Pathophysiology of Enteric Fever Transmission Diagram

Pathophysiology of Enteric Fever is shown below in the cycle of usual infection transmission. Salmonella paratyphi
may produce ulceration lower down in the intestines and these organisms pass through the feces resulting in
contamination of the water and food supply by carriers or flies which are the usual transmission of infection

The mostly cause of enteric fever, Salmonella typhi, enters the lymphoid follicles and affects the ileum (particularly
lower part). If necrosis and ulceration happened, the mesenteric lymph nodes become infected and the salmonella
invades the bloodstream via the thoracic duct. This conditions called bacteremia which could be happened up to the
fourth week. Now, the bone marrow, spleen, kidney, liver, and gallbladder may become infected and the gallbladder
may re-infect the intestines causing further acute inflammation of the lymphoid follicles.

Typhoid Fever - Presentation Transcript

1. Typhoid Fever Presented by: Dave Jay S. Manriquez, BSN, RN

2. Other names:
o Enteric Fever
o Bilious Fever
o Yellow Jack
3. Causative Agent Salmonella Typhi
4.
o 3 main antigenic factors:
o the O, or somatic antigen
o the Vi, or encapsulation antigen
o the H, or flagellar antigen
5. Epidemiology
o World: 17 million cases per year
o U.S.: 400 cases per year (70% in travelers)
o Philippines: (Nov 2006) 478 in Agusan del Sur; (May 2004) 292 in Bacolod City
6.
o Incidence of Typhoid Fever
o red - strongly endemic; orange – endemic;
o gray - sporadic cases
7. Mode of Transmission
o Ingestion of contaminated food or water; rarely from person to person transmission
through fecal-oral route.
8. Incubation Period
o First 7-14 days after ingestion
9. Symptoms
o Diarrhea may occur
o Active infection
o Severe Headache
o Generalized Abdominal Pain
o Anorexia
10. Symptoms
o Fever [usually higher in the evening]
o - Intermittent Fever initially
o - Sustained Fever to high temperatures later
11. Symptoms
 o Severe cases
o ulcers on the intestinal wall
o shock
o delirium
o stupor
12. Pathognomonic Sign
o Rose Spots
o Blanching pink macular spots 2-3 mm over trunk
13. Complications
o Intestinal perforation, gastrointestinal hemorrhage and peritonitis may occur in the 3rd
and 4th week of illness; rarely pancreatitis, hepatic and splenic abscesses, disseminated
intravascular coagulation, myocarditis, meningitis, encephalitis.
14. Pathophysiology
o Salmonella Typhi

survives the acidity of the stomach invades the Peyer’s Patches of the intestinal wall
macrophages (Peyer’s Patches) the bacteria is within the macrophages and survives bacteria
spreads via the lymphatics while inside the macrophages

15. Pathophysiology access to Reticuloendothelial system, liver, spleen, gallbladder and bone
marrow First week: elevation of the body temperature Second week: abdominal pain, spleen
enlargement and rose spots Third week: necrosis of the Peyer’s Patches leads to perforation,
bleeding and, if left untreated, death is imminent
16. Diagnostics
o CBC (normal WBC despite fever), platelet count
o Tourniquet Test
17. Diagnostics
o Typhi dot test (if illness is 4 days or longer)
o Interpretation:
o Ig M Ig G
o (+) (- ) Acute infection
o (+) (+) Recent infection
o (- ) (+) Equivocal: Past
o infection or acute
o infection
18. Diagnostics
o Malarial smear (Differential diagnosis)
o Chest X-ray
o Urinalysis
19. Diagnostics
o First Week of illness: Blood C/S
o Second Week of illness: Urine G/S, C/S
o Third Week of illness: Stool C/S
20. Management
o A. Prevention:
o Choose foods processed for safety
o Prepare food carefully
 o Foods prepared by others (avoid if possible)
21. Management
o Keep food contact surfaces clean
o Eat cooked food as soon as possible
o Maintain clean hands
22. Management
o Steam or boil shellfish at least 10 minutes
o All milk and dairy products should be pasteurized
o Control fly populations
23. Management
o B. Antibiotics
o For uncomplicated cases, use Conventional Therapy:
o 1. Chloramphenicol 3-4 gm per day PO in 4 divided doses x 14 days (50-100 mg/kg BW)
except it with low WBC.
o 2. Co-trimoxazole forte or double-strength tab BID PO x 14 days
o 3. Amoxicillin 4-6 gm per day PO in 3 divided doses x 14 days
24. Management
o For cases with complications, presence of severe symptoms, or clinical deterioration
despite conventional therapy, use Empiric Therapy for Suspected Resistant Typhoid
Fever:
o 1. Ceftriaxone (Rocephin) 3 gm IV infusion OD x 5-7 days
o Ceftriaxone may be used for pregnant women and children.
o 2. Fluoroquinolones:
o Ciprofloxacin (Ciprobay) 500 mg tab PO BID x 7-10 days
o Ofloxacin (Inoflox) 400 mg tab PO BID x 7-10 days
o Perfloxacin (Floxin) 400 mg tab PO BID x 7-10 days
25. Management
o C. Vaccines

5 years 1 capsule every other day, total of 3 capsules Oral 6 years Ty21 a, live 3 years 0.5 ml
Subcutaneous 2 years Vi CPS 3 years 0.5 ml (0.25 ml for children < 10y) x 2 times, 4 weeks apart
Subcutaneous 5 years Killed whole-cell vaccine Revaccination Dosage Route Age Vaccine

26. Management
o D. Public Health Nursing
o Responsibility
o - Teach members of the family how to report all symptoms to the attending physician
especially when patient is being cared for at home.
27. Management
o - Teach, guide and supervise members of the family on nursing techniques which will
contribute to the patient’s recovery.
28. Management
o - Interpret to family nature of disease and need for practicing preventive and control
measures.
29. Management
o E. Nursing Care
 o - Demonstrate to family how to give bedside care, such as tepid sponge bath, feeding,
changing of bed linen, use of bedpan and mouth care.
30. Management
o - Any bleeding from the rectum, blood in stools, sudden acute abdominal pain,
restlessness, falling of temperature should be reported at once to the physician or the
patient should be brought at once to the hospital.
31. Management
o - Take TPR, I&O and teach family members how to take and record same.
32. Historical Background Mary Mallon (September 23, 1869 – November 11, 1938)