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Typhoid Fever

Presented by: Dave Jay S. Manriquez, BSN, RN

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Other names:

Enteric Fever Bilious Fever

Yellow Jack

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Causative Agent

Salmonella Typhi

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3 main antigenic factors:

theO

, or somatic antigen the Vi, or encapsulation

antigen

the H, or flagellar antigen

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Epidemiology

World: 17 million cases per

year

U.S.: 400 cases per year

(70% in travelers) Philippines: (Nov 2006) 478

in Agusan del Sur; (May

2004) 292 in Bacolod City

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Incidence of Typhoid Feverred - strongly endemic; orange endemic;

gray - sporadic cases

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Mode of Transmission

Ingestion ofcontaminated food or

water; rarely from person

to person transmissionthrough fecal-oral route.

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Incubation Period

First 7-14 days after

ingestion

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Symptoms

Diarrhea may occur

Active infection Severe Headache

Generalized AbdominalPain

Anorexia

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Symptoms

Fever [usually higher in the

evening]

- Intermittent Fever initially

- Sustained Fever to high

temperatures later

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Symptoms

Severe cases

ulcers on the intestinalwall

shock

delirium

stupor

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Pathognomonic Sign

Rose Spots

Blanching pink macular spots 2-

3 mm over trunk

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Complications

Intestinal perforation,

gastrointestinal hemorrhage

and peritonitis may occur in the3rd and 4th week of illness;

rarely pancreatitis, hepatic and

splenic abscesses,disseminated intravascular

coagulation, myocarditis,

meningitis, encephalitis.

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PathophysiologySalmonella Typhi

survives the acidity of the stomach

invades the Peyers Patches of the intestinal wall

macrophages (Peyers Patches)

the bacteria is within the macrophages and survives

bacteria spreads via the lymphatics while inside themacrophages

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Pathophysiology

access to Reticuloendothelial system, liver, spleen,gallbladder and bone marrow

First week: elevation of the body temperature

Second week: abdominal pain, spleen enlargement and rose spots

Third week: necrosis of the Peyers Patches

leads to perforation, bleeding

and, if left untreated, death is imminent

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Diagnostics

CBC (normal WBC despite

fever), platelet count

Tourniquet Test

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Diagnostics

Typhi dot test (if illness is 4 days or

longer)Interpretation:

Ig M Ig G

(+) (- ) Acute infection

(+) (+) Recent infection

(- ) (+) Equivocal: Past

infection or acute

infection

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Diagnostics

Malarial smear (Differentialdiagnosis)

Chest X-ray

Urinalysis

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Diagnostics

First Week of illness: BloodC/S

Second Week of illness: UrineG/S, C/S

Third Week of illness: StoolC/S

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Management

A. Prevention:

Choose foods processedfor safety

Prepare food carefully

Foods prepared by others

(avoid if possible)

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Management

Steam or boil shellfish at

least 10 minutes All milk and dairy

products should be

pasteurized

Control fly populations

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Management

B. Antibiotics

For uncomplicated cases, useC

onventional Therapy:1. Chloramphenicol 3-4 gm per day PO in

4 divided doses x 14 days (50-100mg/kg BW) except it with low WBC.

2. Co-trimoxazole forte or double-strengthtab BID PO x 14 days

3. Amoxicillin 4-6 gm per day PO in 3divided doses x 14 days

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Management

For cases with complications, presence of severesymptoms, or clinical deterioration despiteconventional therapy, use Empiric Therapy forSuspected Resistant Typhoid Fever:

1. Ceftriaxone (Rocephin) 3 gm IV infusion OD x 5-7days

Ceftriaxone may be used for pregnant women andchildren.

2. Fluoroquinolones:

Ciprofloxacin (Ciprobay) 500 mg tab PO BID x 7-10days

Ofloxacin (Inoflox) 400 mg tab PO BID x 7-10 days

Perfloxacin (Floxin) 400 mg tab PO BID x 7-10 days

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Management

C. Vaccines

5 years1 capsule every

other day,

total of 3

capsules

Oral6 yearsTy21 a, live

3 years0.5 mlSubcutaneous2 yearsVi CPS

3 years0.5 ml (0.25 ml

for

children < 10y)x 2 times,

4 weeks apart

Subcutaneous5 yearsKilled whole-

cell vaccine

RevaccinationDosageRouteAgeVaccine

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Management

D. Public Health Nursing

Responsibility

- Teach members of thefamily how to report allsymptoms to the attending

physician especially whenpatient is being cared for athome.

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Management

- Teach, guide and

supervise members of thefamily on nursing

techniques which will

contribute to thepatients recovery.

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Management

- Interpret to family nature

of disease and need forpracticing preventive and

control measures.

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Management

E. Nursing Care

- Demonstrate to familyhow to give bedside care,such as tepid sponge

bath, feeding, changing ofbed linen, use of bedpanand mouth care.

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Management

- Any bleeding from therectum, blood in stools,

sudden acute abdominalpain, restlessness, falling oftemperature should bereported at once to the

physician or the patientshould be brought at once tothe hospital.

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Management

- Take TPR, I&O and teach

family members how totake and record same.

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Historical Background

Mary Mallon

(September 23, 1869 November 11, 1938)

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Thank you!