TYPHOID FEVER and HEPATITIS A

TYPHOID FEVER
 TYPHOID FEVER
Typhoid fever is a bacterial infection that can spread throughout the body, affecting many
organs. Without prompt treatment, it can cause serious complications and can be fatal.

HISTORY:
Antonius Musa
a Roman physician who achieved fame by treating the Emperor Augustus 2,000 year ago, with cold
baths when he fell ill with typhoid.
Thomas Willis
who is credited with the first description of typhoid fever in 1659.
Pierre Charles Alexandre Louis
French physician who first proposed the name “typhoid fever”.
William Wood Gerhard
who was the first to differentiate clearly between typhus & fever and typhoid in 1837.
Carl Joseph Eberth
who discovered typhoid bacillus in 1880.
Georges Widal
who described the ‘Widal agglutination reaction’ of the blood in 1896.
1. The best known carrier was
"Typhoid Mary“; Mary Mallon
was a cook in Oyster Bay, New
York in 1906 who is known to have
infected 53 people, 5 of whom
died.

2. Later returned with false name but

detained and quarantined after
another typhoid outbreak.

3. She died of pneumonia after 26

years in quarantine.
CAUSATIVE
Typhoid fever, also called typhoid, acute infectious disease caused by the bacterium
Salmonella enterica serovar Typhi. The bacterium usually enters the body through the
mouth by the ingestion of contaminated food or water, penetrates the intestinal wall, and
multiplies in lymphoid tissue; it then enters the bloodstream and causes bacteremia.

1. Caused by the bacterium Salmonella Typhi .

2. Ingestion of contaminated food or water.

3. Contact with an acute case of typhoid fever.

4. Water is contaminated where inadequate sewerage systems and poor sanitation.

5. Contact with a chronic asymptomatic carrier.

6. Eating food or drinking beverages that handled by a person carrying the bacteria.

7. Salmonella enteriditis and Salmonella typhimurium are other salmonella

bacteria,cause food poisoning and diarrhea.
How the infection spreads
•The Salmonella typhi bacteria will be in the poo (stools) of an infected person after they have
been to the toilet.
•If they don't wash their hands properly afterwards, they can contaminate any food they
touch. Anyone else who eats this food may also become infected.
•Less commonly, the Salmonella typhi bacteria can be passed out in an infected person's pee
(urine).
•Again, if an infected person handles food without washing their hands properly after peeing, they
can spread the infection to someone else who eats the contaminated food.
•In parts of the world with poor sanitation, infected human waste can contaminate the water
supply.
•People who drink contaminated water or eat food washed in contaminated water can develop
typhoid fever.
•Other ways typhoid fever can be contracted include:
•using a toilet contaminated with bacteria and touching your mouth before washing your hands
•eating seafood from a water source contaminated by infected poo or pee
•eating raw vegetables that have been fertilised with human waste
•contaminated milk products
•having oral or anal sex with a person who's a carrier of Salmonella typhi bacteria
Carriers
• Up to 1 in 20 people who survive typhoid fever without being treated will become carriers of the
infection.
• This means the Salmonella typhi bacteria continue to live in the carrier's body and can be spread
as normal in poo or pee, but the carrier doesn't have any noticeable symptoms of the condition.

How the bacteria affect the body

• After eating food or drinking water contaminated with the Salmonella typhi bacteria,
the bacteria moves down into the digestive system, where they will quickly multiply.
• This triggers a high temperature, stomach pain and constipation or diarrhea.
• Left untreated, the bacteria can get into the bloodstream and spread to other areas
of the body.
• This can cause the symptoms of typhoid fever to get worse during the weeks after
infection.
• If organs and tissues become damaged as a result of the infection, it can cause
serious complications, such as internal bleeding or a section of the bowel splitting
open.
Salmonella Enterica
• Member of the genus Salmonella.
• Rod shaped, flagellated, aerobic,
Gram negative bacterium.
• Large number of fimbrial and non-fimbrial adhesins
are present, mediate biofilm formation and contact to host cells.
• Secreted proteins involved in host cell invasion and intracellular
proliferation.
• Infects cattle, poultry, domestic cats, hamsters, humans etc.
• Refrigeration and freezing substantially slow or halt their growth.
• Pasteurizing food irradiation kill Salmonella for commercially-
produced foodstuffs containing raw eggs such as ice cream.
• Foods prepared in the home from raw eggs can spread salmonella if
not properly cooked before consumption.
 Ingestion of contaminated food or water

Salmonella bacteria

Invade small intestine and enter the bloodstream

Carried by white blood cells in the liver, spleen, and bone marrow

Multiply and reenter the bloodstream Bacteria invade the gall bladder, biliary
system, and the lymphatic tissue of the bowel and multiply in high numbers.

Then pass into the intestinal tract and can be identified for diagnosis in
cultures from the stool tested in the laboratory.
Mode of Transmission
1. Fecal – oral route
2. Urine- oral route(rare)

Source of the infection:

Primary source:
Feces and urine of the cases and carriers
Secondary sources:
Contaminated water, foods, finger, and flies

Incubation period:
Usually 10-14 days
But the incubation period my be as short as 3-days
It may be as long as 3 weeks thus depending on the dose of the bacilli
ingested.
Period of communicability:
From 3 days to over 60 days; usual range is 8-14 days depending on innoculum size
and on host factors. Period of communicability as long as S. Typhi is being excreted in
stools or urine, ususally from one week after symptom onset, through convalence, and
for a variable period thereafter.

Reservoir:
Man is the only known reservoir of the infection via cases or carrier.

Cases:
The case maybe mild, missed or severed a case (carrier) is infectious as long as bacilli
appears in the stool or urine.

Carrier:
The carrier maybe temporary, incubatory, convalescent or chronic.
How the bacteria affect the body

• After eating food or drinking water contaminated with the Salmonella

typhi bacteria, the bacteria moves down into the digestive system, where
they will quickly multiply.
• This triggers a high temperature, stomach pain and constipation or
diarrhea.
• Left untreated, the bacteria can get into the bloodstream and spread to
other areas of the body.
• This can cause the symptoms of typhoid fever to get worse during the
weeks after infection.
• If organs and tissues become damaged as a result of the infection, it can
cause serious complications, such as internal bleeding or a section of the
bowel splitting open.
The symptoms of typhoid fever usually develop 1 or 2 weeks
after a person becomes infected with the Salmonella typhi
bacteria.
• With treatment, the symptoms of typhoid fever should quickly improve within 3 to
5 days.
• If it isn't treated, it'll usually get worse over the course of a few weeks, and there's
a significant risk of life-threatening complications of typhoid fever developing.

Without treatment, it can take weeks – or even months – to fully recover, and
symptoms can return.The main symptoms of typhoid fever are:
• a high temperature, which can reach up to 39 to 40C
• a headache
• general aches and pains
• a cough
• constipation
• Later, as the infection progresses you may lose your appetite, feel sick and have a
tummy ache and diarrhea. Some people may develop a rash.
Control of the thypoid fever:
a. Control of the reservoir
b. Control of the sanitation
c. Immunization

The usual method of the control of the reservoir are their

d. Identification ( identify either the case or carrier)
e. Isolation
f. Treatment
g. Disinfection

Control of the typhoid fever in case

h. Early diagnosis
i. Notification
j. Isolation
Treatment:
Antibiotics

Chloramphenicol
Cotrimoxazole
Amoxicillin
Thrimethoprim
Hydrocortisone 100mg daily, 3-4 days injection

Time frame:
First stage typhoid fever
Second stage
Typhoid stage
Diagnostic:
a. Blood, bone marrow or stool cultures test
b. Widal test
c. Slide agglutination
d. Antimicrobial susceptibility testing.
Vaccination
Vaccination is strongly recommended if you're going to be staying or working
with local people, or if you're going to be staying for prolonged periods in
areas where sanitation and food hygiene are likely to be poor.

High-risk areas
•Typhoid is found throughout the world, but it's more likely to occur in areas
where there's poor sanitation and hygiene.
•High-risk areas include:
•the Indian subcontinent
•Africa
•south and southeast Asia
•South America

Types of vaccinaton
Vi vaccine – given as a single injection
Ty21a vaccine – given as 3 capsules to take on alternate days
Combined typhoid and hepatitis A injections are also available for people
aged 15 or over. Protection against hepatitis A lasts 1 year and protection
against typhoid lasts 3 years.
The vaccines work by stimulating your body to create antibodies (infection-
fighting proteins) that prevent you getting ill if you become infected with the
typhoid bacteria.
But neither typhoid vaccine is 100% effective, so you should always
take precautions when eating food and drinking water abroad.
As the Ty21a vaccine contains a live sample of Salmonella typhi bacteria, it
isn't suitable for people with a weakened immune system – for example,
people receiving certain types of treatment, such as chemotherapy.
It also isn't usually recommended for children under 6, whereas children can
have the Vi vaccine from 2 years of age.
It's unclear whether the Vi and Ty21a vaccines present a risk to pregnant or
breastfeeding women. But vaccination should be considered if there's a
significant risk of getting typhoid.
The typhoid vaccine should ideally be given at least 1 month before you
travel, although if necessary it can be given closer to your travel date.
Booster vaccinations are recommended every 3 years if you continue to be at
risk of infection with typhoid bacteria.
 HEPATITIS A
“Hepatitis” means inflammation of the liver. The liver is a vital organ that
processes nutrients, filters the blood, and fights infections. When the liver is
inflamed or damaged, its function can be affected.
Hepatitis A is a highly contagious liver infection caused by the hepatitis A
virus. The virus is one of several types of hepatitis viruses that cause
inflammation and affect your liver's ability to function.

CAUSATIVE:
Infectious agent of hepatitis A. Hepatitis A virus (HAV), classified as
hepatovirus, is a small, unenveloped symmetrical RNA virus which shares
many of the characteristics of the picornavirus family.
Reservoir: The gastrointestinal tracts of humans (and possibly certain
primates including chimpanzees).
Causes
Hepatitis A is caused by a virus that infects liver cells and causes
inflammation. The inflammation can affect how your liver works and cause
other signs and symptoms of hepatitis A.
The virus most commonly spreads when you eat or drink something
contaminated with fecal matter, even just tiny amounts. It does not spread
through sneezing or coughing.
Here are some of the specific ways the hepatitis A virus can spread:
Eating food handled by someone with the virus who doesn't thoroughly wash
his or her hands after using the toilet
Drinking contaminated water
Eating raw shellfish from water polluted with sewage
Being in close contact with a person who's infected — even if that person has
no signs or symptoms
Having sex with someone who has the virus
DISCOVERY:
HAV was first discovered in 1973 by Steven M. Feinstone as a nonenvoloped, spherical, positive
stranded RNA virus.

Transmission:
The virus is acquired through close contact with infected individuals or through faecally contaminated
food or drinking-water. There is no insect vector or animal reservoir. Transmission:
Primary: Person to person spread via the faeco-oral route. It is likely that less than 10% of cases are
transmitted by food. Food vehicles most commonly associated include shellfish and garden produce.
Secondary: Ingestion of contaminated food or water.

Incubation period:
approximately 28 days
The incubation period of hepatitis A is approximately 28 days (range 15-50 days). The clinical course of
acute hepatitis A is indistinguishable from that of other types of acute viral hepatitis. The illness
typically has an abrupt onset of fever, malaise, anorexia, nausea, abdominal discomfort, dark urine and
jaundice.
Symptoms:
Hepatitis A signs and symptoms typically don't appear until you've had the virus for a
few weeks. But not everyone with hepatitis A develops them. If you do, hepatitis signs
and symptoms can include:

Fatigue
Sudden nausea and vomiting
Abdominal pain or discomfort, especially on the upper right side beneath your lower
ribs (by your liver)
Clay-colored bowel movements
Loss of appetite
Low-grade fever
Dark urine
Joint pain
Yellowing of the skin and the whites of your eyes (jaundice)
Intense itching
Outbreak Potential:

Hepatitis A has moderate outbreak potential if transmitted through food

and person to person contact and a high outbreak potential if
transmitted through water.

Period of communicability:

From two weeks before the onset of jaundice until one week after. In
anicteric patients, infectivity generally corresponds to period of peak
levels of alanine transaminase (ALT). Prolonged viral excretion (for up to
six months) can occur in infants and small children. The infectious dose
is not known but is very probably low (10-100 virus particles). Feces can
contain up to 108 particles/ml just before and in the first week of
jaundice.
Diagnostic Test:

a. Abdominal ultrasound
b.Autoimmune blood markers
c. Hepatitis virus serology
d.Liver function test
e.Liver biopsy

Blood tests. Blood tests can detect signs of the hepatitis B virus in your body and
tell your doctor whether it's acute or chronic. A simple blood test can also
determine if you're immune to the condition.
Liver ultrasound. A special ultrasound called transient elastography can show the
amount of liver damage.
Liver biopsy. Your doctor might remove a small sample of your liver for testing
(liver biopsy) to check for liver damage. During this test, your doctor inserts a thin
needle through your skin and into your liver and removes a tissue sample for
laboratory analysis.
Prevention:
Immunization of children (1-18 years of age) consists of two or three doses of the
vaccine. Adults need a booster dose six to 12 months following the initial dose of
vaccine. The vaccine is thought to be effective for 15–20 years or more.
Hepatitis A vaccine is an inactivated (killed) vaccine. You will need 2 doses for long-
lasting protection. These doses should be given at least 6 months apart. Children are
routinely vaccinated between their first and second birthdays (12 through 23 months
of age).

Treatment:
Agents used include analgesics, antiemetics, vaccines, and immunoglobulins.
Although acetaminophen may be safely used to treat some of the symptoms
associated with hepatitis A virus (HAV) infection, the dosage should be no higher
than 4 g/day.
Lots of rest, proper nutrition, and adequate fluid intake are recommended
treatments for hepatitis A.