TYPHOID ENTERIC FEVER

Medical Lifestyle
August 31, 2024

TYPHOID

ENTERIC FEVER

DEFINITION:-

Typhoid fever is also known as Enteric fever because It infects your small intestines (gut) and causes high fever, stomach pain and other symptoms.The term enteric means within, by way of, or related to the intestines.

The term “ENTERIC FEVER” includes both typhoid and para typhoid fevers•

  1. Typhoid fever: It is an infectious disease caused salmonella typhi bacteria.
  2. Paratyphoid fever: Paratyphoid fever is a infectious disease caused by the bacteria Salmonella Paratyphi. These diseases cause a similar illness. Paratyphoid infections tend to be less severe and less common than typhoid.




CAUSES/AETIOLOGY:-

  1. Salmonella typhi
  2. Salmonella paratyphi A
  3. Salmonella paratyphi B

Bacteria structure:

  • Gram negative bacilli
  • 1-3 / 0.5 microns
  • Motile
  • Family-Enterobacteriacea
  • Best grows at 37 °C.




TRANSMISSION:-

Faecal-oral route:

  • Close contact with patients or carriers.
  • Contaminated water and food.
  • Flies and cockroaches.


INCUBATION PERIOD:-

  • The incubation period ranges from 7-14 days on average, but can range from 3 days to two months.


PATHOPHYSIOLOGY:-

    Ingestion of bacteria via cotaminated water or food.
    ↓
    Bacteria crosses acid barrier in the stomach.
    ↓
    Travel across macrophages cells in the peyer's patches of small intestine
    ↓
    Bacteria is phagocytosed by macrophages and multiply within them
    ↓
    Bacteria spreads to reticuloendothelial tissues via lymphatics
    ↓
    Bacteria drains from thoracic duct into the bloodstream
    ↓
    As a result Bacteremia


CLINICAL MANIFESTATION:-

There are four stages of typhoid fever, when it gets untreated:

  1. Stage one:
    • A gradually increase in temperature.
    • Headache, Cough, Malaise, Relative bradycardia.
    • Chills are typical

  2. Stage two:
    • High grade fever.
    • Bradycardia, dicrotic pulse wave
    • Abdomen pain
    • Delirium is frequent, calm and sometimes agitated.
    • Rose spots.

  3. Stage three:
    • Intestinal hemorrhage.
    • Hepatosplenomegaly.
    • Perforation of intestine because of ileocecal lymphatic hyperplasia of peyer's patches.
    • Peritonitis and secondary bacteremia.
    • Septic shock and altered level of consciousness occurs.
    • Encephalitis.

  4. Stage four:
    • High grade fever.
    • Death occurs due to complications such as pneumonia, sepsis, kidney failure etc.


CLINICAL MANIFESTATION:-

    Early Stage:
  • Fever 103–104°F (39–40°C)
  • Weakness
  • Stomach pain
  • Headache
  • Diarrhea or constipation
  • Cough
  • Loss of appetite
    Rare:
  • Bleeding from the rectum
  • Delirium
  • Diarrhea
  • Temporary pink spots on the chest and abdomen


COMPLICATIONS:-

Most common:

  • Internal bleeding: Occurs in digestive tract.
  • Perforation: Perforation is potentially a very serious complication. This is because bacteria that live in your digestive system can move into your stomach and infect the lining of your abdomen

Others:

  • Sepsis
  • Pnuemonia
  • Kidney failure
  • Peritonitis.


DIAGNOSTIC EVALUATION:-

  • Physical examination
  • Blood culture
  • Specific serologic test to identify Salmonella antibodies / antigens (Fluorescent antibody study to look for substances that are specific to Typhoid bacteria)
  • Widal Test and ELISA
  • Urine and Stool Culture (2nd & 3rd week).


MEDICAL MANAGEMENT:-

Uncomplicated typhoid:

 Susceptibility  First-line Drug  Second-line Drug 
 Fully susceptibile  Fluoroquinolone (e.g, ofloxacin) 15mg/kg 5-7 days  Chloramphenicol 50-75 mg/kg 14-21 days

Amoxicillin 75-100 mg/kg 14 days

Trimethprim 8mg/kg 14 days

sulfamethoxazole 40mg/kg 14 days 
 Multidrug resistant  Fluoroquinolone 15mg/kg 5-7 days  Azithromycin 8-10 mg/kg 7 days

Cefixime 20 mg/kg 7-14 days. 
 Quinolone-resistant  Azithromycin 8-10 mg/kg 7 days

or

Fluoroquinolone 20 mg 10-14 days 		 Cefixime 20 mg/kg 7-14 days 




Complicated typhoid:

 Susceptibility  First-line Drug  Second-line Drug 
 Fully susceptibile  Fluoroquinolone (e.g, ofloxacin) 15mg/kg 10-14 days  Chloramphenicol 100 mg/kg 14-21 days

Ampicillin 100 mg/kg 10-14 days

Trimethprim 8mg/kg 10-14 days

sulfamethoxazole 40mg/kg 10-14 days 
 Multidrug resistant  Fluoroquinolone 15mg/kg 10-14 days  Ceftriaxone 60 mg/kg 10-14 days

OR

Cefotaxime 80 mg/kg 10-14 days. 
 Quinolone-resistant  Ceftriaxone 60 mg/kg 10-14 days

OR

Cefotaxime 80 mg/kg 10-14 days.

OR

Fluoroquinolone 20 mg 10-14 days 		 Fluoroquinolone 20 mg/kg 10-14 days 



NURSING MANAGEMENT:-

  • To maintain a normal body temperature.
  • To maintain a normal fluid volume.
  • Improve daily activities of living.
  • To improve intake of nutritional requirements.
  • Provide health education.
  • To reduce or diminish pain.
  • Provide follow- up service.


PREVENTION:-

There are two vaccines to prevent typhoid fever. One is an inactivated (killed) vaccine and the other is a live, attenuated (weakened) vaccine.

  1. Inactivated typhoid vaccine: It is administered as an injection (shot). It may be given to people 2 years and older. One dose is recommended at least 2 weeks before travel. Repeated doses are recommended every 2 years for people who remain at risk.

  2. Live typhoid vaccine: It is administered orally (by mouth). It may be given to people 6 years and older.
    One capsule is taken every other day, for a total of 4 capsules. The last dose should be taken at least 1 week before travel.
    Each capsule should be swallowed whole (not chewed) about an hour before meals with cold or lukewarm water.
    A booster vaccine is needed every 5 years for people who remain at risk. Important: live typhoid vaccine capsules must be stored in a refrigerator (not frozen)