TYPHOID FEVER

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Reported by: Neil Anthony L. Valdez

DEFINITION

Also known as enteric fever, an infection that causesdiarrheaand arash-most commonly due to a type of bacteria called Salmonella typhi(S. typhi). 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.

Causative Agent: Salmonella typhi, Typhoid bacillus

a bacteria found in infected animals and transmitted to persons in contaminated food or fluids. 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.

Incubation period: usually between 7-14 days Period of communicability: for as long as bacteria are in the stools

Mode of transmission: by food and water contaminated by stools and urine of patients or carriers. The vehicles are the 5 Fs: Feces, Food, Flies, Fomites, Fingers

Pathophysiology
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

Pathophysiology

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

Diagnostic Exams DEFINITIVE DIAGNOSIS:

- Isolation of S. typhi in the blood, bone marrow or specific anatomic lesions.

Blood culture- during the prodromal stage

Diagnostic Exams Widal test to determine the antigen left by the microorganism a. Antigen O presently infected b. Antigen H- has been exposed before or has received toxin

Urine Culture Stool Culture

Signs and Symptoms

Prodomal stage- for 3-4 days Dull headache; malaise Chills; fever; body aches Vomiting or diarrhea

Signs and Symptoms

Fastigeal/ pyrexial stage- during the second week Exanthem: rose spots- 4-5 pecular rose-colored macules or maculopapules seen on the 7th to the 12th day on the abdomen and chest (in adults) or on the face (infants) Ladder-like fever

Enlarged spleen

Signs and Symptoms

Typhoid psychosis a. Coma-vigil look- pupils dilate and patient appears to have blank stares or staring b. Difficulty putting out the tounge c. Carphologia- involuntary and aimless picking of linen d. Subsultus Tendinuminvoluntary twitching of the tendon of the wrists

Signs and Symptoms

Deferenscence stage- 3rd week Intestinal haemorrhagemicroorganism produces ulcers in the intestine.

Signs and Symptoms

Intestinal perforationspillage of fecal material in the peritoneum, causing peritonitis a. Persistence of fever

b. Abdominal pain, distention, rigidity Cough and pneumonia

Signs and Symptoms

Lysis/ convalescence stagealthough signs and symptoms subside, patient should still be observed for relapses which could be fatal

Management

Prevention Immunization- CDT (Cholera, Dysentery, Typhoid) a. Given IM at the deltoid b. Children- 0.25 ml, Adults- 0.5 ml c. 6 months immunity

Vivotif q Capsule form q Given 1 hour before meal every other day for 3 doses q 3 years immunity q Control

Proper handwashing; clean environment Boil drinking water Avoid streetfoods and improperly washed or improperly cooked food

PHARMACOLOGIC MANAGEMENT

ANTIBIOTICS ANTIMICROBIAL THERAPY

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%.

ANTIMICROBIAL THERAPY

Fluroquinolonesattain excellent tissue penetration, kill S. typhi in its intracellular stationary stage in monocytes/macrophages and achieve higher active drug levels in the gall bladder and other drugs.

ANTIMICROBIAL THERAPY

IV Dexamethasone- patients with changes in mental status, characterized by delirium, obtundation and stupor,

ANTIMICROBIAL THERAPY

Surgical consultation- for suspected intestinal perforation. Metronidazole and gentamicin or cefriazone should be administered before and after surgery. Supportive measures- Oral & IV hydration, antipyretic, nutrition & blood transfusion (if indicated)

PHARMACOLOGIC MANAGEMENT

Alternative antibiotics (resistance is common) Chloramphenicol Amoxicillin TrimethoprimSulfamethoxazole (Septra)

nursing MANAGEMENT

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

nursing MANAGEMENT

Teach, guide and supervise members of the family on nursing techniques which will contribute to the patientsrecovery Interpret to family nature of disease and need for practicing preventive and control measures

nursing MANAGEMENT

Management Demonstrate to family how to give bedside care such as tepid sponge, feeding changing of bedlinen,use of bedpan and mouth care

nursing MANAGEMENT

Management Any bleeding from the rectum,blood in stoolssudden acuteabdominal painrestlessness, falling of temperature should be reported at once to the physician or the patient should be brought at once to the hospital.

nursing MANAGEMENT

Management Take vital signs and teach patient family member how to take and record same