……………..

"EPIDEMIOLOGY OF TYPHOID"………………

(Compilation submitted as partial fulfilment of the curricular requirement of

IIIrd Professional Year B.A.M.S.)

Prepared by:
Vadhadiya Tulsiben Kishorkumar

Guided by:
DR.L.P.PANDEY

Department of Swasthavritta and Yoga

State Model Govt. Ayurveda College, Kolavada, Gandhinagar

Gujarat Ayurved University, Jamnagar-361008

“Accredited Grade “A” by NAAC (C.G.P.A 3.28
 Department of Swasthavritta and Yoga

State Model Govt. Ayurveda College, Kolavada, Gandhinagar

Gujarat Ayurved University, Jamnagar-361008

“Accredited Grade “A” by NAAC (C.G.P.A 3.28)”

-: CERTIFICATE:-

This is to certify that Vadhadiya Tulsiben Kishorkumar student of IIIrd Professional

Year B.A.M.S. has satisfactorily completed the compilation titled as

……………………………………………………………... ……….

………………………………………………………………….. under our guidance in

two terms of the academic year 20…. -……..

Date:-

Place:-

Lecturer/ Reader Head of the Department

 INDEX

TOPIC PAGE NO.

INTRODUCTION
CAUSES
RISK FACTORS
SIGNS AND SYMPTOMS
PATHOPHYSIOLOGY
COMPLICATIONS
DIAGNOSIS
TREATMENT
PREVENTION
CONCLUSION
 INTRODUCTION

➡. Typhoid fever is a life-threatening infection caused by the

bacterium Salmonella Typhi. It is usually spread through contaminated
food or water.
➡. An estimated 11–20 million people get sick from typhoid and
between 128 000 and 161 000 people die from it every year.
➡ It is transmitted by the fecal–oral route through
contaminated water and food.

➡ Typhoid fever is a major public health problem in low-income

and middle-income countries (LMICs). where there are substandard
hygiene and unsafe drinking water supplies and the quality of life is
poor
➡ Typhoid fever is a systemic infection caused by human-specific
food and water-borne pathogens, such as Salmonella enterica subspecies,
enterica serovar typhi (S. typhi) or by the related but less virulent
Salmonella paratyphi A, B, and C, collectively called typhoidal Salmonella
 CAUSES
➡. Typhoid fever is caused by dangerous bacteria called Salmonella
typhi.
➡ The bacteria spreads through contaminated food, drink, or water.
People infected with Salmonella typhi carry the bacteria in their
intestinal tract and blood.
➡ Salmonella typhi is shed (discarded from the body) in feces (stool).
You may get typhoid fever if you ingest food or beverages prepared by
someone who is shedding the bacteria and who does not wash their
hands properly. In less developed countries, sewage containing
Salmonella typhi may contaminate local water supplies.
➡ In some cases, people who have previously had typhoid fever
still carry Salmonella typhi bacteria. These people are carriers of the
disease. They may spread the infection even when they have no
symptoms.
➡ Some regions have a higher incidence of typhoid. These include
Africa, India, South America, and Southeast Asia.

☛ salmonella typhi in microscope

☛ salmonella typhi in elecron microscope

 RISK FACTORS
➡ Travel to endemic areas
➡ Poor hygiene habits
➡ Poor sanitation conditions
➡ Proximity to flying insects feeding on feces
➡ Contact with someone who recently suffered from typhoid
fever
➡ Recent use of antibiotics
➡ Immunosuppressive illnesses such as AIDS
➡ Crowded housing
➡ Consumption of raw fruits and vegetables
contaminated with sewage
➡ Prolonged illness
➡ Being a health care worker
➡ Being a clinical microbiologists who handles salmonella
typhi
➡ Childhood
 SIGNS AND SYMPTOMS

● What Are the Symptoms of Typhoid Fever?

➡ Incubation period is typically about 10-14 days but can be longer, and
the onset may be insidious. - Symptoms are often non- specific and
clinically non- distinguishable from other febrile illnesses.
➡. However, clinical severity varies and severe cases may lead to serious
complications or even death.

CLINICAL FEATURES
➡ 1 (1ST WEEK)
• Slowly rising (stepladder fashion) of temperature for 45 days

• Abdominal pain & myalgia

• Malaise

• Headache Constipation

• Relative bradycardia Stage

➡ End of 1ST WEEK

• Rose spots may appear on the upper abdomen & an the back of sparse

• Cough Splenomegaly Abdominal distension, diarrhoea.

➡ 2 (2ND WEEK)

• Signs and symptoms of 1" weok progress

➡ End of 2ND WEEK

• Delirium, complications, then coma & death (if untreated)

☛ Rose spots
➡ Stage 3 (3D WEEK) • Febrile become taxic & anorexic
• Significant weight loss Typhoid state (Apathy, confusion & psychosis)
High risk (5-10%) of hemorrhage and perfaration may cause death.

➡4 (4TH WEEK) Recovery period

• If the individual survives to the fourth week, the fever, mental
state, and abdominal distension slowly improve over a few days.

• Intestinal and neurologic complications may still occur in surviving

untreated individuals.
 PATHOPHYSIOLOGY
Ingest contaminated food
↓

Ingested bacilli invade small intestinal mucosa

↓

Taken up by macrophage & transported to lymph node

↓

S.typhi multiply in the intestinal lymphoid tissue

↓

Intact with enterocytes & M cells(ileal Peyer's pathches) during the 1-

3 week of incubation period (diarrhoea)
↓

End of incubation period, bacilli enter bloodstream

(Bacteraemia phase) ( onset of typhoid fever)
↓

Bacteria invade the gallbladder, biliary system and lymphatic tissue of the
bowel multiply in high number.and pass into stool.
 COMPLICATIONS
➡ The most severe complication of typhoid fever is the development of
perforation in the intestine which can lead to the contents of the intestine
leak into the abdominal cavity It may also result in internal bleeding Other
less common complications include:

➡ Inflammation of the heart muscle-Myocarditis

➡ Inflammation of the heart and valves-Endocarditis

➡ Inflammation of the pancreas- Pancreatitis

➡ Lung infection such as Pneumonia Kidney or Bladder infections

➡ Infection and inflammation of the protective membranes
covering the brain and spinal cord- Meningitis

➡ Psychiatric symptoms such as delirium hal ucinations

and psychosis

. ulcers in intestinal
 DIAGNOSIS

• Blood culture

• Specifik serologie test identify Salmonella antibodies / antigens

( Fluorescent antbody study to look for substances that are specific to
Typhoid bacteria OWidal Test and ELISA

• Urine and Stool Culture (2& 3 week)

• Marrow Culture 90% sensitive unless until after 5 days

commencement of antibiotic

• Punch-biopsy samples of rose spots Culture - 63% sensitive

• Clot culture *culture may be obtained from CSF, peritoneal fluid,

mesenteric INs, resected intestine, galblad der, pharynx, tonsils, abscess,
bone
 Serology

• WIDAL Test - Tube agglutination test

• Detects O and H antibodies

• Diagnosis of Typhoid and Paratyphoid

• Testing for Hagglutinins in Dryers tubes a narrow tube floccules at the

bottom Testing for O agglutinins in Felix tubes Chalky

• Incubated at 3 º covernight

☛WIDAL TEST
 Other non- specific lab studies

• Moderate anemic increased ESR thrombocytopenia lymphopenia

• Slightly elevated PT and APTT decreased fibrinogen level

• Liver transaminases & bilirubin- increased 2x normal

• Mild hyponatremia & hypokalemia

• Serum ALT: LDH 9: = viral hepatitis 9: = typhoid

hepatitis

TREATMENT
• Activity - rest is helpful

• Medical care ▶Antibiotic ▶Corticosterois ( for severe typhoid fever)

▶Antipyretics

• Diet - fluid and electrolytes should be monitored. Soft digestible

diet is preferable in absence of abdominal distension and ileus

• Surgical care - in cases of intestinal perforation

Antibiotic

Chloramphenicol (500mg gid) Ampicillin

( 750mg qid)

Co-trimoxazole ( 2 tablets/ iv bds)

NOTE: Above antibiotics has resistance in many areas of the

world, especially India & South-east Asia
➡Fluoroquinolone (Drug of choice)- ciprofloxacin (500mg
bds)
➡ 3" generation cephalosporin- ceftriaxone, cefotaxime
(alternative)
➡Azithromycin ( 500mg once daily) alternative when
fluoroquinolone resistant is present
➡Treatment should be continued for 14 days
➡Chronic carriers were formerly treated for 4 weeks with
ciproflaxacin but may require an alternative agent and
duration, as guided by antimicrobial sensitivity testing.
➡ Cholecystectomy may be necessary.
 PREVENTION

➡Wash your hands Frequent hand-washing in hot soapy

water is the best way to control infection

➡ Always drink boiled water Avoid untreated water use bottled water
➡ Always wash fruits and vegetables before use

➡ Get vaccinated
 CONCLUSION
 Morbidity and mortality from typhoid fever remain an
important problem for public health authorities in developing
countries.
 Control of the disease was conducted with effective antibiotics,
unfortunately the emergence and the world-wide spread of S. typhi
strains that are resistant to most previously useful antibiotics raises
again the question of an effective tool for controlling this disease.
 As a consequence, there is renewed interest to better
understand the epidemiology of typhoid fever and some
aspects of its pathogenesis.
 More importantly, perhaps, there is much pre-occupation in
exploring expanded roles for typhoid vaccines.
 One important challenge for public health authorities is to devise
ways to utilise the two currently available improved typhoid
vaccines, oral Ty2la and parenteral Vi polysaccharide, in large-
scale school-based immunisation programs and monitor the public
health impact.
 Since humans constitute the reservoir of typhoid infection through
shoft-term and long-term carriers, vaccines that actually prevent
infection with wild type ^S. typhi as well as conferring protection
against clinical illness can, if used in con- junction with other
control measures, help eradicates. typhi disease even in less-
developed regions of the world.