TYPHOID

FEVER
What is typhoid fever?
* Typhoid fever is 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.

* Most of the cases are acquired during foreign travel to

underdeveloped countries.
• Outbreaks are rare.

• The germ that causes typhoid is a

unique human strain of Salmonella
called Salmonella typhi.
Causes
• It is caused by infection with Salmonella typhi –
a bacteria found in infected animals and transmitted to
persons in contaminated food or fluids. It is most often
found in countries with poor sanitary conditions or
contaminated water supplies. 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.
How does the bacteria
cause disease?
• After the ingestion of contaminated food or water, the
Salmonella bacteria invade the small intestine and enter the
bloodstream temporarily. The bacteria are carried by white blood
cells in the liver, spleen, and bone marrow. The bacteria then
multiply in the cells of these organs and reenter the
bloodstream. Patients develop symptoms, including fever, when
the organism reenters the bloodstream. Bacteria invade the
gallbladder, biliary system, and the lymphatic tissue of the
bowel. Here, they multiply in high numbers. The bacteria pass
into the intestinal tract and can be identified for diagnosis in
cultures from the stool tested in the laboratory.
Who gets typhoid fever?

• Anyone can get typhoid fever but the

greatest risk exists to travelers visiting
countries where the disease is common.

• Occasionally, local cases can be traced to

exposure to a person who is a chronic carrier.

• Infants and persons over 60 usually have the

severest cases.
Transmission
• Ingestion of contaminated food

• Typhoid germs are passed in the feces and, to some

extent, the urine of infected people.

• The germs are spread by eating or drinking water or

foods contaminated by feces from the infected
individual.
Epidemiology: Incidence
• 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
• ♦ Strongly endemic
• ♦ Endemic
• ♦ Sporadic cases
Risk factors

• Travel to developing country or refugee

camp
• Highly dense living conditions
What are the symptoms?
• The symptoms may occur rapidly, particularly in children.
• However, in adults, they usually come on slowly

• Relapses are common.

• Fatalities are less than 1% with antibiotic treatment.

• Symptoms generally appear one to three weeks after exposure.

Symptoms
• Incubation (first 7-14 days after ingestion)
• Usually asymptomatic
• Diarrhea may occur
• Active infection
• Severe Headache
• Generalized Abdominal Pain
• Anorexia
• Constipation more common than Diarrhea
• Fever [usually higher in the evening] 103 F-104 F (39 C-40 C).
• Intermittent Fever initially
• Sustained Fever to high temperatures later
Signs
• Pulse-Temperature Dissociation (uncommon)
• Rose Spots (present in 25% of cases)
• Blanching pink macular spots 2-3 mm over trunk
• Complications: (occurs in 10-15% of cases)
• Gastrointestinal Bleeding (2-10% of cases)
• Bowel perforation
• Typhoid encephalopathy
Rose spots on the chest of a patient with typhoid
fever due to the bacterium Salmonella typhi.
For how long can an
infected person carry the
typhoid germ?
• The carrier stage varies from a
number of days to years.
• Only about 3% of cases go on to
become lifelong carriers of the germ
and
• This tends to occur more often in
adults than in children.
Laboratory Exam
• Blood Culture
• Best Test Sensitivity in first week
• Bone Marrow culture
• Higher sensitivity than Blood Culture
• Fecal culture
• Low sensitivity (~33%)
• Salmonella serology (Widal's Test)
• Poor Test Specificity
• Low Test Sensitivity (70%)
 Should infected people
be
• Because isolated?
the germ is passed in the feces of infected people, only
people with active diarrhea who are unable to control their bowel
habits (infants, certain handicapped individuals) should be isolated.

• Most infected people may return to work or school when they have
recovered, provided that they carefully wash hands after toilet
visits.

• Children in daycare, health care workers, and persons in other

sensitive settings must obtain the approval of the local or state
health department before returning to their routine activities.

• Food handlers may not return to work until three consecutive

negative stool cultures are confirmed.
 Is there a vaccine for
typhoid?
• A vaccine is available
• but is generally reserved for people
traveling to underdeveloped
countries where significant exposure
may occur.
• Types of vaccines include:
• Ty21a is a live attenuated bacterial vaccine that protects
against typhoid.It is one of two typhoid vaccines currently
recommended by the World Health Organization.The
vaccine offers between 33 and 78% protection. The
vaccine is most commonly used to protect travellers to
endemic countries, but there is no reason why the vaccine
could not be used in large scale public prevention
programmes.
• The vaccine is given by mouth. The vaccine is presented
either as capsules or a liquid suspension.
• The Vi capsular polysaccharide vaccine (or ViCPS)

• The vaccine is only 60 to 80% protective and the traveller

should still be warned to take all usual precautions
(careful hygiene, hand washing and food preparation).
• The vaccine is injected either under the skin or into a
muscle at least seven days before traveling to the
typhoid-affected area (recommend 14 days). The vaccine
is not effective in children under the age of two.
• To maintain immunity, the vaccine should be repeated
every three years.
Management: Antibiotics
Specific antibiotics are often used to treat cases of
typhoid.

• Antibiotic Resistance is increasing

• First-Line: Fluoroquinolones
• Alternative antibiotics (resistance is common)
– Chloramphenicol
– Amoxicillin
– Trimethoprim-Sulfamethoxazole (Septra)
Prevention
• Choose foods processed for safety
• Prepare food carefully
• Foods prepared by others (avoid if possible)
• Keep food contact surfaces clean
• Eat cooked food as soon as possible
• Maintain clean hands
• All milk and dairy products should be pasteurized
• Control fly populations
• When you drink water, buy it bottled or bring it to a rolling boil
for 1 minute before you drink it.
• Ask for drinks without ice unless the ice is made from bottled
or boiled water. Avoid popsicles and flavored ice that may
have been made with contaminated water.
• Avoid raw vegetables and fruits that cannot be peeled.
Vegetables like lettuce are easily contaminated and are very
hard to wash well.
• Avoid foods and beverages from street vendors. It is difficult
for food to be kept clean on the street, and many travelers
get sick from food bought from street vendors.
• Get vaccinated against typhoid fever.
Causative Agent:
Salmonella
Virulence Factors: S.typhi
typhi has a
combination of characteristics
that make it an effective
pathogen. This species contains
an endotoxin typical of Gram
negative organisms, as well as
the Vi antigen which is thought
to increase virulence. It also
produces and excretes a
protein known as “invasin” that
allows non-phagocytic cells to
take up the bacterium, where it
is able to live intracellularly. It
is also able to inhibit the
DESCRIPTION:
Salmonella typhi
can be very dangerous if not taken care of properly.
-only live in the bloodstream or intestinal tract of humans,
-but is also found in sewage.
Even though most people either die or use antibiotics to stop
the growth of these bacteria, a very small percentage of
the people who get typhoid fever have certain antibodies
that are able to restrict the growth of salmonella typhi and
therefore are able to live.
These people plus the people that are cured through
antibiotics are called carriers because even though they
will have no more symptoms of typhoid fever, they will still
have the bacteria inside of them.
Since salmonella typhi is passed through bodily fluids, you
can contract it by eating some food or a drink handled by
a carrier. You can also contract these bacteria by having
food or water that has been contaminated with sewage
containing salmonella typhi.

• WHERE IT IS FOUND:
• Usually found contracted in the developing nations of the
world such as the Latin American, African, and Asian
countries. The reason for this is that the water in these
countries is contaminated often with sewage that on
some occasions is carrying Salmonella typhi.
• RATE OF DAMAGE:
• The symptoms of typhoid fever can begin to occur one to three
weeks after the person has contracted Salmonella typhi. These
symptoms then usually get the worst during the third week of
symptoms and then subside. By the fourth week, many people do
not have any of the symptoms of typhoid fever.

• NUMBER OF VICTIMS:
• Typhoid fever affects about 400 people in the United States each
year. Of these 400 people, 70% of them got the Salmonella typhi
while traveling internationally. In developing nations though, 12.5
million people are affected by this disease each year.
 Nursing Care
INTERVENTION RATIONALE
Independent:
*Monitor patient temperature •Fever pattern may aids in
degree and diagnosing underlying disease.
patterns.
•Chills often precede during
*Observe for shaking chills and high temperature and in
profuse diaphoresis. presence of generalized
infection.
*Wash hands with anti-
bacterial soap before and after •Reduces cross contamination
each care of activity and and prevents the spread of
encourage proper hygiene. infection.

•Provide tepid sponge baths •May help reduce fever. Use of

and avoid the use of ice water ice water and alcohol may
and alcohol. cause chills and can elevate
temperature.
INTERVENTION RATIONALE
•Monitor for signs of •May reflect inappropriate
deterioration of condition or antibiotic therapy.
failure to improve with therapy.

Collaborative:
•Used to reduce fever by its
•Administer antipyretics central action
as on the hypothalamus.
prescribed.

•Administer antibiotics •To control the

as spread of
prescribed Infection.
 END
•Que, Honey Sharlotte L.
•Romero, Michellene
Kaye S.