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Lecture- 7 Typhoid Fever

Typhoid fever, caused by Salmonella enterica serovar Typhi and Paratyphi, is transmitted through contaminated food and water, with symptoms including prolonged fever, headache, and abdominal issues. Diagnosis involves clinical evaluation and cultures, while treatment typically includes antibiotics such as ceftriaxone or ciprofloxacin, with alternatives like azithromycin. Complications can arise, and vaccination is recommended for travelers to endemic areas.

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11 views

Lecture- 7 Typhoid Fever

Typhoid fever, caused by Salmonella enterica serovar Typhi and Paratyphi, is transmitted through contaminated food and water, with symptoms including prolonged fever, headache, and abdominal issues. Diagnosis involves clinical evaluation and cultures, while treatment typically includes antibiotics such as ceftriaxone or ciprofloxacin, with alternatives like azithromycin. Complications can arise, and vaccination is recommended for travelers to endemic areas.

Uploaded by

ikramullahmohmand574
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Typhoid Fever/ Enteric fever

Modified by Mr. Nasib Ur Rahman


Demonstrator Health Technology
Institute of paramedical Sciences-KMU
Lecture objectives!
 Diseases- causative agents, transmission
 Pathogenesis of the diseases
 Clinical outcomes
 Diagnosis, differential diagnosis & treatment
 References
Disease introduction
 Typhoid Fever- alternatively called “Enteric fever”
 Causative agents:
 Salmonella enterica serovar typhi, S. enterica serovar Para-

typhi (ABC)
 Salmonella enterica is a species of bacteria that includes

various serovars (or subspecies), some of which can cause


significant infections in humans. Two of these serovars are
Salmonella enterica serovar Typhi and Salmonella enterica
serovar Paratyphi, which are responsible for typhoid fever
and paratyphoid fever, respectively.
 Once malaria has been ruled out, typhoid fever is commonly
the cause of a febrile illness lasting >10 days.
 Vaccination is recommended before travel (especially to the
Indian subcontinent) as it is diagnosed in 2% travelers but yet
is only 75% effective
 Transmission: The disease is transmitted in a dose-related
fashion after food contamination by feces or urine from actively
infected cases or healthy disease carriers.
 House flies are the most comon vectors
 So the disease tends to be more prevelent in rain seasons
 People with all age groups could get infected,
incubation period
 Incubation times and disease severity depend on bacteria dose
exposure and vary from 1 to 3 weeks.
Pathogenesis
 After ingestion, bacteria adhere to the small-bowel mucosa,
invade lymphoid tissues, and disseminate by lymphatics to the
bone marrow, gallbladder, and spleen to reproduce in
macrophages.
 Most pathology occurs in the gut as a consequence of
inflammation, necrosis, and ulceration.
Clinical Features
 Typhoid fever classically begins with fever and headache,and
then progresses to:
 high fever with chills
 headache
 cough
 Abdominal distention
 myalgias
 Constipation- Most patients, however, present with constipation
rather than diarrhea
 prostration
Differential Diagnosis
 Malaria
 Typhus
 Viral Hepatitis
 Amebic Liver Abscess
 Other Types Of Infective Enteritis
Signs
 Bradycardia relative to fever is classic (may be absent)
 after several days of fever, a pale red macular rash may appear
on the trunk (“rose spots”)
 As disease progresses, splenomegaly develops.
 Patients may develop leukopenia and elevated liver enzymes
Complications
 Small-bowel Ulceration,
 Anemia
 DIC
 Pneumonia
 Meningitis
 Myocarditis
 Cholecystitis
 Renal Failure
Diagnosis- investigations!
 Clinical diagnosis

 Blood culture
Urine culture (during the second week)
 Stool culture

 “rose spot” aspiration biopsy.


 bone marrow culture is most sensitive
Treatment- Antibiotics
 Current recommendations for the treatment of typhoid fever
are either:

 ceftriaxone, 2 grams IV every 24 hours for 14 days



OR
 ciprofloxacin, 400 milligrams IV every 12 hours for 10 days

OR
 ciprofloxacin, 500 to 750 milligrams PO twice daily for 14
days.
Alternatives include!
 Azithromycin, 1 gram PO on the first day followed by 500
milligrams PO daily for 6 days,

OR
 Azithromycin, 1 gram PO daily for 5 days, or

OR
 Cefixime, 10 to 15 milligrams/ kg IV every 12 hours for 8 days.
Antibiotic resistance!
 Antibiotic resistance has caused ampicillin, trimethoprim-
sulfamethoxazole, and chloramphenicol to be unreliable
treatments.
Treatment- Corticosteroids
 For severe typhoid fever with delirium, coma, shock, or DIC:
 administer Dexamethasone, 3 milligrams/ kg IV loading dose
over 30 minutes followed by 1 milligram/kg IV every 6 hours for
eight doses.
Supportive treatment includes!
 IV rehydration
 in the event of serious GI bleeding, blood transfusion.
 If untreated, mortality is 10% to 15%, mostly in young children
References
 Oxford handbook of acute medicines infectious
diseases
 Kumar and Clarks Clinical Medicine (8th Edition)
 Muhammad Inam Danish Medical diagnosis and
management
 Davidson's Principles and Practice of Medicine
21st Edition
ANY
QUESTION ?
THANK YOU

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