TYPHOID

Presented by: Minahil Mansoor

Presented to: Ma’am Ruby Bashir
 TYPHOID
Typhoid is a bacterial infection caused
due to Salmonella typhimurium which
lives in intestine and blood and spread by
feces.
It is characterized by fever, headache and
abdominal discomfort.
It is also known as enteric fever.
Etiology
Caused by
S.typhi
Typhoid

S. paratyphi
Para Typhoid
Type A

Type B

Type C
Pathophysiology
Clinical Features
Incubation period: 7-21days
Symptoms occurs after Incubation period
1 week: Start
• Slowly rising (stepladder fashion) of temperature for
4-5 days
• Abdominal pain & myalgia
• Malaise
• Headache
1 week: End
• Rose spots may appear on the upper abdomen
• Splenomegaly
• Abdominal distension
• Diarrhea
 Blood and stool culture: Found Salmonella
typhi bacteria
Diagnosis CBC: WBCs increased
Widal test: Detection of agglutinating antibody
against O and H antigen
 • First line treatment
1. Chloramphenicol
Pediatric dose: 50mg/kg P.O Q.I.D(2 weeks)
Adult dose:50mg/kg P.O Q6hr(2 weeks) or
2. Ampicillin
Pediatric dose: 100mg/kg P.O Q.I.D(2 weeks)
Adult dose:500mg/kg P.O Q6h (2 weeks) or
3. Ciprofloxacin
Medication 500 mg PO b.i.d (2 weeks) indicated in multiple drug
resistant typhoid or
4. Ceftriaxone
1-2 g IV once daily (2 weeks) or
5. Furazolidone
7.5mg/kg PO 10 days in uncomplicated multiple drug
resistant typhoid, safe in children, efficacy 85% cure
 Chronic state:
Ampicillin:
4-5 g/d plus probenecid 2 g/d q.id. 6 weeks (for
patients with normally functioning gallbladder
without evidence of cholelithiasis)
Ciprofloxacin:
Medication 500 mg PO b.i.d. for 4-6 weeks is also efficacious.
(Chloramphenicol resistance has been reported in
Mexico, South America, Central America, Southeast
Asia, India, Pakistan, Middle East and Africa)
Second line treatment:
Trimethoprim- Sulfamethoxazole
 Typhoid Vaccine
Composition: Purified Vi capsular polysaccharide of
Salmonella typhi
Strength: 25 mg polysaccharide
Brand name: Typbar, Typherix, Vac T
Typhoid immunisation is advised for:
•Travellers to areas where typhoid is endemic,
especially if staying with or visiting local people
•Travellers to endemic areas where frequent or
prolonged exposure to poor sanitation and poor food
hygiene is likely
•Laboratory personnel who, in the course of their work,
may be exposed to Salmonella typhi.
 Oral typhoid vaccine is contained in an enteric-
coated capsule.
Oral Typhoid Vaccine One capsule taken on alternate days for a total of
3 doses, provides protection 7–10 days after the
last dose.
Protection may persist for up to 3 years in those
constantly (or repeatedly) exposed to Salmonella
typhi, but those who only occasionally travel to
endemic areas require further courses at intervals
of 1 year.
 Additional Treatment
Project analysis slide 2
Consider evidence of biliary tract disease Fluid and electrolyte support

Additional
Consider intolerance to antibiotics Strict isolation of patient stool and urine
Treatment

Consider age, public health Consider serial plain abdominal illness

Thank You