TYPHOID FEVER

WHAT IS TYPHOID FEVER?

 An acute enteric infectious disease

 Caused by Salmonella typhi (S.Typhi)
 Clinically characterized by typical continuous fever for 3-4 weeks
 May occur sporadically, epidemically or endemically. Found only in
humans
HISTORICAL PERSONALITIES

Thomas Willis who was credited with the first description

of typhoid fever in 1659

French physician Pierre Charles Alexandre Louis

first proposed the name "typhoid fever"
EPIDEMIOLOGY
EPIDEMIOLOGICAL DETERMINANTS

 Agent Factors
 Host Factors
 Environmental & Social Factors
 Incubation Period
 Mode of Transmission
AGENT FACTORS

1. HOST
 Typhoid fever mainly caused by the bacterium Salmonella typhi from the
family Enterobacteriacea
 S. typhi is a gram-negative, facultative aerobic, non spore forming
bacteria that is motile due to its peritrichous flagella
 The bacteria grows best at 37 C
 AGENT FACTORS

2. RESERVOIR

CASES
 A case is infectious as long as the
bacilli appears in stools or urine
 Case may be missed, mild or severe
CARRIERS
 Temporary/Incubatory - excrete bacilli to 6-8
weeks
 Chronic – excrete bacilli for more than a
year. Organism persist in gall bladder/biliary
tract
e.g. "Typhoid Marry" real name Mary Mallon
 TYPHOID MARY

Mary Mallon better known as "Typhoid Mary"

who was a food handler responsible for
infecting at least 85 people, killing 5. These
highly infectious carriers pose a great risk to
public health.
MARY MALLON

1900
 She worked in Mamaroneck, New
York, where, within two weeks of her
employment, residents developed
typhoid fever.
1901
 She moved in Manhattan
 Members of the family where she
worked developed fevers, and
diarrhea, and the laundress died.
 MARY MALLON
1904
 She worked for a lawyer
 Seven of the eight
people in that
household became ill
1906 1907
 Became a cook in  Worked as a cook in a
Oyster Bay, Long Island family of wealthy New
York banker, Charles
 Within two weeks, 10 of Henry Warren
the 11 family members
were hospitalized with  6 of the 11 people in
typhoid the family came
down with typhoid
fever
MARY MALLON

 Public health pioneer, Sarah Josephine Baker, MD, PhD tracked her down after
discovering that she was the common link among many people who had become ill
from typhoid fever. She was traced to typhoid outbreaks a second time so she was put
in prison again where she lived until died.

 Mallon admitted poor hygiene, saying she did not understand the purpose of hand-
washing because she did not pose a risk. In prison, she was forced to give stool and
urine samples. Doctors found a significant nidus of typhoid bacteria in her gallbladder.
Authorities suggested removing her gallbladder, but she refused as she did not believe
she carried the disease.
MARY MALLON

 Mallon spent the rest of her life in quarantine at the Riverside Hospital. Six years
before her death, she was paralyzed by a stroke. On November 11, 1938, she died
of pneumonia at age 69. An autopsy found evidence of live typhoid bacteria in
her gallbladder. Mallon's body was cremated, and her ashes were buried at Saint
Raymond's Cemetery in the Bronx.
AGENT FACTORS

3. SOURCE OF INFECTION

PRIMARY SOURCE SECONDARY SOURCE

 Feces & urine of cases and  Contaminated:

carriers
 Water
 Fecal carriers are more
 Food
frequent than urinary carriers
 Fingers
 Flies
ETIOLOGY
ETIOLOGY
HOST FACTORS

AGE SEX IMMUNITY

 Occur at any age  Cases are more in  Antibody may be stimulated by
but highest Males than Females infection or immunity. Antibody
incidence in 5-19 against (O) antigen is higher in
 Carrier rate are
years age group patient with the disease and
more in Females
antibody against (H) antigen is
higher in immunized person.
ENVIRONMENTAL & SOCIAL FACTORS

 Increased incidence in July – September

 Outside human body bacilli found in:

• Water – 2-7 days but do not multiply
• Soil irrigated with sewage – 35-70 days
• Ice and Ice cream – over a month
• Food – multiply and survive for sometime
• Milk – grow rapidly without altering its taste
ENVIRONMENTAL & SOCIAL FACTORS

 Vegetables grow in sewage plant

 Pollution of drinking water supplies
 Open area defecation and urination
 Low personal hygiene
 Health ignorance
INCUBATION PERIOD

 Usually 10-14 days but it may be as short as 3 days or as long as 21 days

depending upon the dose of bacilli ingested
MODE OF
TRANSMISSION
The disease is transmitted by
"feco-oral" or "urine-ocal" route
either directly through hand
soiled with feces or urine of
cases or carriers. Or indirectly by
ingestion of contaminated
water, milk, food or through flies.
Contaminated ice, ice cream
and milk products are a rich
source of infection.
CLINICAL FEATURES

 FIRST WEEK: malaise, headache, cough and sore throat in prodromal

stage. The disease classically presents with step ladder fashion rise in
temperature (40-41 C) over 4 to 5 days accompanied by abdominal pain,
constipation and diarrhea.
 SECOND WEEK: between the 7th – 10th day of illness, mild hepato
splenomegally occurs in majority of ptients. Relative bradychardia may
occur and rose-spots may be seen.
 THIRD WEEK: the patient will appear in the "typhoid state" which is a state
of prolonged apathy, toxemia, delirium, disorientation and/or coma.
Diarrhea will then become apparent. If left untreated by this time, there is
a high risk of (5-10%) of intestinal hemorrhage and perforation.
ROSE SPOTS
Pink papules 2-3mm found in
the skin, fade on pressure
and disappear after 3-4 days
SIGNS AND SYMPTOMS
GENERAL COMPLICATIONS

TONSILITIS BOILS DEHYDRATION

TREATMENT
VACCINE

There are two vaccines to prevent typhoid:

 One is an inactivated  The other is live, attenuated

(killed) vaccine gotten as a shot (weakened) vaccine, which is taken
orally (by mouth).
QUIZ

1. An acute enteric infectious disease associated with continuous

fever
2. Causative agent responsible for typhoid fever
3. Better known as typhoid mary who is responsible for typhoid
outbreaks in New York areas
4-6. Give 3 environmental factors contributing to typhoid fever
7. Usual incubation period for typhoid fever
8-9. 2 modes of transmission
10. Pink papules found in the skin