Typhoid

ln~troduction

c• Typh oid feve r is due to syst emic infe ction

main ly by Salm onel la typh i
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"ENTERIC FEVER" includ es both typho id and
para typhoi d fevers
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The disease may occur sporad ically,
epidem ically or endem ically
 f: ff»u r» r:: ~,~ ~ (Q)lOG ~ ( /-\l DfET(E RM CNA~\JTS

AGENT:
1.S alm one lla typh i is the maj or cause of ent ric
feve r
2. [Link] /~ & [Link] Bar e rela tive ly infr equ ent
 lVP~~O~D BA (~l ll

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[Link] has thre e mai n anti gen s : 0, H & Vi and
a num ber of pha ge type s
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[Link] phi surv ives intr ace llula rly in the tissues of
.
vari ous orga ns
c It is rea dily kille d by dryi ng, pas teur izat ion and
com mon disi nfec tant s
 Factors
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infecting dose
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virulence of the organism
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the only known reservoir of infection
i\lla,1 is
(,,ia cases Rt carriers)
° CASES: A case is infectious as long as bacilli
appears in stools or urine
° CARRIERS: The carriers may be temporary
(incubatory, convalescent) or chronic
° Convalescent carriers excrete bacilli for 6-8
weeks (after which their numbers diminish
rapidly by the end of three months)
 Carriers ..
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Persons who excr ete baci lli for mor e than one
year are afte r clinic al attac k are calle d chro nic
carri ers
In mos t chro nic carri ers the baci lli exis ts in gall
blad der and in the billia ry trac t. A chro nic
carr ier n1ay e><crete the baci li for seve ral year s
(mav be as long as 50 years)
 Carriers ..
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A famous case of "Typhoid Mary" who gave
raise to 1300 cases in her life time is an
example for a chronic carrier state
° Faecal carriers are more common than urinary
.
ca rr1ers
 SOURCE OF INFECTION
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The primary sources of infection are faeces
and urine of cases or carriers
() The secondary sources include contaminated
water, food, fingers and flies
 HO§l fAClOiR§

1. AGE: Typhoid fever may occur at any age

2. GENDER: Males are more affected than
females
3. IMMUNITY: All ages are susceptible to
infection
The host factors that contributes to resistance
to the bacilli are gastric acidity & local
intestinal immunity
 l:io [E~~V~ulONMlENTAl gt SOCIAL
FACTOR
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Ente ric feve rs are obs erve d all thro ugh out the
yea r
C) The pea k inci den ce is repo rted dur ing July-
Sep tem ber
, \/eg etab les gro wn in sewage farm land s or
vvashed in con tam inat ed wat er are pos itive
hea lth hazard
r -

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whic h case inges tion of such raw milk
0 social facto rs as pollu tion of drink ing wate r
supp lies, open air defec ation and urina tion,
low stand ards of food and personal hygiene
and healt h ignor ance
0 Ther efore typ,1oid feve r may be regarded as
, H1 incie1{ of gene ral sanit ation in any country
c Usually 10-14 days
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can be as short as 3 days or as long as 3
vveeks, depending on the dose of baci II i
ingested
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faecal-o ral route or urine- oral routes
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t hrough soiled hands contami nated with
f aeces or urine of cases or carriers or
indirectl y by t he ingestio n of contami nated
v,, a t e r, n1 i Ik, food o r t h ro ugh f Ii es
CLli\llC,L\L FEATURES
0 The onset is insidious, but in children may be
abrupt with chills and high fever.
During the prodrom al stage - malaise,
headache, cough and sore throat often with
abdomin al pain and constipa tion
The fever ascends in step ladder fashion
After about 7-10 days, the fever reaches a
plateau and the patient looks toxic appearing
exhausted and often prostrated
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marked constipation, especially in the early
stages or "pea soup diarrhoea 11
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marked abdominal distension
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leukopenia and blood, urine and stool culture
is positive for salmonella
 !Eady phase
splenomegaly, abdominal distension and
tenderness, relative bradycardia, dicrotic pulse
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The rash (rose spots)commonly appear during
t he second week of the disease
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The indivic1ual spot , found princi pally on tl1e
trunk, is a pink papule 2-3 m m in diameter
iJ1at fades on pressure. It disappears in in 3-4
,.
c,a,,s
I
I
I

I
I

- --- ~
~--
I
 Complications
o f p a ti e n ts (e sp e c ia lly those
en t
o c c u r in up to 1 0 p e rc
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fo r lo n g e r th a n 2 w e e k s and who
w h o h a v e b e e n ill
n o t re c e iv e d p ro p e r tr e a tm e n t)
hav e
e - m a n if e st e d b y a su d den
hag
1 . In te s ti n a l h a e m o rr g n s o f sh oc k , followed by
a n d si
d ro p in te m p e ra tu re o ol
r fr e sh b lo o d in th e st
d a rk o uring the
o st lik el y to o c cu r d
o n is m
2. In te s ti n a l p e rf o ra ti
th ir d w e e k
p li c a ti o n s a re u ri n ary retention,
Less fr e q u e n t com , m y o ca :~ it is , psychosis,
p h le b it is
p n e u m o n ia , thrombo te o myel1t1s
ti s , n e p h ri ti s a n d o e
cholecysti
 lLABO~AlO~V D~AGNO§~S
• MICROBIOLOGICAL PROCED
URES
- iso lat io n of th e baci\\i fro m bl
oo d, bo ne ma rro w an d sto ol s .
Bl oo d cu \tu re is th e ma in sta y of
di ag no sis of th is di se as e
• SEROLOGICAL PROCEDURE
° Fe lix -W ida \ te st m ea su re s ag gl
ut in ati ng an tib od y lev els ag ain st
an tig en s O& H
o Usually "O " antibod
ies appear on day 6-8 and "H"
day 10 -1 2 af te r th e onset of dis antibodies on
ease
0 Th e te st is us ua lly pe rfo rm ed
on an ac ut e se ru m (a t fir st co nt
wi th th e pa tie nt ) ac t
0 It ca n be ne ga tiv e up to 30 % of
cu ltu re - pr ov en ca se of ty ph oi
fe ve r d
• Th is ma y be be ca us e of pr io
r an tib io tic th er ap y, th at ha s bl
th e an tib od y re sp on se un ted
Di a Ll:11()S i S
-- () r E 11 tcri C rc\1 Cr
 PREVENTION

° CONTROL Of TVPl~OID FEVER O The control or

elimination of the typhoid fever is well within
t he scope of modern public health
 lf}]eu"e 2-nre gerneraij~y ·LChree iir~es of
d1e·u-eu1ce a1g~nn1s·~ u:vtohoi(Oj fever:
0 Y1.. Control of reservoir
0 2. Control of sanitation
0 3. Immunization
·· COt\t-rROL OF RESER\IOIR "..
The usual n,ethods
o f co n t r o l o f res e r v o i r a re t h e
i r i d enti f Icat i o n ,
is o la tio n . treatn1ent & disinfec
tion
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f\!OT~l'=~CAT!ON: Notification must be done in
areas where it is mandatory

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~§OlATijON: Since typhoid is an infectious
d isease the cases are to be transferred to
hospit al
 l~tATfu1E~T
Q FI (0 t1 r o Cj v1 i,1 o Io ,1 es
: (1 !o re n1 lG) ~1 er~ ico I, a rfl tJ i ci II in, a n1 o ,d c iII i11, a n d
·~:rnLJ1et~1oprim & sulphar-flei:t10},azole
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~ ·;:-~-~:3t2:1ts s~t~c11 ~~s~1~ ill 0H1d profoundly to,cic
S~'tO~~;ci be gi,,er~ ~,,j of hydrocortisone 100 mg
~ -~
(); au,r.,.,.
YOV'
~ n ~
.:v -r..g. C~ol,fS
~
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sto ols and uri ne are the sol e sou rce s of
infe ctio n. Th ey sho uld be rec eiv ed in in clo sed
con tain ers and dis infe cte d wit h 5% cre sol for
at lea st 2 hou rs
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All soi led clo the s and line n sho uld be soa ked
in a sol utio n of 2% chl ori ne and be str ea m
ste riliz ed
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Do cto rs and nur ses sho uld dis infe ct the ir
han ds
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ident ificat ion and treat men t
1. IDE f\, TIFICATION : Carriers are ident ified by
cultu re and serological exam inatio ns.
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The antib odies are prese nt in abou t 80% of
chron ic carriers
2. TREATf\/iEi\,T OF CARRIERS: The carriers shou ld
be given an inten sive cours e of ampi cillin or
amox ycillin (4-6 g a day) toget her with
probe necid (2g/d ay) for 6 weeks
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1. Vi poivssaccha ride vaccine
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2. The Type 21a vaccine