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To understand natural history of

typhoid infection
Susceptibility Stage
• Eating food or beverages handled by a carrier/unvaccinated food
• neglecting hand hygiene when using toilet or handling food
• Eating undercook shellfish,raw vegetable,contaminated cendol or raw
• Drink unboiled water
• Using contaminated water in food preparation
• travelers
• Food from street vendors
• Individual who use antacids or undergo gastrectomy which can
decrease stomach acidity
• Immunocompetent individual
• Has close contact with infected individual
• Handling or cutting raw meat or eggs and then using the knife, cutting
board, bowl, or other utensils for other food items such as vegetables
or fruit
Subclinical Stage
• Typhoid fever begins 7-14 days after ingestion of the organism
• Can be longer, and onset is insidious
Clinical Stage
• During first week of illness, patient will have abdominal
pain,constipation ,fever,dry cough,headache,malaise or relative
• At the end of the first week of illness, the fever plateau at 39-40°C.
The patient develops rose spots,abdominal distension with
tenderness or splenomegaly
• In second week,sign and symptom progress
• In third week, febrile become toxic &anorexic. Patient has significant
weight loss
• Thypoid state: apathy,confusion and psychosis
• High risk for intestinal perforation
• In fourth week, is recovery period
Sign and symptom
• Sustained and prolonged fever up to 40°C
• Diarrhea/Constipation
• Abdominal pain
• Headache
• Malaise (Weekness/ Lethargic)
• Loss of apetite
• Dry cough
• Slow heart rate (bradycardia)
• Rose coloured spots on the upper body(fair skin)
• Hepatosplenomegaly
Recovery/Disability/Death Stage
• If the individual survives salmonella infection, the fever, mental state,
and abdominal distension slowly improve over a few days.
• Intestinal and neurologic complications may still occur in surviving
untreated individuals.
• Weight loss and debilitating weakness last months.
• Some survivors become asymptomatic S typhi carriers and have the
potential to transmit the bacteria indefinitely
• long-term or permanent neuropsychiatric complications.
• Necrotic Peyer patches may cause bowel perforation and
• Myocarditis or nephritis
• Meningitis
• overwhelming toxemia, myocarditis, or intestinal hemorrhage may
cause death