TYPHOID

FEVER
Other names:

Enteric Fever
Bilious Fever
Yellow Jack

Typhoid Fever
Is a bacterial infection
transmitted by contaminated
water, milk, shellfish or other
food. It is an infection of the
GIT affecting the lymphoid
tissues (Peyers patches) of the
small intestine.

Etiologic Agent
The disease is caused by an organism

Salmonella typhosa/typhi.
1. Gram-negative, motile and non-spore

forming
2. Pathogenic to man only
3. It is a hardy organism and easily
survives in natural habitat like water or
inorganic materials.

Sources of
1. A person who recovered from the
Infection
disease or one who took care of the
patient with the Typhoid and was
infected can be considered a
potential carrier.
2. Ingestion of shellfish (oysters)
taken from waters contaminated by
sewage disposal.
3. Stool and vomitus of infected
individual.

Anatomy and Physiology

Function of Peyers
patches
Because the lumen of the
gastrointestinal tractis exposed to the
external environment, much of it is
populated with potentiallypathogenic
microorganisms. Peyer's patches thus
establish their importance in the immune
surveillance of the intestinal lumen and in
facilitating the generation of the immune
response within themucosa.

Clinical
1.Manifestations
Onset
a. Headache, chilly sensation, aching all over
the body.
b. Nausea, vomiting and diarrhea
c. By the 4th and 5th day, all symptoms are
worst.
d. Fever is higher in the morning than it was
in the afternoon.
e. Breathing is accelerated, the tongue is
furred, the skin is dry and hot, abdomen is
distended and tender.

f. Rose spots appear on the abdominal wall on

the 7th to 9th day.
g. On the 2nd week symptoms become more
aggravated. Temperature remains in uniform
level. Rose spots become more prominent.
2. Typhoid State
a. Intense symptoms decline in severity.
b. The tongue protrudes, becomes dry and
brown.
c. Teeth and lips accumulate a dirty brown
collection of mucus and bacteria known as
sordes (preventable by good nursing care)

d. Patients seems to be staring blankly

(Coma vigil).
e. Twitching of the tendon sets in specially
the wrist (subsultus tendinum)
f. Patient mutters deliriously and picks up
aimlessly at bedclothes with his fingers
in continuous fashion (Carphologia)
g. There is constant tendency for the
patient to slip down to the foot part of
the bed.
h. In severe cases rambling delirium sets
in, often ending in death.

Pathognomonic Sign
Rose Spots

blanching pink macular spots

2-3mm over trunk

Statistics in the Philippines

World: 17 million cases per year
US :400 cases per year (70% in travelers)
Philippines: (Nov. 2006) 478 in Agusan del

Sur
(May 2004) 292 in Bacolod City
suspected cases in of typhoid fever in
Real, Quezon is 84
typhoid fever cases in Iloilo province with
684 cases already recorded from January
to July 23 this year.

Areas with high typhoid fever cases are the

towns of Cabatuan, 87; Sara, 84; San Dionisio,

43; Dumangas, 37; Concepcion, 33; Maasin,
31; Pototan, 31; Lemery, 28; Passi City, 27;
and Calinog, 25.
he other cases were in Pandan (3), Rawis (3),
Palnab del Norte (3), Sto. Nio (2), Sta. Cruz
(2), Palnab del Sur (2), San Roque (1), BLISS
(1), Tibgao (1() San Pablo (1), Marcelo Alberto
(1), Imperial Homes Subdivision (1),
Constantino (1), San Pedro (1), Bigaa (1),
Magnesia (1), and, Moonwalk (1).
Other suspect typhoid cases were from San
Andres (4), Bato (2), San Miguel (2), Gigmoto
(2) and Bagamanoc (1).

Incubation

Period
The period is from five
to forty days with a
mean of ten to twenty
days.
7 to 14 days after
ingestion

Period of communicability

The period of

communicability is
variable. As long as the
patient is excreting the
microorganism, he is still
capable of infecting others.

Mode of Transmission
1. The disease can be passed from

one person to another through fecaloral transmission

2. Organism can be transmitted
through the five (5) Fs.
3. The disease can be transmitted
through the ingestion of
contaminated food, water and milk.

Pathogensis
1. The organism gains access to the blood
stream through the bowel, principally
through the infected Peyers patches of the
lymphoid tissues.
2. On the first week these lymph nodes are
swollen. Necrosis of the lymph node follows,
caused by progressive edema and eventual
vascular obstruction from the center to the
periphery of the node, resulting in an oval
ulcer along the long axis of the bowel.
3. In the second week, they form sloughs which
are often bile- colored.

4. On the third week, the sloughs

separate and leave an ulcerated
surface.
5. Hemorrhage and perforation may
occur due to extension of the lesion
and continuous erosion of the
epithelial lining of the small
intestines.
6. Since toxin is absorbed by the blood
stream, almost all organs of the body
are affected, most commonly the
heart, the liver, and the spleen. The
mesenteric lymph glands are red and

Complication

1. Hemorrhage or perforation- the two most dreaded

2.

3.
4.
5.
6.
7.
8.
9.

complications
Peritonitis- inflammation of the peritoneum which
may be due to chemical irritation or bacterial
invasion.
Bronchitis and Pneumonia
Meteorism or excessive distension of the bowels
(Tympanites)
Thrombosis and embolism
Early Heart failure
Typhoid spine or neuritis
Septicemia
Reiters syndrome- joint pain, eye irritation, painful
urination that can lead to chronic arthritis.

Diagnostic
1. Typhi dot test- confirmatory
Procedure
If illness is 4 days or longer.
Interpretation:
IgM IgG
(+)
(-)
Acute infection
(+)
(+) Recent Infection
(-)
(+) Equivocal: Past infection
or acute

2. ELISA - Enzyme-linked

immunosorbent assay(ELISA), also

known as anenzyme
immunoassay(EIA), is abiochemical
technique used mainly inimmunologyto
detect the presence of anantibodyor an
antigenin a sample.
3. Widalis a presumptiveserologicaltest
forenteric feverorundulant fever. In case
ofSalmonellainfections, it is a
demonstration of agglutinating antibodies
against antigens O-somatic and H-flagellar
in the blood.
4. Rectal swab

Modalities of Treatment
1.
2.
3.
4.
5.

Chloramphenicol- drug of choice

Ampicilin
Co-trimoxazole
Ciprofloxacin or Ciftriaxone
If patient does not respond to
Chloramphenicol, 3rd and 4th
generation drug are administered.

Nursing management
1. Isolation by medical aseptic technique
2. Maintain or restore fluid and electrolyte

balance in a small quantities at frequent

intervals.
3. Monitor patients vital signs
4. Prevent further injury ( fall) of patient with
typhoid psychosis.
5. Maintain good personal hygiene and mouth
care.
6. Cooling measures are necessary during
febrile state. 7. Watch fot signs of intestinal
bleeding.

Nursing
Self-care deficit
Diagnosis
Fluid volume (Diarrhea)
Constipation
Knowledge deficit
High risk for injury (typhoid

psychosis)
Anxiety
Hyperthermia

Prevention and
Conrtol
Sanitary and proper disposal of excreta
Proper supervision of food handlers
Enteric isolation
Adequate protection or provision of safe

drinking water supply.

Reporting of cases to health authorities
Detection and supervision of typhoid
carriers
Education of general public on the mode of
transmission.

Thank You for listening!

Prepared by:

Angelyn Echimane
Bombase
Karyll Myra Epres
Bona