Typhoid Fever 

 is an acute illness associated with fever caused by the Salmonella enterica serotype

Typhi bacteria. 
 also known as enteric fever

Etiologic Agent- caused by Salmonella typhi bacteria.

Mode of Transmission
 Fecal-oral transmission
 The bacteria that cause typhoid fever spread through contaminated food or
water and occasionally through direct contact with someone who is infected
 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. The
bacteria can survive for weeks in water or dried sewage.

Incubation Period- The incubation period is usually 1-2 weeks, and the duration of the
illness is about 3-4 weeks.

Period of Communicability- as long as the patient es excreting microorganism, and

untreated capable of infecting others.

Signs and Symptoms

 Fever- The fever pattern is stepwise, characterized by a rising temperature over the
course of each day that drops by the subsequent morning; the peaks and troughs
rise progressively over time.
 Gastrointestinal symptoms-Over the course of the first week of illness, the notorious
gastrointestinal manifestations of the disease develop; these include diffuse
abdominal pain and tenderness and, in some cases, fierce colicky right upper
quadrant pain.
 Rose spots. The patient develop rose spots, which are salmon-colored, blanching,
truncal, maculo-papules usually 1-4 cm wide and fewer than 5 in number; these
generally resolve within 2-5 days.
 Abdominal distention. The abdomen becomes distended, and soft splenomegaly is
common; on the third week, abdominal distention is severe.
 Pea soup diarrhea. Some patients experience foul, green-yellow, liquid diarrhea.

Diagnostic Procedure
 Medical and travel history
 Body fluid or tissue culture
 For the culture, a small sample of your blood, stool, urine or bone marrow is
placed on a special medium that encourages the growth of bacteria. The culture
is checked under a microscope for the presence of typhoid bacteria. A bone
marrow culture often is the most sensitive test for Salmonella typhi.
  detect antibodies to typhoid bacteria in your blood or a test that checks for
typhoid DNA in your blood.
 Typhi-dot test to detect IgG & IgM antibodies in typhoid fever. 

Treatment Modalities
 Ciprofloxacin (Cipro).  doctors often prescribe this for nonpregnant adults. Another
similar drug called ofloxacin also may be used.
 Azithromycin (Zithromax). This may be used if a person is unable to take
ciprofloxacin or the bacteria is resistant to ciprofloxacin.
 Ceftriaxone. This injectable antibiotic is an alternative in more-complicated or
serious infections and for people who may not be candidates for ciprofloxacin, such
as children.

Nursing Management
 Diet. Fluids and electrolytes should be monitored and replaced diligently; oral
nutrition with a soft digestible diet is preferable in the absence of abdominal
distention or ileus.
 Activity. No specific limitation on activity are indicated for patients with typhoid
fever; as with most systemic diseases, rest is helpful, but mobility should be
maintained if tolerable.
 Monitor for fever and the intake and output

Prevention
 Access to safe water and adequate sanitation, hygiene among food handlers and
typhoid vaccination are all effective in preventing typhoid fever.
 Two vaccines have been used for many years to protect people from typhoid fever:
 an injectable vaccine based on the purified antigen for people aged over 2
years
 a live attenuated oral vaccine in capsule formulation for people aged over 5
years
 These vaccines do not provide long-lasting immunity and are not approved
for children younger than 2 years old.
 A new typhoid conjugate vaccine, with longer lasting immunity, was
prequalified by WHO in December 2017 for use in children from the age of 6
months.:
 Ensure food is properly cooked and still hot when served.
 Avoid raw milk and products made from raw milk. Drink only pasteurized or boiled
milk.
 Avoid ice unless it is made from safe water.
 When the safety of drinking water is questionable, boil it or if this is not possible,
disinfect it with a reliable, slow-release disinfectant agent (usually available at
pharmacies).
 Wash hands thoroughly and frequently using soap, in particular after contact with
pets or farm animals, or after having been to the toilet.
 Wash fruits and vegetables carefully, particularly if they are eaten raw. If possible,
vegetables and fruits should be peeled.