Typhoid Fever CHD

8/4/2019 Typhoid Fever CHD

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Pamela Shiermaine D. Filomeno

II-Bn 1

Communicable Disease:TYPHOID FEVER


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What is typhoid fever?

Typhoid fever is a bacterial infection of the

intestinal tract and occasionally the bloodstream.

The disease rarely occurs in developed countries. It

is most commonly seen in countries with poor

sanitary conditions and contaminated water supplies.

Most of the cases are acquired during foreign travel

to underdeveloped countries.

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Outbreaks are rare.

The germ that causes typhoid is a unique

human strain of Salmonella called

Salmonella typhi and Typhoid bacillus.

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Causes:

It is caused by infection with Salmonella typhi

a bacteria found in infected animals and transmitted

to persons in contaminated food or fluids. It is most

often found in countries with poor sanitaryconditions or contaminated water supplies. Boiling

water and thoroughly cooking food can kill the

microorganism. The infection can also be spread

asymptomatic carriers. These are people who have

the bacteria in their gastrointestinal tract, but do not

have symptoms.

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Pathophysiology

Systemic bacterial infection (Enteric Fever)

1.Salmonella typhi (Typhoid fever)

Most common and more severe form

2. Salmonella paratyphi (Paratyphoid fever)

Much more mild than Typhoid fever

Qurrataini I. Balocang MED IA 5


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Who gets typhoid fever?

Anyone can get typhoid fever but the greatest risk

exists to travelers visiting countries where the

disease is common.

Occasionally, local cases can be traced toexposure to a person who is a chronic carrier.

Infants and persons over 60 usually have theseverest cases.



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How do patients get typhoid

fever?

Typhoid fever is contracted by theingestion of the bacteria in contaminatedfood or water. Patients with acute illness

can contaminate the surrounding watersupply through stool, which contains ahigh concentration of the bacteria.

Contamination of the water supply can, inturn, taint the food supply. About 3%-5%of patients become carriers of the

bacteria after the acute illness. 7


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Some patients suffer a very mild illnessthat goes unrecognized. These patientscan become long-term carriers of thebacteria. The bacteria multiplies in thegallbladder, bile ducts, or liver and

passes into the bowel. The bacteria cansurvive for weeks in water or driedsewage. These chronic carriers may

have no symptoms and can be thesource of new outbreaks of typhoidfever for many years.

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How does the bacteria causedisease, and how is it

diagnosed?After the ingestion of contaminated food or

water, the Salmonella bacteria invade thesmall intestine and enter the bloodstream

temporarily. The bacteria are carried by whiteblood cells in the liver, spleen, and bonemarrow. The bacteria then multiply in thecells of these organs and reenter thebloodstream. Patients develop symptoms,including fever, when the organism reentersthe bloodstream.

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Bacteria invade the gallbladder, biliary system,and the lymphatic tissue of the bowel. Here,they multiply in high numbers. The bacteria

pass into the intestinal tract and can beidentified for diagnosis in cultures from the stooltested in the laboratory. Stool cultures aresensitive in the early and late stages of the

disease but often must be supplemented withblood cultures to make the definite diagnosis.

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What are the Symptoms?

The incubation period is usually one to twoweeks, and the duration of the illness is aboutfour to six weeks. The patient experiences poor

appetite;

- abdominal pain;- headaches;

- generalized aches and pains;- fever, often up to 104 F;- lethargy (usually only if untreated);

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- intestinal bleeding or perforation (after two tothree weeks of the disease);- diarrhea or constipation.

People with typhoid fever usually have a sustainedfever as high as 103 F-104 F (39 C-40 C).

Chest congestion develops in many patients, andabdominal pain and discomfort are common. The feverbecomes constant. Improvement occurs in the thirdand fourth week in those without complications. About10% of patients have recurrent symptoms (relapse)

after feeling better for one to two weeks. Relapses areactually more common in individuals treated withantibiotics.

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Signs:

Pulse-Temperature Dissociation (uncommon)

Rose Spots (Pathognomonic, present in 25% of

cases)

Blanching pink macular spots 2-3 mm over trunk

Complications: (occurs in 10-15% of cases)

Gastrointestinal Bleeding (2-10% of cases)

Bowel perforation

Typhoid encephalopathy

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For how long can an infectedperson

carry the typhoid germ? The carrier stage varies from a number of days to

years.

Only about 3% of cases go on to become lifelongcarriers of the germ and

This tends to occur more often in adults than in

children.


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Mode of Transmission

Ingestion of contaminated food

Typhoid germs are passed in thefeces and, to some

extent, the urine of infected people.

The germs are spread by eating or drinking water or

foods contaminated by feces from the infectedindividual.



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Laboratory Exam

Blood Culture

Best Test Sensitivity in first week

Bone Marrow culture

Higher sensitivity than Blood Culture

Fecal culture

Low sensitivity (~33%) Salmonella serology (Widal's Test)

Poor Test Specificity

Low Test Sensitivity (70%) 16


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Should infected people beisolated?

Because the germ is passed in the feces of infected people,

only people with active diarrhea who are unable to controltheir bowel habits (infants, certain handicapped individuals)should be isolated.

Most infected people may return to work or school when they

have recovered, provided that they carefully wash hands aftertoilet visits.

Children in daycare, health care workers, and persons in othersensitive settings must obtain the approval of the local or state

health department before returning to their routine activities.

Food handlers may not return to work until three consecutivenegative stool cultures are confirmed.


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Is there a vaccine for typhoid?

A vaccine is available

butis generally reserved for people traveling to

underdeveloped countries where significant exposure

may occur. Strict attention to food and waterprecautions while traveling to such countries is the

most effective preventive method.


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Management: Antibiotics

Specific antibiotics are often used to treat cases of typhoid.

Antibiotic Resistance is increasing

First-Line: Fluoroquinolones Alternative antibiotics (resistance is common)

Chloramphenicol

Amoxicillin

Trimethoprim-Sulfamethoxazole (Septra)


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Prevention

Choose foods processed for safety

Prepare food carefully

Foods prepared by others (avoid if possible)

Keep food contact surfaces clean (3 wash cycle) Eat cooked food as soon as possible

Maintain clean hands

Steam or boil shellfish at least 10 minutes

All milk and dairy products should be pasteurized

Control fly populations


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Nursing Responsibility

Teach members of the family how to report allsymptoms to the attending physician especiallywhen patient is being cared for at home.

Teach, guide and supervise members of thefamily on nursing techniques which willcontribute to the patient recovery.

Interpret to family the nature of disease andneed for practicing preventive and controlmeasures.



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Nursing care:

Demonstrate to family how to give bedsidecare, such as tepid sponge bath, feeding,changing of bed linen, use of bedpan andmouth care.

Any bleeding from the rectum, blood in stools,sudden acute abdominal pain, restlessness,falling of temperature should be reported at

once to the physician or the patient should bebrought at once to the hospital.

Take vital signs and teach family member howto take and record same.

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Mary Mallon(September 23, 1869 November 11, 1938)


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Also known as Typhoid Mary

was thefirstperson in the United States to be

identified as a healthy carrier of typhoid fever.

She seemed a healthy woman when a health inspector

knocked on her door in 1907, yet she was the cause of

several typhoid outbreaks.


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Since Mary was thefirst"healthy carrier" of typhoid fever in theUnited States, she did not understand how someone not sickcould spread disease -- so she tried to fight back.

She was forcibly quarantined twice by public health authoritiesand died in quarantine.

Over the course of her career as a cook, she infected 47 people,

three of whom died from the disease.

It was also possible that she was born with the disease, as hermother had typhoid fever during her pregnancy.


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MaryMallon died on November 11, 1938 at the age of 69

due topneumonia (not typhoid), six years after a stroke had

left her paralyzed.

However, an autopsy found evidence oflive typhoid bacteria in

her gallbladder.

Her body was cremated with burial in Saint Raymond's Cemeteryin the Bronx.

Typhoid Fever CHD

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