Ans 12

Definition: typhoid fever is an acute infectious fever caused by

salmonella typhi of eberth and characterized clinically by intense
frontal headache, prolonged high continued temperature having a
step ladder like rise during the first week and ending by lysis by the
end of the third week, relative bradycardia during the first week,
stupor, typhoid rash, gurgling in the right iliac fossa and a tender
enlarged spleen.
Aetiology:
1. causative organisms: salmonella typhi (E. typhi, bacillus
typhosus).
2. Predisposing causes:
a. Age - chiefly between 5 to 35 year.
b. Sex- slightly more in males.
c. Over crowding, bad sanitation, fatigue and overwork.
d. Common in tropical countries especially in india.
Clinical features:
1. onset insidious, very rarely abrupt in children.
2. Prodromal or initial symptoms:
a. lassitude and malaise
b. anorexia
c. frontal headache
d. muscular pains
e. constipation
f. epistaxis
g. insomnia
h. step ladder like rise of temperature being higher in the
evening than in the morning.
General mamnagement:
Prophylactic:
1. T.A.B.C injection to those who are not affected.
2. Complete isolation of the patient.
3. Disposal of all excreta after being carefully sterilized.
4. Feeding vessels, linen etc, soaked in 1 in 20 carbolic lotion for
2 hours and then boiled.
5. Avoidance of contact.
6. Hands should be washed well with soap and water after
attending the patient and afterwards rinsed in 1 in 2000
perchloride of Hg. Lotion.
7. Water and milk should be boiled.
8. Ice cream etc. forbidden.
9. Flies-avoided.
Curative:
1. free ventilation in the room.

2. Complete bed rest until the temperature has been normal for
two weeks. The patient should lie flat and turned frequently
from side to side to prevent hypostatic congestion and bed
sores. Air rings are to be given under the pelvis and pressure
points e.g elbows, heels etc. back treated daily with spirit and
powder. Body sponged daily with tepid water and powdered.
Smoothness of bed clothes is essential.
3. Bed pan is to be used.
4. Oral hygiene is to be maintained.
5. Hydrotherapy-water inside water outside is of great value.
6. Fluid intake- at least 5 pints in 24 hours.
7. Diet- 2000 to 3000 calories in 24 hours; 6 to 8 ozs. Every 2 to
4 hours and at night 4 to 6 hours. Ingredients: a. milk and milk
products. Milk alone, diluted, flavoured with tea, coffee,
ovaltine, chocolate etc; modified milk e.g skimmed milk, acid
butter milk, Horlicks, whey, ghole or lassi etc. b. protiens :
half-boiled eggs, boiled fish etc. c. cereals khai with milk,
corn flour, well boiled rice. D. smashed boiled potatoes (skin
peeled off). E. soups: chicken, dal etc. f. fruits orange, sweet
lime, grape juices. G. drinks dextrose lemonade.
Common complications:
1. parotitis
2. tympantitis
3. haemorrhage
4. performation
5. peritonitis
6. cholecystitis
7. bronchitis and broncho-pneumonia
8. hypostatic pneumonia
9. laryngitis
10.
embolism of the lung.
11.
Myocardial and peripheral failure
12.
Menigism
13.
Encephalitis
14.
Hyperpyrexia
15.
Polyneuritis
16.
Orchitis and mastitis
17.
Zenkers degeneration of the rectus muscles.
18.
Thrombosis of the femoral vein
19.
Bed sores
20.
Typhoid state
21.
B. coli pyelitis
22.
Neurasthenia, post- typhoid insanity etc
23.
Otitis media
24.
Nephritis.