Typhoid fever

S. Enterica serovar Typhi (S. Typhi)

(10 : 1)
Salmonella Paratyphi A
S. Paratyphi B
S. Paratyphi C
Enteric fever
EPIDEMIOLOGY
 Route of infection
Ingestion of foods or water
contaminated with S. Typhi
waterborne outbreaks as a
consequence of poor sanitation or
contamination
 water

Feces
soil
and Foods Mouths
urine raw of
from or well
cases or cooked persons
carriers flies

fingers
 PATHOGENESIS
ingestion of the organism
invade the body through the gut
mucosa in the terminal ileum
enter the mesenteric lymphoid
system and then pass into the blood-
stream via the lymphatics.
Bacteremia
reticuloendothelial system
 Clinical features
The incubation period of typhoid
fever is usually 7-14 days
Low-grade fever, malaise, and slight,
dry cough
abdominal discomfort and multiple
complications.
In children, diarrhea may occur in the
earlier stages of the
 25% of cases, a macular or
maculopapular rash (rose spots) may
be visible around the 7th-10th day of
the illness, and lesions may appear
in crops of 10-15 on the lower chest
and abdomen and last 2-3 days
 Complications
Intestinal hemorrhage (<1%)
Perforation (0.5-1%)
hepatitis, jaundice, and cholecystitis
 Diagnosis
a positive result of culture from the blood or
another anatomic site.(positive in 40-60%)
stool and urine culture results become
positive after the 1st wk
leukocytosis is common and may reach
20,000-25,000 cells/L
Thrombocytopenia may be a marker of
severe illness and may accompany DIC
Liver function test results may be deranged
 DIFFERENTIAL DIAGNOSIS
acute gastroenteritis
Sepsis
Brucellosis
infectious mononucleosis.
acute hepatitis,
Malaria
 TREATMENT
The vast majority of children with typhoid fever can
be managed at home with oral antibiotics
Adequate rest, hydration
correct fluid and electrolyte imbalance. Antipyretic
therapy (acetaminophen 10-15 mg/kg every 4-6 hr
PO)
Antibiotic therapy is critical to minimize complications
Chloramphenicol or amoxicillin
Quinolones and third-generation cephalosporins is
associated with higher cure rates.
Azithromycin
 additional treatment with
dexamethasone (3 mg/kg for the
initial dose, followed by 1 mg/kg
every 6 hr for 48 hr) is recommended
for severely ill patients with shock,
obtundation, stupor, or coma; c
Prognosis
PREVENTION
Control of Typhoid fever
MEASURES DIRECTED TO RESERVOIR
a) Case detection and treatment
b) Isolation
c)Disinfection of stools and urine
d)Detection & treatment of carriers
MEASURES AT ROUTES OF TRANSMISSION
a) Water sanitation
b) Food sanitation
c) Excreta disposal
d) Fly control
MEASURES FOR SUSCEPTIBLES
a) immunoprophylaxis
b)health education
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