Introduction of typhoid fever, its causative agent and sources of spread. Case study of typhoid fever. What kind of diet is given in typhoid fever.

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2. TYPHOID FEVER
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3. ROAD MAP
• What is Typhoid Fever?
• Sources of infection
• Clinical signs & symptoms
• Problem statement
• Case study of typhoid fever
• MNT for typhoid fever
• Diet plan
• Conclusion
• References 3

4. TYPHOID FEVER
• An acute illness associated with fever caused by Salmonella
typhi or Salmonella enterica
• Salmonella paratyphi causes less severe illness – Paratyphoid
• Enteric Fever, Food & water- born illness
• Bacterium grows in the intestines and blood
4CDC, 2016

5. CAUSATIVE AGENT
• Bacterium Salmonella typhi, also
known as Salmonella enterica
• Grows in the intestines and blood
• Grows best at 37ºC
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The Bacterium Salmonella
tyhpi

6. SOURCES OF INFECTION
Primary Sources
• Feces and urine of cases
and carriers
• Fecal carriers are more
frequent than urinary
carriers
Secondary Sources
• Contaminated
̵ Water
̵ Food
̵ Fingers
̵ Flies
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7. CLINICAL SIGNS
• Headache, malaise, sore throat & anorexia
• Sustained fever as high as 103° to 104° F persisting for 4-5 days
• Bronchitis - cough is common
• Relative bradycardia
• Involvement of intestinal lymphoid tissues, macrophage system &
gall bladder
Danish, 2011 7

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9. PROBLEM STATEMENT
Approx. 21 million cases &
0.2 million deaths worldwide
WHO, 2015
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10. 10
Common in developing world,
affecting 21.5 million people each
year
CDC, 2016

11. 451.7 cases per 100,000
persons /year in Pakistan
WHO, 2008
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12. CASE STUDY
Patient’s name: Shamim
Age: 42 years
Weight: 55 kg
Height: 5.3”
BMI: 21.5 kg/m2
Medical History: DM⁻ , HTN⁻ , IHD⁻
Presenting Complaint: Cough with sputum and fever from 7 days
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13. LABORATORY FINDINGS
Tests Results Normal ranges Remarks
Total WBCs 13.2 * 10³/ µL 4-11 * 10³/ µL Leukocytosis
Neutrophils 86 % 40-70 % Neutrophilia
Lymphocytes 10% 20-40% Lymphocytopenia
Total RBCs 3.8 * 10⁶/µL 4-5.5 * 10⁶/µL Low
ESR 10 mm/1st h. Up-to 10 mm/1st hr. Borderline normal
ALT 27 U/I 0-41 U/I Normal
AST 22 U/I 8-40 U/I Normal
BP 90/60 mmHg 120/80 mmHg Hypotension 13

14. MEDICAL REPORTS
• Typhoid Report
IgG – Positive
IgM – Positive
Interpretation: Acute Typhoid fever (in middle state of infection)
• USG Report
Liver is minimally enlarged.
Echo pattern changes in liver could be fatty.
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15. DIAGNOSIS
• Acute Bacterial Infection
• Acute Typhoid Fever (in middle stage of infection)
• Mild Hepatomegaly (in USG)
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16. 24 Hrs. DIETARY RECALL
Meals Foods
Breakfast 1 cup Tea + Biscuit (2-3)
Lunch 1 plate Mutton stock/Yakhni
Snack 1 Orange
Dinner ---
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17. MEDICAL NUTRITION THERAPY
• Should be consisting of small and frequent meals
• High calorie, High Protein, Low residue diet
• Maintenance of water and electrolytes
• Oral Nutrition with a soft, easily digestible diet
• Immune boosting, Anti-inflammatory foods
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18. WHY AVOID HIGH FIBER FOOD?
High fiber foods are restricted in typhoid fever because they
 Have increased stay time in stomach/intestine
 Can cause irritation/stress to damaged digestive system
 Provide favorable conditions for the bacterium to grow
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19. PROGRESSIVE DIET
• During first few (2-3) days
Liquid diet - fresh fruit/vegetables juices, broths, electrolyte
solutions
• After few days, when appetite gets better
Soft/Bland diet - blended soups, boiled white rice, lentil
soups
• Gradual shifting to normal diet
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Khosla , 2008

20. DIETARY REQUIREMENTS
• Total Energy Requirement = 1850 kcal/day
• Total Protein Requirement = 85 g
• Fluid requirement = 1925 mL or 7-8 glass/day
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Strengthening
the immune
system
Reducing the
complications
Rapid
Recovery
Improved
quality of life

21. DIET PLAN
Meals Timings Foods
Before Breakfast 6:30 – 7:00 am ½ cup carrot juice (fresh & strained)
Breakfast 7:00 – 8:00 am
1 cup cooked/Blended porridge with 1 cup
skimmed milk
1 small banana
9:00 – 9:30 am
1 cup (250 mL) fresh seasonal fruit juice
(orange)
Mid morning
Snack
10:30 – 11:30 am
1 cup Tomato soup (garlic & ginger
added)/Black chickpea soup 21

22. Meals Timings Foods
Lunch 1:00 – 2:00 pm
Khichri ( 1 cup soft, boiled rice + ½ cup
split yellow gram/moong lentil), low spices
Afternoon At 3:30 pm
1 small cup of cinnamon ( ½ inch stick) +
ginger ( ½ inch) tea
Evening snack 4:30 – 5:00 pm Grapes/Jujube (1 cup whole)
Dinner 6:30 – 7:30 pm
1 bowl Chicken (4 oz., organic) & vegetable
soup (blended)
Post 8:00 – 9:00 pm
1 cup lukewarm, low fat milk + 1/2 tsp
flaxseed powder (OR) turmeric powder 22

23. FOOD CHOICES
ALLOWED RESTRICTED
Refined cereals, de-husked pulses Whole grains, whole pulses, pulses with husk
Soft fruits & well cooked fruits, vegetables in
soft and puree form
Raw fruits and vegetables, strongly flavored
vegetables cabbage, capsicum, turnip, radish
Skim milk, shakes, custard, buttermilk, yogurt Whole milk & whole milk products
Eggs, lean meats, fish, poultry (organic) Fatty meat, red meat, processed meat
Simple carbohydrates like jam, honey Fried fatty foods, chemical irritants
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24. CONCLUSION
• Proper diet helps to reduce LSH by rapid recovery
• Dietary modifications help to minimize the weakness left by
typhoid fever
• Proper hygienic practices, drinking boiled water
• Proper washing of fruits and vegetables, proper cooking
practices
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25. REFERENCES
• CDC (2016) Typhoid Fever, Accessed from https://www.cdc.gov/typhoid-
fever/index.html
• Danish I (2011) Short Text Book of Medical Diagnosis & Management, 11th
ed., Pakistan: Paramount Books (Pvt.) Ltd
• WHO (2015) Typhoid, Immunization, Vaccines and Biologicals, Accessed
from http://www.who.int/immunization/diseases/typhoid/en/
• Khosla SN (2008) Typhoid Fever Its Cause, Transmission And Prevention,
New Delhi, India: Atlantic Publishers & Distributers
• Ochiai RL, Acosta CJ, Danovaro-Holliday MC, Baiqing D, Bhattacharya SK,
(2008) A study of typhoid fever in five Asian countries: disease burden and
implications for controls, pp 260-268. 25