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17 Espina, Pia Xyra A.

18 Faderugao, Martina D.

Pharmaceutical Care 2

Typhoid fever (Enteric 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.
-is contracted by drinking or eating the bacteria in contaminated food or water. People with
acute illness can contaminate the surrounding water supply through stool, which contains a
high concentration of the bacteria. Contamination of the water supply can, in turn, taint the
food supply.
Epidemiology
Between 1 January and 13 November 2013, 28 224 cases of suspected or clinically
diagnosed typhoid fever were recorded in the Philippines. Two of these cases resulted in
death, yielding a case-fatality rate of 0.27%
During the same time period in Regions 6, 7, and 8 and the National Capital Region, there
were 5 637 suspected or clinically diagnosed cases and 60 laboratory-confirmed cases.
People can transmit the disease as long as the bacteria remain in their system; most people
are infectious prior to and during the first week of convalescence. About 10% of untreated
patients will discharge bacteria for up to three months; 2 to 5% of untreated patients will
become permanent carriers.
Establish the factors that cause the disease and those that modify to prevent
occurrence or spread of disease
Transmission
S typhi can be transferred:
 via food handled by an individual who chronically sheds the bacteria through stool or,
less commonly, urine
 Hand-to-mouth transmission after using a contaminated toilet and neglecting hand
hygiene
 Oral transmission via sewage-contaminated water or shellfish
Risk Factors
 Worldwide, children are at greatest risk of getting the disease
 Work in or travel to endemic area
 Have close contact with someone who is infected or has recently been infected with
typhoid fever
 Weak immune system such as use of corticosteroids or diseases such as HIV/AIDS
 Drinking water contaminated by sewage that contains S. typhi
Prevention

Wash your hands.
Avoid drinking
untreated water.
Avoid raw fruits and
vegetables
Choose hot foods.

A booster dose is needed every two years for people who remain at risk. emergence of domestically acquired ceftriaxone-resistant Salmonella infections has been described.Vaccines Inactivated typhoid vaccine (shot) Should not be given to children younger than two years old. given two days apart. abdominal pain and diarrhea or constipation.  Amoxicillin Interferes with synthesis of cell wall mucopeptides during active multiplication.  Cefotaxime Arrests bacterial cell wall synthesis. One dose provides protection. step-ladder( now seen in < 12%). Proven to be highly effective for typhoid and paratyphoid fevers. Third-generation cephalosporin with gram-negative spectrum.5 years after vaccination is about 72%. At least as effective as chloramphenicol in rapidity of defervescence and relapse rate. insidious onset of fever  Fever up to 39-400C in 5-7 days. toxic. headache chills. Defervescence occurs in 3-5 days. Clinical manifestations The initial period (early stage due to bacteremia)  First week: non-specific. tired. symptoms should quickly improve. Protection is induced about 7 days after the injection. The fastigium stage  second and third weeks. the symptoms develop over four weeks. Drug therapy  Ciprofloxacin Inhibits bacterial DNA synthesis and. Usually given PO with a daily dose of 75-100 mg/kg tid for 14 days. Excellent in vitro activity against S typhi and other salmonellae and has acceptable efficacy in typhoid fever. with new symptoms appearing each week but with treatment. Live typhoid vaccine (oral) Should not be given to children younger than six years old. A booster dose is needed every five years for people who remain at risk. Excellent in vitro activity against S typhi and other salmonellae. Not currently recommended for use in children and pregnant women because of observed potential for causing cartilage damage in growing animals. which inhibits bacterial growth. and convalescent carriage and relapses are rare. resulting in bactericidal activity against susceptible bacteria. Establish Clinical Diagnosis of disease Clinical presentation  The incubation period for typhoid fever is 7-14 days (range 3-60 days)  If not treated. In countries or areas at risk. consequently. are needed for protection. Fluoroquinolone are highly effective against multi-resistant strains and have intracellular antibacterial activity. Only IV formulations are available. Recently. Four doses. It should be given at least two weeks before travel to allow the vaccine time to work. The last dose should be given at least one week before travel to allow the vaccine time to work. growth. after 3 years it is about 50%. sore throat. cough. the protective efficacy 1.  Ceftriaxone Third-generation cephalosporin with broad-spectrum gram-negative activity against gram-positive organisms. .

The conjunctivae are injected. myocarditis. severe toxemia and septicemia. disappear in 2-3 days. shock. on the trunk.5 % ). Some survivors become asymptomatic carriers and have the potential to transmit the bacteria indefinitely Convalescence stage  the fifth week: disappearance of all symptoms. hepatomegaly  rash ( rose-spots): 30%. Urine and stool cultures: increase the diagnostic yield. bleeding and other complications.  Larger volumes 10-30 ml and clot cultures increase sensitivity  Blood culture is positive as follows: st 1 week in 90% 2nd week in 75% 3rd week in 60% 4th week and later in 25% Bone marrow culture: the most sensitive test. circulatory failure. microbiologist. Community containment and public health management Close collaboration between the infectious disease consultant. Blood cultures in Typhoid fever  In Adults 5-10 ml of Blood is inoculated into 50 – 100 ml of Bile broth ( 0. positive less frequently and stool culture better in 3rd~4th weeks Duodenal string test: to culture bile useful for the diagnosis of carriers. and abdominal distension slowly improve over a few days. The( typhoid state) is characterized by apathy. typhi and S. Some patients experience foul. This complication may be masked by corticosteroids.  more toxic and anorexic with significant weight loss. delirium. Intestinal and neurologic complications may still occur. even in patients pretreated (up to 5 days) with antibiotics. paratyphi through the community. Signs and symptoms:  relative bradycardia.  Splenomegaly.  In the aged temperature not high. the fever. overwhelming toxaemia. fade on pressure 2-4 mm in diameter. confusion. maculopapular. green-yellow. public health physician and general practitioner helps to prevent the spread of S. Weight loss and debilitating weakness last months. Last 10-14 days. Necrotic Peyer patches may cause bowel perforation and peritonitis. . slightly raised round or lenticular.early intestinal bleeding or perforation. High fever. mental state. but can relapse A typical manifestations :  Mild infection: very common seen recently symptom and signs are mild good general condition temperature is 380C short period of disease recovery expected in 1~3 weeks seen in early antibiotic users in young children more common easy to misdiagnose  Persistent infection: disease continue > 5 weeks  Ambulatory infection: mild symptoms. DIC. chill. At this point. myocarditis. more complications and high mortality. fever reaches a plateau at 39-40.  Fulminant infection: rapid onset. coma. and the patient is tachypneic with a thready pulse and crackles over the lung bases. and even psychosis. weakness common. a faint pale color. Abdominal distension is severe. Defervescence stage  By the fourth week of infection: If the individual survives . or intestinal haemorrhage may cause death. less than 10 in No. liquid diarrhea (pea soup diarrhea).

Same year. the Department of Health declared a typhoid outbreak in Calamba. . In an emergency.597 cases of typhoid were reported This only goes to show that most Asian countries like the Philippines and India. Cases of typhoid fever are up slightly in 2015.  In areas where typhoid fever is known to be present. or Northern Mindanao reported 2. Region X. Laguna. Health officials report nearly 11.000 suspected and confirmed cases of the bacterial disease. its springs were kept unprotected from bacteria and germs. Moreover.656 cases accounting for nearly a quarter of all cases. 10. Same Outbreak also occur in Cebu (2014). Most of the countries plagues with this disease are those that lack clean source of water and sanitation.  Appropriate facilities for human waste disposal must be available for all the community. the use of human excreta as fertilizers must be discouraged. the Department of Health (DOH) encouraged the public to follow safety measures against typhoid fever.  Health education is paramount to raise public awareness on all the above mentioned prevention measures. During the first six months of 2014.400 people displayed typhoid symptoms. must be implemented. In the Philippines in 2008. Typhoid fever remained common in Asian and African countries. More than 1. The bacteria was said to may have been spread by a contamination in the water system. pit latrines can be quickly built. Evaluate the effectiveness of health care program of the government Despite the Effort of WHO and DOH in mass vaccination and spreading awareness about typhoid fever. especially during the rainy season. 11 people have died from typhoid. It later turned out that the San Jose local waterworks system was built some forty years ago and only irregular chlorination was being done. Collection and treatment of sewage. the government are implementing health care programs poorly. Water samples were taken from various points (sources and outlets) and were found positive for fecal coliform.