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TYPHOID FEVER

Reported by:
Espina, Pia Xyra
Faderugao, Martina

Typhoid

Also known as Enteric fever
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
the contaminated food or water.

27% About 10% of untreated patients will discharge bacteria for up to three months 2 to 5% of untreated patients will become permanent carriers .Epidemiolo gy Between January 1 and November 13. 244 cases of suspected or clinically diagnosed typhoid fever in the Philippines Two resulted in death Case-fatality rate of 0. 2013: 28.

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Transmission o S typhi has no nonhuman vectors. less commonly.  via food handled by an individual who chronically sheds the bacteria through stool or. 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 .

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

the protective efficacy 1.5 years after vaccination is about 72%. A booster dose is needed every two years for people who remain at risk . after 3 years it is about 50%.Vaccin Inactivated typhoid vaccine (shot) es It should not be given to children younger than two years old Protection is induced about 7 days after injection It should be given at least two weeks before travel to allow the vaccine time to work In countries or areas at risk.

are needed for protection The last dose should be given at least one week before travel to allow the vaccine time to work A booster dose is needed every five years for people who remain at risk .Live attenuated vaccine (oral) It should not be given to children younger than six years old Four doses. given two days apart.

growth  Proven to be highly effective for typhoid and paratyphoid fevers  Defervescence occurs in 3-5 days.DRUG Ciprofloxacin THERAPY  Inhibits bacterial DNA synthesis and. consequently.  Not currently recommended for use in children and pregnant women because of observed potential for causing cartilage damage in growing animals. and convalescent carriage and relapses are rare. .  Fluoroquinolone are highly effective against multi-resistant strains and have intracellular antibacterial activity.

which inhibits bacterial growth  Excellent in vitro activity against S typhi and other salmonellae and has acceptable efficacy in typhoid fever  Only IV formulations are available .Ceftriaxone  Third-generation cephalosporin with broad-spectrum gramnegative activity against gram-positive organisms  Excellent in vitro activity against S typhi and other salmonellae Cefotaxime  Third-generation cephalosporin with gram-negative spectrum  Arrests bacterial cell wall synthesis.

Amoxicillin Interferes with synthesis of cell wall mucopeptides during active multiplication. Usually given PO with a daily dose of 75-100 mg/kg tid for 14 days . resulting in bactericidal activity against susceptible bacteria At least as effective as chloramphenicol in rapidity of defervescence and relapse rate.

the symptoms develop over four weeks. . with new symptoms appearing each week but with treatment. symptoms should quickly improve.Clinical presentation The incubation period for typhoid fever is 7-14 days (range 3-60 days) If not treated.

toxic. abdominal pain and diarrhea or constipation. headache chills. tired.Clinical manifestations The initial period (early stage due to bacteremia)  First week: non-specific. sore throat. . stepladder( now seen in < 12%). cough. insidious onset of fever Fever up to 39-400C in 5-7 days.

Last 10-14 days. Abdominal distension is severe. This complication may be masked by corticosteroids. green-yellow. At this .  more toxic and anorexic with significant weight loss. confusion. The conjunctivae are injected. liquid diarrhea (pea soup diarrhea). Some patients experience foul. and the patient is tachypneic with a thready pulse and crackles over the lung bases.  fever reaches a plateau at 39-40. The( typhoid state) is characterized by apathy.The fastigium stage  second and third weeks. Necrotic Peyer patches may cause bowel perforation and peritonitis. and even psychosis.

on the trunk. disappear in 2-3 days. fade on pressure 2-4 mm in diameter. maculopapular a faint pale color. Signs and symptoms:  relative bradycardia. . less than 10 in No. slightly raised round or lenticular.  Splenomegaly. hepatomegaly  rash ( rose-spots):30%.

spots  Appear in crops of upto a dozen at a time .Rash in Typhoid  Rose.

Some survivors become asymptomatic carriers and have the potential to transmit the bacteria indefinitely convalescence stage  the fifth week: disappearance of all symptoms. the fever. mental state. but can relapse . Intestinal and neurologic complications may still occur.defervescence stage  By the fourth week of infection: If the individual survives . Weight loss and debilitating weakness last months. and abdominal distension slowly improve over a few days.

Atypical 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 .

early intestinal bleeding or perforation. . Persistent infection: disease continue > 5 weeks  Ambulatory infection: mild symptoms.

High fever. Fulminant infection: rapid onset. myocarditis. chill. shock. delirium. bleeding and other complications. . severe toxemia and septicemia. DIC. coma. circulatory failure.

More complications. High mortality. weakness common. In the aged temperature not high. .

mplications Intestinal bleeding or perforation The most serious complication of typhoid fever Other. less common • Myocarditis • Pneumonia • pancreatitis • UTI • Osteomyelitis • Meningitis • Psychiatric problems .

Blood cultures in Typhoid fever  In Adults 5-10 ml of Blood is inoculated into 50 – 100 ml of Bile broth ( 0.  Larger volumes 10-30 ml and clot cultures increase sensitivity  Blood culture is positive as follows: 1st week in 90% 2nd week in 75% 3rd week in 60% 4th week and later in 25% .5 % ).

 Bone marrow culture the most sensitive test even in patients pretreated (up to 5 days) with antibiotics.  Urine and stool cultures increase the diagnostic yield positive less frequently stool culture better in 3rd~4th weeks  Duodenal string test to culture bile useful for the diagnosis of carriers. .

must be implemented. pit latrines can be quickly built.Community containment and public health management Close collaboration between the infectious disease consultant. typhi and S. In an emergency.  Health education is paramount to raise public awareness on all the above mentioned prevention measures. . paratyphi through the community. especially during the rainy season. public health physician and general practitioner helps to prevent the spread of S.  In areas where typhoid fever is known to be present. the use of human excreta as fertilizers must be discouraged.  Collection and treatment of sewage. microbiologist.  Appropriate facilities for human waste disposal must be available for all the community.

. Same Outbreak also occur in Cebu (2014) and Leyte (2009). More than 1.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.400 people displayed typhoid symptoms. Laguna. the  Department of Health (DOH)  encouraged the public to follow safety measures against typhoid fever.  In the Philippines in 2008. Typhoid fever remained common in Asian and African countries. the Department of Health declared a typhoid outbreak in Calamba. Most of the countries plagues with this disease are those that lack clean source of water and sanitation. Same year.

the government are implementing health care programs poorly.000 suspected and confirmed cases of the bacterial disease.656 cases accounting for nearly a quarter of all cases. . or Northern Mindanao reported 2. Cases of typhoid fever are up slightly in 2015. 11 people have died from typhoid. Health officials report nearly 11. 10.  During the first six months of 2014.597 cases of typhoid were reported  This only goes to show that most Asian countries like the Philippines and India. Region X.