Typhoid fever

Infectious
Disease
 Definition

 An infectious feverish disease caused by the bacterium Salmonella typhi.

 Acute generalized infection of the

reticulo endothelial system,
intestinal lymphoid tissue, and the gall bladder.

 The infection always comes from another human, either an ill person or a
healthy carrier of the bacterium. The bacterium is passed on with water
and foods and can withstand both drying and refrigeration.
1. The best known carrier was "Typhoid
Mary“; Mary Mallon was a cook in Oyster
Bay, New York in 1906 who is known to
have infected 53 people, 5 of whom died.

2. Later returned with false name but

detained and quarantined after another
typhoid outbreak.

3. She died of pneumonia after 26 years in

quarantine.
 Causes
1. Caused by the bacterium Salmonella Typhi .

2. Ingestion of contaminated food or water.

3. Contact with an acute case of typhoid fever.

4. Water is contaminated where inadequate sewerage systems and poor sanitation.

5. Contact with a chronic asymptomatic carrier.

6. Eating food or drinking beverages that handled by a person carrying the bacteria.

7. Salmonella enteriditis and Salmonella typhimurium are other salmonella bacteria,

cause food poisoning and diarrhoea.
How does the bacteria cause disease ?
 Ingestion of contaminated food or water

Salmonella bacteria

Invade small intestine and enter the bloodstream

Carried by white blood cells in the liver, spleen, and bone marrow

Multiply and reenter the bloodstream

Bacteria invade the gallbladder, biliary system, and the lymphatic tissue of
the bowel and multiply in high numbers

Then pass into the intestinal tract and can be identified for diagnosis in
cultures from the stool tested in the laboratory
 Symptoms
 No symptoms - if only a mild exposure; some people become "carriers" of
typhoid.
 Loss of appetite,
 Headaches,
 Generalized aches and pains,
 Fever, Lethargy,
 Diarrhea,
 Have a sustained fever as high as 103 to 104 degrees Fahrenheit (39 to 40
degrees Celsius),
 Chest congestion develops in many patients, and abdominal pain and
discomfort are common,
 Constipation, mild vomiting, slow heartbeat.
 Intestinal perforation may occur in some cases.
Rose spots Aches and pains High fever

Diarrhea Chest congestion Typhoid Meningitis

 Time frame
 Occurs gradually over a few weeks after exposure to the bacteria.
Sometimes children suddenly become sick.
 The condition may last for weeks or even a month or longer without
treatment.

First-Stage Typhoid Fever

The beginning stage is characterized by high fever,fatigue, weakness,
headache, sore throat, diarrhea, constipation, stomach pain and a skin
rash on the chest and abdominal area. According to the Mayo Clinic,
adults are most likely to experience constipation, while children usually
experience diarrhea.
 Second stage
Second-stage typhoid fever is characterized by weight loss, high fever,
severe diarrhea and severe constipation. Also, the abdominal region
may appear severely distended.

Typhoid State
When typhoid fever continues untreated for more than two or three
weeks, the effected individual may be delirious or unable to stand and
move, and the eyes may be partially open during this time. At this point
fatal complications may emerge.
 Diagnosis

Diagnosis of typhoid fever is made by

 Blood, bone marrow, or stool cultures test

 Widal test

 Slide agglutination

 Antimicrobial susceptibility testing

 Widal test

" A test involving agglutination of typhoid bacilli when they are

mixed with serum containing typhoid antibodies from an
individual having typhoid fever; used to detect the presence
of Salmonella typhi and S. paratyphi."
 Standard test tube method
Take four sets of 8 test tubes and label them 1 to 8 for O,H,AH and BH antibody detection.

Pipette in to the tube No.1 of all sets 1.9 ml of isotonic saline.

To each of the remaining tubes (2 to 8) add 1.0 ml of isotonic saline.

To the tube No. 1 tube in each row add 0.1 ml of the serum sample to be tested and mix
well.

Transfer 1ml of the diluted serum from tube no.1 to tube no.2 and mix well.

Discard the 1ml of the diluted serum from tube no.7 of each set.
Tube no.8 in all sets,serves as a saline control. Now the dilution of the serum sample
achieved in each set is as follows:

Tube no. 1 2 3 4 5 6 7 8 (control)

Dilutions 1:20 1:40 1:80 1:160 1:320 1:640 1:1280 –

To all tubes (1 to 8) of each set add one drop of the respective WIDAL TEST antigen
suspension (O,H,AH,BH) from reagent vials and mix well.

Cover the tubes and incubate at 37 C overnight (approx. 18 hrs).

Dislodge the sedimented button gently and observe.

 How do you read Widal test
results for typhoid fever?

 The highest dilution of the patients serum in which agglutinations occurs is

noted, ex. if the dilution is 1 in 160 then the titer is 169.

 Agglutination in dilution up to <1:60 is seen in normal individuals .

Agglutination in dilution 1:160 is suggestive of Salmonella infection.

 Agglutination in dilution of and more than 1:320 is confirmatory of Enteric

fever .
Prevention
And
Treatment
 Prevention
Two main typhoid fever prevention strategies:

1. Vaccination

First type of vaccine:

 Contains killed Salmonella typhi bacteria.
 Administered by a shot.

Second type of vaccine:

 Contains a live but weakened strain of the Salmonella bacteria that causes
typhoid fever.
 Taken by mouth.
 Be vaccinated against typhoid while traveling to a country where typhoid is common.
 Need to complete your vaccination at least one week before travel.
 Typhoid vaccines lose their effectiveness after several years so check with your
doctor to see if it is time for a booster vaccination.

2. Avoid risky food and drinks

 Buy bottled drinking water or bring it to a rolling boil for one minute before drinking it.
 Ask for drinks without ice, unless the ice is made from bottled or boiled water.Avoid
Popsicles and flavored ices.
 Eat food that have been thoroughly cooked and that are still hot and steaming.
 Avoid raw vegetables and food that cannot be peeled like lettuce.
 When eat raw fruit and vegetables that can be peeled, peel yourself. Don’t eat the
peelings.
 Avoid foods and beverages from street vendors.
 Treatment
Consultations

 An infectious disease specialist or surgeon should be consulted.

Surgical Care

 Usually indicated in cases of intestinal perforation.

 Most surgeons prefer simple closure of the perforation with drainage of the
peritoneum.
 Small-bowel resection is indicated for patients with multiple perforations.
 If antibiotic treatment fails to eradicate the hepatobiliary carriage, the gallbladder
should be resected.
 Cholecystectomy is not always successful in eradicating the carrier state because of
persisting hepatic infection.
 Diet

 Fluids and electrolytes should be monitored and replaced diligently.

 Oral nutrition with a soft digestible diet is preferable in the absence of
abdominal distension or ileus.

Activity

 No specific limitations on activity are indicated.

 Rest is helpful, but mobility should be maintained if tolerable.
 The patient should be encouraged to stay home from work until recovery.
 Some common home remedies
 Take two grains of Un nab, Munnakka 4, Kuhbkalan 3 gm's. and Misri 10
gm's. grind all of them and mix in 100 ml. of water, preferably boiled and
cooled. Strain the water and make the patient drink at four hourly interval.

 Take 4 basil leaves, saffron 7 shreds, 7 grains of black pepper. Grind them
to a paste by adding water and form small tablets out of the whole lot. Take
each tablet twice or thrice everyday with lukewarm milk. The fever would
also subside and the patient would get the desired relief.

 1 to 2 teaspoons of fresh juice of coriander leaves mixed in 1 cup buttermilk

and taken 2-3 times a day.

 Mash a ripe banana along with 1 tablespoon honey and eat twice a day for a
few days.
 Medication
Antibiotics
 Antibiotics, such as ampicillin, chloramphenicol, fluoroquinolone
trimethoprim-sulfamethoxazole, Amoxicillin and ciprofloxacin etc used to
treat typhoid fever.

 Prompt treatment of the disease with antibiotics reduces the case-

fatality rate to approximately 1%.
Epidemiology

♦ strongly endemic
♦ endemic
♦ sporadic cases
 Misdiagnosis
 Paratyphoid fever- similar to typhoid fever but usually less severe.
 Paraenteric fever- a typhoid-like fever but not caused by Salmonella.
 Gastroenteritis- mild case of typhoid fever may be mistaken for gastroenteritis.
 Typhomalarial fever
 Brucellosis
 Tuberculosis
 Infective endocarditis
 Q fever
 Rickettsial infections
 Acute diarrhea (type of Diarrhea)
 Viral Hepatitis
 Lymphoma
 Adult Still's disease
 Malaria