typhoid fever

2. What is Typhoid Fever?



Typhoid Fever is a life-
threatening illness caused by
the bacterium Salmonella
Typhi.
Typhoid Fever is also known
as enteric fever, bilious fever
or Yellow Jack.
It is a gram-negative short
bacillus that is motile due its
flagellum.
 Gram-negative bacteria are
pathogenic, meaning they can
cause disease in a host
organism.

3. Typhoid Fever



About 400 cases of
Typhoid Fever occur
each year in the United
States.
70% of these cases are
acquired while traveling
internationally.
Typhoid Fever affects
approximately 12.5
million people each year.

4. Typhoid Fever



,patients with acute illness can
contaminate the surrounding water
supply through their feces which
has a very high concentration of
the bacteria.
After the acute, illness about
3%-5% of the people become
carriers of the disease.
Sometimes the illness goes
unnoticed but these people
become long-term carriers.
The bacteria will multiply while in
the gallbladder, bile ducts and the
liver and then pass into the bowel.

5. 


After ingested, the bacteria
temporarily enter the blood
stream and travel to the
small intestine.
White blood cells carry the
disease to the liver, spleen
and bone marrow where it
reproduces and reenters the
blood stream.
The bacteria then invades
the gallbladder, biliary
system, and the lymphatic
tissue of the bowel.
The Disease
Typhoid Nodule in the liver

6. Affected Organs
 Abdominal Cavity
including:
 Liver
 Gallbladder
 Stomach
 Small intestine
 Large intestine

7. How is Typhoid Fever Contracted?



Typhoid Fever is contracted
by the ingestion of the
bacteria in contaminated
food or water.
The bacteria itself only lives
in humans and is carried
through the blood stream
and intestinal tract.
Both ill people and carriers
of the disease spread the
Typhoid bacteria through
their feces.

8. Transmission


Typhoid can be passed
through animals, only
through humans.
Flies however, are known to
help transmit the disease
because when they land on
human excrement, it
remains on their
appendages and can be
transmitted when they land
on something else.

9. Symptoms
 Symptoms include:









Fevers up to 103° or 104°
Weakness
Headaches
Poor appetite
Generalized aches and
pains
Diarrhea
Occasionally a rash of flat,
rose-colored spots
Discomfort
Abdominal Tenderness

10. Symptoms Continued ….









Constipation, then
diarrhea
Bloody Stools
Nosebleed
Chills
Delirium
Confusion
Agitation
Fluctuating moods
Hallucinations

11. Stages of Typhoid Fever


Classically, the untreated
typhoid fever is broken down
into four different stages, each
lasting about a week.
Stage One:
 A slowly rising temperature
 Relative bradycardia
(unusually slow heart rate),
malaise (discomfort or
uneasiness), headache and
cough.
 In ¼ of cases, epistaxis
(acute hemorrhage from the
nostril, nasal cavity, or
nasopharynx) can occur.

12. Stages of Typhoid Fever

Stage Two:
 Continuing high fever
 Extremely distended
abdomen
 Considerable weight loss
 Bradycardia continues
 Dicrotic pulse wave
 Delirium is frequent,
frequently calm and
sometimes agitated.

13. Stages of Typhoid Fever
 Stage Three:
 A number of complications can
occur:






Intestinal hemorrhage due to
bleeding
Intestinal perforation
Encephalitis (inflammation of
the brain)
Fever is still very high
Dehydration occurs and
increases delirium
Lies motionless with eyes half-
opened
 Stage Four:
 Defervescence (very high fever)
commences that continues into the
fourth week.

14. Complications
 Death occurred from the
development of other
complications such as:






Overwhelming infections
Pneumonia
Intestinal bleeding
Intestinal perforation
Kidney Failure
Peritonitis (inflammation of
the peritoneum, the thin
membrane that lines the
abdominal wall and covers
most of the organs of the
body)

15. Complications Continued ….





Inflammation of the
pancreas
Infections of the spine
Inflammation of the
membranes surrounding
the spinal cord and brain
(meningitis)
Inflammation of the heart
muscle
Psychiatric problems

16. Diagnosis


Diagnosis is made by
blood, bone marrow,
or stool.
The Widal test is
commonly used to
diagnose Typhoid.
 Looks for salmonella
antibodies against
antigens O-somatic
and H-flagellar)

17. Exams and Tests






An elevated white blood
cell count
A blood culture the shows
the bacteria
A stool culture
An ELISA test to show
the Vi antigen
A platelet count (low
platelet count)
A fluorescent antibody
study

18. Antibody Testing


Fluorescent Antibody
Test
The test checks for
the antibody specific
to the S. Typhi
bacterium.

19. Antigen Testing


Enzyme-linked
immunosorbent assay
(ELISA)
The blood test looks
for the antigen
specific to the typhoid
bacteria.

20. Carriers of Typhoid



3%-5% of people who
have been infected
become carriers of the
disease.
Carriers are treated with
prolonged antibiotics.
Removal of the
gallbladder or the site of
the infection will usually
cure the patient.Typhoid Carrier undergoes treatment

21. 


Typhoid is treated with an
antibiotic that kills the
Salmonella bacteria.
With antibiotics,
improvement can be seen
in 1-2 days and recovery
in 7-10 days.
Intravenous fluids and
electrolytes may also be
given to patients.
Treatment
Typhoid Vaccine

22. Treatment



In most cases typhoid fever
is not fatal.
Antibiotics such as
ampicillin, chloramphenicol,
trimethethoprim-
sulfamethoxazole, and
ciprofloxican.
These antibiotics have been
used in most developed
countries.

23. Resistance



Resistance to ampicillin,
chloramphenicol, trimethoprim-
sulfamethoxazole and
streptomycin are common
drugs used against Typhoid
but have now become
resistant.
These drugs have not been
used in over 20 years.
Typhoid that is resistant to
multiple drugs is known as
multidrug-resistant typhoid
(MDR typhoid).

24. Chloramphenicol


Chloramphenicol was
the original prescribed
drug to patients with
Typhoid Fever.
However due to
certain side effects,
this drug has been
replaced by others. Chloramphenicol

25. Choice of Drugs



The type of antibiotic
prescribed is based on
the region in which the
disease originates.
Bacteria from certain
areas in South America
show a resistivity to many
antibiotics.
Relapses of the disease
are dealt with by the
administration of
antibiotics.

26. Improvement



With the use of
antibiotics, improvement
can come usually in the
fourth week.
The fever generally
decreases back down to
normal temperature in
7-10 days.
Signs and symptoms
however, can return in up
to 2 weeks after the fever
has subsided.

27. Fatality


Before the antibiotic,
the death rate was
20%.
Antibiotics have
reduced the fatality
rate 1%-2%.
Antibiotic to prevent Typhoid Fever

28. How can Typhoid be avoided?







Avoid risky foods or drinks
Get vaccinated
Use only clean water
Ask for drinks without ice
unless you know where
it’s coming from
Only eat foods that have
been thoroughly cooked
Avoid raw fruits and
vegetables
Avoid food and drinks
from street vendors