Typhoid fever

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Typhoid fever

  1. 1. By DR. ASHOK JAISINGANI
  2. 2. Typhoid fever is the result of the infection mainly by the S – typhiThe disease is mainly characterized by the typical continuous feverfor three – four weeksRelative bradycardia with involvement of the lymphoid tissues andconsiderable constitunal symptomsEnteric Fever: The term enteric fever involve both the typhoid andparatyphoid fever
  3. 3. The Disease may occurSporadicallyEpidemicallyEndemically
  4. 4. Salmonella Typhi:A gram – negative rod motile bacteria, is a major cause of thefeverOther relatively less common areSalmonella typhi A & BSalmonella typhi has three antigensO, H, Vi
  5. 5. Man is host of the disease man may in the form of thea) Casesb) CarrierCases: In cases age group involve 5 – 19 years more prone, after the 20 years of the age the infection falls probablyMales are affected more than femaleCarrier: These mayTemporary carrierChronic carrier
  6. 6. Man is the only known reservoir of the infection via cases or carrierCases:The case may be mild, missed or severed a case (carrier) is infectiousas long as bacilli appears in the stool or urineCarrier:The carrier may be temporary, incubatory, convalescent or chronic
  7. 7. 1) Feco – oral route2) Urine – oral route ( Rare)Source Of The Infection:The primary source:Faces and urine of the cases and carriersSecondary Sources:Contaminated water, foods, finger and fliesThere is no evidence that typhoid bacilli are excreted in sputum or milk
  8. 8. Enteric fever observe all through the yearsThe peak incidences are observed during the July and September,this period coincides with the rainy season and an increase in flypopulationOutside the humane body the bacilli are found in the water, ice,milk, foods and soil for the varying period of the timeThe typhoid bacilli do not multiply in the water, many of themperish within the 48 hours, but some survive for about 7 – daysThe typhoid bacilli survive for over month in the ice and ice-cream
  9. 9. Typhoid bacilli survive for up to 70 – days in soil irrigated with thesewage under the moist winter conditions and about half of that periodin drier summer conditionsFood being a bed conductor of the heat, provide the shelter to thebacilli, which may multiply and survive for the some time in foodTyphoid bacilli grow rapidly in milk without altering its test orappearance in any wayVegetables grown in sewage form or washed in contaminated waterare a positive health hazardsThese factors are compounded by the such social factors as pollutionof the drinking water supply
  10. 10. Incubation period is usually 10 – 14 daysBut the incubation period may be as short as 3 – daysIt may be as long as 3 – weeks thus depending on the dose of thebacilli ingested
  11. 11. The onset is usually insidious but in children may be abrupt withChills and high feverProdromal Stage: There isMalaiseHeadacheCough and sore throat often with the abdominal pain andconstipation, this fever ascend in stepladder fashionAfter 7 – 10 days the fever reach a plateau and the pt looks toxic,exhausted and often prostrated
  12. 12. In early stages there may be marked constipation or “pea group”diarrheaAbdominal distensionLukopeniaThere is blood, urine and stool cultures are positive for thesalmonella typhiIf there are no complications the pts conditions improve over the 7 –10 daysRelapses may occurs for up to 2 weeks after termination of thetherapy
  13. 13. Complication occurs in about 30% of the untreated cases andaccounts for the 75% of the all deaths in typhoid feverIntestinal hemorrhage is manifested by the sudden drop intemperature and sign of the shock followed by the dark or freshblood in stoolIntestinal perforation is most likely to occurs during the third weekLess frequent complications are urinary retention, pneumonia,thrombophlebitis, myocarditis, psychosis, cholecystitis, nephritisand osteomyelitis
  14. 14. The control or elimination of the typhoid fever is well within the scope of the modern public health, this is an accomplished fact in many developed countries, there are generally three lines of the defense against the typhoid fevera) Control of the reservoirb) Control of sanitationc) ImmunizationThe weakest link in the chain of the transmission is sanitation which is amenable to control
  15. 15. The usual method of the control of the reservoir are theirIdentification (Identify either case or carrier)IsolationTreatmentDisinfections
  16. 16. Early Diagnosis: This of the vital importance as the early symptoms are non-specific, culture of the blood and stools are important, investigation in the diagnosis of the casesNotification: This should be done where such notification is mandatoryIsolation: Since typhoid fever is infectious and has prolong course, the cases are better transmitted to the hospitals for the proper treatment as well as to prevent the infection As a rule cases should be isolated till three bacteriologically negative stools and urine report are obtained on 3 separate days
  17. 17. Chloramphenicol remains the drug of the choice if the bacilli aresensitive to itFor the adult the dose is 500mg (approx. 50mg/kg of bodyweight/day), 4 – hourly while febrile and thereafter 500mg 6 –hourly for a total period of the 14 – daysCotrimoxazole, Amoxcillin and trimethoprim are equally effective,resistance to these drugs now riseCiprofloxcin is now the drug of the choicePatient seriously ill and profoundly toxic may be given an injectionof the hydrocortisone 100mg daily for 3 – 4 days
  18. 18. Stool and urine are sole source of the infection, they should bereceived in closed container and disinfected within 5% cresol for atleast 2 –hoursAll soiled clothes and linen should be socked in the solution of the2% chlorine and steam – sterilizedNurses and doctor should be not forgated to disinfected their hands
  19. 19. Examination of the stool and urine should be done for the S- typhi 3– 4 months after the discharge of the patient and again after the 12 –months to prevent the development of the carrier stateWith the early diagnosis and appropriate treatment mortality beenreduced to about 1% as compared to the about 30% of the untreatedcases
  20. 20. Protection and purification of the drinking water suppliesImprovement of the basic sanitation and promotion of the foodhygiene are essential measure to interrupt transmission of thetyphoid feverTyphoid fever never were major clinical problem when there is aclean domestic water supplySanitary measures are not followed by the health education mayproduce only temporary resultWhen sanitation is combined with the health education, the effecttend to be cumulative, resulting in a steady reduction of the typhoidfever morbidity
  21. 21. Immunization is complimentary approach to preventionImmunization is only specific preventive measuresImmunization against the typhoid fever does not give 100%protection but definitely lower the incidences and seriousness of theinfection, it can be given at any age upward of the one yearIt is recommended toThose living in endemic areas, household contact, groups at risk ofthe infection such as school children and hospital staff, travelerproceeding to the endemic areas
  22. 22. The anti-typhoid vaccine currently available asMonovalent anti-typhoid vaccineBivalent anti-typhoid vaccineTAB vaccine
  23. 23. The vaccine of the choice is naturally the monovalent typhoidvaccine, which is an agar grown, heat killed and phenol preservedvaccine, containing 1000 million of the S – typhi per mlIt also be prepared by the inactivation of the organisms with theacetone and the vaccine is known as AKD (Acetone killed anddried) anti-typhoid vaccine
  24. 24. The bivalent vaccine contain s-typhi and s-paratyphi A in theproportion of the 1000 million and 500million organismsrespectivelyThe organisms are killed and preserved by the heating at 540C forone hour and by addition of the 0.5% phenolThe bivalent vaccine may also be prepared by the inactivation of theorganisms with the acetone and dried form (AKD vaccine)
  25. 25. The traditional TAB vaccine contain S – typhi (1000 million), S –paratyphi A (500 – 700 million) & S – paratyphi B (500 – 750million) organisms per literThe paratyphoid antigens in the vaccine are not only thought to beof the doughtful effectiveness, but there presence enhanced reactioncaused by the extra-protein of the paratyphoid A & B componentsTherefore the traditional TAB vaccine has fallen in to disfavorThe WHO recommended that the TAB vaccine should bediscontinue

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