TYPHOID FEVER

Typhoid Fever
 Is a bacterial infection transmitted by
contaminated water,milk,shellfish to other
food.
 It is an infection of the GIT affecting the
lymphoid tissues (peyer’s patches) of the
small intestines
Etiologic Agent
 The disease is caused by an organism
SALMONELLA TYPHOSA/TYPHI
1. gram-negative, motile and non-spore forming
2. Pathogenic to man only
3. It is hardy organism and easily survives in
natural habitat like water or inorganic
materials
Incubation Period
 The incubation period if from five to forty
days with a mean of ten to twenty days
Period of Communicability
 The period of communicability is variable. As
long as the patient is excreting the
microorganism, he is still capable of infecting
others.
Sources of Infection
 A person who recovered from the disease or
one who took care of a patient with Typhoid
and was infected can be considered a potential
carrier
 Ingestion of shellfish (oysters) taken from
waters contaminated by sewage disposal can
be a source of infection
 Stoll and vomitus of infected individual are
source of infection
Mode of Transmission
 The disease can be passed from one person to
another through fecal-oral transmission
 Organism can be transmitted through the five
(5) F’s
 The disease can be transmitted through the
ingestion of contaminated food,water and
milk
Pathogenesis
 The organism gains access to the blood stream
through the bowel,pricipally through the infected
Peyer’s patches of the lymphoid tissues
 On the first week these lymph nodes are swollen
 On the second week, they form sloughs which are
often bile colored
 On the third week, the sloughs separates and leave
an ulcerated surface
 Hemorrhage and perforation may occur due to
extension of the lesion and continuous erosion of the
epithelial lining of the small intestines
 Since toxin is absorbed by the blood stream,
almost all organs of the body are affected,
most commonly the heart, the liver, and the
spleen. The mesenteric lymph glands are red
and swollen
Clinical Manifestations
 Onset
a. Headaches, chilly sensation, aching all over
the body
b. Nausea, vomiting and diarrhea
c. By the 4th and 5th day, all symptoms are worst
d. Fever is higher in the morning than it was in
the afternoon
e. Breathing is accelerated, the tongue is furred,
the skin is dry and hot, abdomen is distended
and tender
f. Rose spots appear on the abdominal wall on
the 7th to the 9th day
g. On the second week symptoms become more
aggravated. temperature remains in uniform
level. Rose spots become more prominent
Typhoid State
 Intense symptoms decline in severity
 The tongue protrudes,becomes dry and brown
 Teeth and lips accumulate a dirty-brown
collection of dried mucus and bacteria known
as SORDES (preventable by good nursing
care)
 Patient seems to be staring blankly (Coma
vigil)
 Twitching of the tendon sets in especially the
wrist bedclothes with his fingers in
continuous fashion (Carphologia)
 There is constant tendency for the patient to
slip down to the foot part of the bed
 In severe cases rambling delirium sets in,
often ending in death
Complications
 Hemorrhage or perforation
 Peritonitis
 Bronchitis and pneumonia
 Meteriosm or excessive distention of the
bowels
 Thrombosis and embolism
 Early heart failure
 Typhoid spine
 Septicemia
 Reiter’s syndrome
Diagnostic Procedure
 Typhidot
 ELISA
 Widal
 Rectal swab
Modalities of Treatment
 Chloramphenicol
 Ampicillin
 Co-trimoxazole
 Ciprofloxacin or Ceftriaxone
 If a patient does not respond to
Chlorampenicol,3rd and 4th generation drugs
are administered
Nursing Management
 Maintain or restore fluid and electrolyte balance
 Monitor patient’s vital signs
 Prevent further injury of patient with typhoid
psychosis
 Maintain good personal hygiene and mouth care
 Cooling measures are necessary during febrile state
 Watch for signs of intestinal bleeding
Prevention and Control
 Sanitary and proper disposal of excreta
 Proper supervision of food handlers
 Enteric isolation
 Adequate protection or provision of safe
drinking water supply
 Reporting of cases to health authorities
The End