Typhoid Fever

Presented by: Dave Jay S. Manriquez, BSN, RN

Other names:
• Enteric Fever • Bilious Fever • Yellow Jack

Causative Agent

Salmonella Typhi

or somatic antigen • the Vi. or flagellar antigen .3 main antigenic factors: • the O. or encapsulation antigen • the H.

: 400 cases per year (70% in travelers) • Philippines: (Nov 2006) 478 in Agusan del Sur.Epidemiology • World: 17 million cases per year • U.S. (May 2004) 292 in Bacolod City .

strongly endemic. gray . orange – endemic.sporadic cases .Incidence of Typhoid Fever red .

. rarely from person to person transmission through fecal-oral route.Mode of Transmission Ingestion of contaminated food or water.

Incubation Period First 7-14 days after ingestion .

Symptoms • Diarrhea may occur • Active infection • Severe Headache • Generalized Abdominal Pain • Anorexia .

Intermittent Fever initially .Symptoms • Fever [usually higher in the evening] .Sustained Fever to high temperatures later .

Symptoms Severe cases • ulcers on the intestinal wall • shock • delirium • stupor .

Pathognomonic Sign • Rose Spots Blanching pink macular spots 23 mm over trunk .

rarely pancreatitis. hepatic and splenic abscesses.Complications Intestinal perforation. . encephalitis. disseminated intravascular coagulation. gastrointestinal hemorrhage and peritonitis may occur in the 3rd and 4th week of illness. meningitis. myocarditis.

Pathophysiology 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 .

liver. spleen. gallbladder and bone marrow First week: elevation of the body temperature Second week: abdominal pain. if left untreated. spleen enlargement and rose spots Third week: necrosis of the Peyer’s Patches leads to perforation. death is imminent .Pathophysiology access to Reticuloendothelial system. bleeding and.

platelet count Tourniquet Test .Diagnostics CBC (normal WBC despite fever).

) Acute infection (+) (+) Recent infection (.Diagnostics Typhi dot test (if illness is 4 days or longer) Interpretation: Ig M Ig G (+) (.) (+) Equivocal: Past infection or acute infection .

Diagnostics Malarial smear (Differential diagnosis) Chest X-ray Urinalysis .

C/S Third Week of illness: Stool C/S .Diagnostics First Week of illness: Blood C/S Second Week of illness: Urine G/S.

Prevention: • Choose foods processed for safety • Prepare food carefully • Foods prepared by others (avoid if possible) .Management A.

Management • Keep food contact surfaces clean • Eat cooked food as soon as possible • Maintain clean hands .

Management • Steam or boil shellfish at least 10 minutes • All milk and dairy products should be pasteurized • Control fly populations .

Antibiotics For uncomplicated cases. Co-trimoxazole forte or double-strength tab BID PO x 14 days 3. Chloramphenicol 3-4 gm per day PO in 4 divided doses x 14 days (50-100 mg/kg BW) except it with low WBC.Management B. Amoxicillin 4-6 gm per day PO in 3 divided doses x 14 days . use Conventional Therapy: 1. 2.

Fluoroquinolones: Ciprofloxacin (Ciprobay) 500 mg tab PO BID x 7-10 days Ofloxacin (Inoflox) 400 mg tab PO BID x 7-10 days Perfloxacin (Floxin) 400 mg tab PO BID x 7-10 days . 2. presence of severe symptoms. use Empiric Therapy for Suspected Resistant Typhoid Fever: 1. or clinical deterioration despite conventional therapy.Management For cases with complications. Ceftriaxone (Rocephin) 3 gm IV infusion OD x 5-7 days Ceftriaxone may be used for pregnant women and children.

5 ml 4 weeks 1 capsule 5 years apart every other day. total of Revaccina tion 3 years Subcutan eous Oral .Management C. Vaccines Vaccine Age Route Subcutan eous Dosage Killed 5 years wholecell vaccine Vi CPS Ty21 a. live 2 years 6 years 0.25 ml for children < 10y) x 2 times. 3 years 0.5 ml (0.

Teach members of the family how to report all symptoms to the attending physician especially when patient is being cared for at home. . Public Health Nursing Responsibility .Management D.

.Management .Teach. guide and supervise members of the family on nursing techniques which will contribute to the patient’s recovery.

Management .Interpret to family nature of disease and need for practicing preventive and control measures. .

Nursing Care .Management E. changing of bed linen. . feeding.Demonstrate to family how to give bedside care. such as tepid sponge bath. use of bedpan and mouth care.

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.Management . .Any bleeding from the rectum. blood in stools.

Management . .Take TPR. I&O and teach family members how to take and record same.

Historical Background Mary Mallon (September 23. 1869 – November 11. 1938) .

Thank you! .

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