Typhoid Fever

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

Other names:

•Enteric Fever•Bilious Fever•Yellow Jack

Causative Agent

Salmonella Typhi

3 main antigenic factors:

•the O, or somatic antigen•the Vi, or encapsulation

antigen•the H, or flagellar antigen

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

Incidence of Typhoid Fever red - strongly endemic; orange – endemic;

gray - sporadic cases

Mode of Transmission

Ingestion of contaminated food or water; rarely from person to person transmission through fecal-oral route.

Incubation Period

First 7-14 days after ingestion

Symptoms

•Diarrhea may occur •Active infection •Severe Headache •Generalized Abdominal Pain•Anorexia

Symptoms

•Fever [usually higher in the evening]- Intermittent Fever initially - Sustained Fever to high temperatures later

Symptoms

Severe cases•ulcers on the intestinal wall•shock•delirium•stupor

Pathognomonic Sign

• Rose SpotsBlanching pink macular spots 2-3 mm over trunk

Complications

Intestinal perforation, gastrointestinal hemorrhage and peritonitis may occur in the 3rd and 4th week of illness; rarely pancreatitis, hepatic and splenic abscesses, disseminated intravascular coagulation, myocarditis, meningitis, encephalitis.

PathophysiologySalmonella Typhi

survives the acidity of the stomach

invades the Peyer’s Patches of the intestinal wall

macrophages (Peyer’s Patches)

the bacteria is within the macrophages and survives

bacteria spreads via the lymphatics while inside the macrophages

Pathophysiologyaccess 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 Peyer’s Patches

leads to perforation, bleeding

and, if left untreated, death is imminent

Diagnostics

CBC (normal WBC despite fever), platelet count

Tourniquet Test

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

Diagnostics

Malarial smear (Differential diagnosis)

Chest X-ray

Urinalysis

Diagnostics

First Week of illness: Blood C/S

Second Week of illness: Urine G/S, C/S

Third Week of illness: Stool C/S

Management

A. Prevention:•Choose foods processed for

safety•Prepare food carefully•Foods prepared by others

(avoid if possible)

Management

•Keep food contact surfaces clean

•Eat cooked food as soon as possible

•Maintain clean hands

Management

•Steam or boil shellfish at least 10 minutes

•All milk and dairy products should be pasteurized

•Control fly populations

Management

B. AntibioticsFor uncomplicated cases, use Conventional

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

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

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

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

Management

For cases with complications, presence of severe symptoms, or clinical deterioration despite conventional therapy, use Empiric Therapy for Suspected Resistant Typhoid Fever:

1. Ceftriaxone (Rocephin) 3 gm IV infusion OD x 5-7 daysCeftriaxone may be used for pregnant women and children.

2. Fluoroquinolones:Ciprofloxacin (Ciprobay) 500 mg tab PO BID x 7-10 daysOfloxacin (Inoflox) 400 mg tab PO BID x 7-10 daysPerfloxacin (Floxin) 400 mg tab PO BID x 7-10 days

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

Management

D. Public Health Nursing Responsibility

- Teach members of the family how to report all symptoms to the attending physician especially when patient is being cared for at home.

Management

- Teach, guide and supervise members of the family on nursing techniques which will contribute to the patient’s recovery.

Management

- Interpret to family nature of disease and need for practicing preventive and control measures.

Management

E. Nursing Care- Demonstrate to family how

to give bedside care, such as tepid sponge bath, feeding, changing of bed linen, use of bedpan and mouth care.

Management

- 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 be brought at once to the hospital.

Management

- Take TPR, I&O and teach family members how to take and record same.

Historical Background

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

Thank you!