid fever. a therapeutic trial time with chloramphenicol is generally undertaken while awaiting the results of Widal test and cultures of the blood and stool. The term "enteric fever" is a collective term that refers to typhoid and paratyphoid. dysentery or pneumonia.
. after excluding malaria. The CFTR protein is present in both the lungs and the intestinal epithelium.
Diagnosis is made by any blood. and the mutant cystic fibrosis form of the CFTR protein prevents entry of the typhoid bacterium into the body through the intestinal epithelium. In epidemics and less wealthy countries.
the treatment of choice is a fluoroquinolone such as ciprofloxacinotherwise.Sanitation and hygiene are the critical measures that can be taken to prevent typhoid. Careful food preparation and washing of hands are crucial to preventing typhoid. There exists an older killed whole-cell vaccine that is still used in countries where the newer preparations are not available. oral Ty21a vaccine (sold as Vivotif Berna) and the injectable Typhoid polysaccharide vaccine (sold as Typhim Vi by Sanofi Pasteur and Typherix by GlaxoSmithKline). because it has a higher rate of side effects (mainly pain and inflammation at the site of the injection). Boosters are recommended every 5 years for the oral vaccine and every 2 years for the injectable form. Typhoid can only spread in environments where human feces or urine are able to come into contact with food or drinking water. Both are between 50% to 80% protective and are recommended for travelers to areas where typhoid is endemic. a third-generation cephalosporin such as ceftriaxone or cefotaxime is the first choice.
. Typhoid does not affect animals and therefore transmission is only from human to human.
1939 conceptual illustration showing various ways that typhoid bacteria can contaminate a water well (center)
The rediscovery of oral rehydration therapy in the 1960s provided a simple way to prevent many of the deaths of diarrheal diseases in general. but this vaccine is no longer recommended for use. Where resistance is uncommon. Cefixime is a suitable oral alternative. A vaccine against typhoid fever was developed during World War II by Ralph Walter Graystone Wyckoff.[ There are two vaccines currently recommended by the World Health Organization for the prevention of typhoid: these are the live.
Pakistan. Antibiotics. Cefixime is the third generation cephalosporin antibiotic which breaks the cell wall of bacteria that is Salmonella typhi and acetylcysteine neutralize the endotoxin which is released by the bacteria as a waste product of metabolism. typhoid fever persists for three weeks to a month. chloramphenicol. Thailand or Vietnam. India. For these patients. Ciprofloxacin resistance is an increasing problem. The common treatment of Typhoid is Mucomelt-Forte which is the combination of Cefixime with Acetylcysteine.
. because most laboratories around the world (including the West) are dependent on disc testing and cannot test for MICs. It is not certain how this problem can be solved. Death occurs in between 10% and 30% of untreated cases in some communities. however. Bangladesh. and that isolates that are sensitive to both CIP and NAL should be reported as "sensitive to ciprofloxacin". It has also been suggested Azithromycin is better at treating typhoid in resistant populations than both fluoroquinolone drugs and ceftriaxone[ Azithromycin significantly reduces relapse rates compared with ceftriaxone. and these agents have not been used as first line treatment now for almost 20 years Typhoid that is resistant to these agents is known as multidrug-resistant typhoid (MDR typhoid).125±1. case-fatality rates may reach as high as 47%. Prompt treatment of the disease with antibiotics reduces the case-fatality rate to approximately 1%. However.Typhoid fever in most cases is not fatal. an analysis of 271 isolates showed that around 18% of isolates with a reduced susceptibility to ciprofloxacin (MIC 0.0 mg/l) would not be picked up by this method. Many centers are therefore moving away from using ciprofloxacin as first line for treating suspected typhoid originating in South America. There is a separate problem with laboratory testing for reduced susceptibility to ciprofloxacin: current recommendations are that isolates should be tested simultaneously against ciprofloxacin (CIP) and against nalidixic acid (NAL). trimethoprim-sulfamethoxazole and streptomycin is now common. such as ampicillin. chloramphenicol. especially in the Indian subcontinent and Southeast Asia. Amoxicillin and ciprofloxacin.This endotoxin cause rise in body temperature which is the main symptom of typhoid. trimethoprim-sulfamethoxazole. have been commonly used to treat typhoid fever in developed countries. the recommended first line treatment is ceftriaxone.
Resistance to ampicillin. but that isolates testing sensitive to CIP but not to NAL should be reported as "reduced sensitivity to ciprofloxacin". When untreated.
Public Health Nursing Responsibility
Teach members of the family how to report all symptoms to the attending physician especially when patient is being cared at home.
Any bleeding from the rectum. feeding. changing linens. restlessness. Teach. use of bedpan and mouth care. blood in stools. sudden acute abdominal pain.
Take vital signs and teach family member how to take and record same
. such as tepid sponge bath. falling of temperature should be reported at once to the physician or the patient should be brought at once to the hospital. guide and suoervise members of the family on nursing techniques which will contribute patient¶s recovery Interpret to family nature of disease and need for practicing preventive and control measures
Demonstrate to family how to give bedside care.
His writings are the primary source on this outbreak. The cause of the plague has long been disputed.Epidemiology
Incidence of typhoid fever strongly endemic Endemic sporadic cases
Death rates for typhoid fever in the U. including their leader Pericles. with modern academics and medical
. Ancient historian Thucydides also contracted the disease. which some believe to have been typhoid fever.
Around 430±424 BC. killed one third of the population of Athens. Its incidence is highest in children and young adults between 5 and 19 years old.000 deaths in endemic areas. 1906±1960 With an estimated 16±33 million cases of annually resulting in 216. a devastating plague.S. ending the Golden Age of Pericles that had marked Athenian dominance in the ancient world. but he survived to write about the plague. the World Health Organization identifies typhoid as a serious public health problem. The balance of power shifted from Athens to Sparta.
a U. The most notorious carrier of typhoid fever²but by no means the most destructive²was Mary Mallon.
. Russell. In the late 19th century. during the period in question. In 1909.S. She was forcibly quarantined as a carrier of typhoid fever in 1907 for three years and then again from 1915 until her death in 1938. Frederick F. She was a cook in New York. the whole population of Attica was besieged within the Long Walls and lived in tents. In 1897.000 cases and 214 deaths. citing serious methodologic flaws in the dental pulp-derived DNA study. In 1907.000. Army physician. However.S.000 people. greatly reducing mortality. Most developed countries saw declining rates of typhoid fever throughout the first half of the 20th century due to vaccinations and advances in public sanitation and hygiene. Almroth Edward Wright developed an effective vaccine. It eliminated typhoid as a significant cause of morbidity and mortality in the U. Antibiotics were introduced in clinical practice in 1942.
Mary Mallon ("Typhoid Mary") in a hospital bed (foreground).000 people per year.[ Other scientists have disputed the findings.scientists considering epidemic typhus the most likely cause. She died of pneumonia after 26 years in quarantine. She was detained and quarantined after another typhoid outbreak. a 2006 study detected DNA sequences similar to those of the bacterium responsible for typhoid fever. She is closely associated with fifty-three cases and three deaths Public health authorities told Mary to give up working as a cook or have her gall bladder removed. The worst year was 1891. An outbreak in the Democratic Republic of Congo in 2004±05 recorded more than 42. military. she became the first American carrier to be identified and traced. Mary quit her job but returned later under a false name.000 people a year. Today. The disease is most commonly transmitted through poor hygiene habits and public sanitation conditions. when the typhoid death rate was 174 per 100. incidence of typhoid fever in developed countries is around 5 cases per 1. typhoid fever mortality rate in Chicago averaged 65 per 100. developed an American typhoid vaccine and two years later his vaccination program became the first in which an entire army was immunized. also known as Typhoid Mary.
Brett Brian D. Atalan BSN 3H