Typhoid fever is caused by the Salmonella typhi bacteria. It is transmitted through the fecal-oral route via contaminated food or water or direct contact. After incubation, the bacteria multiply in the intestines and spread to the liver, spleen and gallbladder causing systemic infection. Common symptoms include fever, abdominal pain and diarrhea. Diagnosis is through blood or stool culture. Treatment involves antibiotics like quinolones or cephalosporins. Prevention focuses on proper hygiene, food handling and water treatment. Typhoid fever is a major public health problem in developing countries.

1. TYPHOID FEVER
PREPARED BY:
ISAAC EDIANGU
MEDICAL CLAIMS ASSESSOR
RCN,*BScN

2. SALMONELLA SPECIES
 Rod-shaped bacilli
 Motile
 Non-spore forming
 Aerobic and anaerobic
 Gram negative
 Have a cell wall composed
of a thin layer of
peptidoglycan covered by a
membrane

3. Salmonella Taxonomy

4. PATHOLOGY
Incubation Period
 In urine it is during the
second week after
infection
 In blood, it is detected
during the first 10 days
 In feces; detected during
the second to third week
Mode of Transmission
 It is mainly the fecal-oral route
through ingestion of the bacteria.
 Person-to-person through direct
contact with the carrier of Salmonella.
 Animal-to-person especially those
who have pets.
 Foodborne through improperly
cooked food like milk, meat, eggs,
salads.

5. PATHOLOGY
 Enteric fever infection begins in the small intestines but few gastro
intestinal symptoms occur
 The bacteria enters and multiplies in the mononuclear phagocytes
of peyer’s patches then spreads to the phagocytes of the liver, gall
bladder and spleen leading to bacteremia
 Enterocolitis; characterized by an invention of the epithelial and
sub-epithelial tissue of the small and large intestines
 The organisms penetrate both through and between the mucosal
cell into the lamina propria leading to inflammation and diarrhea
 Bacteria can pass through the intestines into the bloodstream and
into the liver, spleen, bone marrow, and gall bladder
 Bacteria from the gall bladder can re infect the intestines,
producing gastroenteritis and a recurrence of bacteremia

6. PATHOLOGY
Adverse complication:
 Ulcerate and perforate the intestinal wall
 Peritonitis
 Cluster Headache
 Destruction of normal flora; hence prebiotics use
 It complicates or can be complicated by gastritis,
PUD
 Typhoid fever outbreak

7. PATHOLOGY

8. PATHOLOGY
 Salmonella typhi is a major public health problem globally in
developing countries
 Over 21 million new cases reported annually, with increasing
resistance to previously used antimicrobials and deaths of 200,000
people
 In Uganda, 210,000 new cases and 200,000-600,000 deaths as per
2013-2016 Uganda medical statistics
 Non-typhi Salmonellae (NTS): Salmonella typhimurium and
Salmonella enteritidis are the common cause of bacteremia and
septicemia

9. Diagnosis

10. Treatment
 Enterocolitis is a self resolving disease which usually does not require
treatment
 Enteric fevers with septicemia may require antibiotics which include:
– Quinolones; ciprofloxacin, ofloxacin
– Cephalosporins; ceftriaxone, cefotaxime
 Treatment can also be through replacement of fluids and electrolytes

11. Prevention
 Proper hand washing before eating and after toilet use
 Proper sewage and waste management or treatment
 Proper cooking of poultry eggs and meat
 Covering all food and proper food handling
 Pasteurization of milk
 Culture of stool and samples from food handlers
 Notification of Salmonellae infection out break
 Vaccination to provide temporary protection to travelers going to
endemic areas

12. Key Facts