Medicine surgery

1. Typhoid

2. Typhoid,
• Is a bacterial infection that can spread throughout the body affecting
many organs and is caused by salmonella typhi
• Etiology
Salmonella typhi

3. Epidemiology
• Is endemic in
 Africa
Central and South America
Middle East

4. Mode of transmission
• Fecal oral through contaminated food, water, milk
• Flies

5. Pathophysiology
• Ingest contaminated food, ingested bacilli invade small intestinal
mucosa and are taken up by the macrophages and transported to
regional lymph nodes where the S. typhi will multiply in the intestinal
lymphoid tissue.
• They become intact with the enterocytes during the 1-3 week of
incubation period , diarrhea occurs. At the end of incubation period,
the bacilli will enter the bloodstream . Bacteremia phase, onset of
typhoid fever .
• The bacteria will invade the gallbladder , lymphatic tissue of the
bowel and multiply in high numbers then pass into the intestinal tract
where they will be passed in stool

6. Clinical features
Anorexia
Malaise
Lethargy
Fever
Headache
Epistaxis
Pulse relatively slow
No productive cough
Abdominal pain
Constipation
Less frequent diarrhea

7. Stages of disease onset
• First stage
• Patient has severe headache , malaise, loss of appetite, body pains
and aches and a tendency of nose bleeding
• Temperature rises day by day to 39.5 degrees Celsius or higher
• Most patients cough because of bronchitis and may also complain of
constipation

8. 1st week
Slowly rising of temperature for 4-
5days
Abdominal pain , myalgia
Malaise
Headache
Constipation
Relative bradycardia
Signs and symptoms of the first week
progress
Delirium , complications , coma and
death if untreated
End of the 1st week
Rose spots
Cough
Splenomegally
Abdominal distension with tenderness
Diarrhea

9. Second stage
• Temperature continues to rise , pulse rate slower
• Swelling of lymphoid tissue in the intestines as well as Peyer`s patches
necrosis and ulcers which cause the abdomen to become distended
and tender
• High temperature and toxemia causes mental confusion and
disorientation in a patient
• Greenish watery diarrhea and bronchopneumonia

10. 2nd week
Signs and symptoms of the first
week progresses
End of the 2nd week
Delirium, complications ,coma and
death if untreated

11. Third stage
• Temperature decreases step by step and the patient improves slowly
• If there is no improvement , the Peyer`s patches in the intestines
perforate and toxemia increases
• The patient becomes delirious and incontinence of urine , stool,
muscle twitch and coma may precede death

12. 3rd week
Anorexic
Typhoid state ( apathy , confusion and psychosis )
High risk of hemorrhage and perforation may cause death

13. Fourth stage
• For the patient who do not suffer the serious complications of the
third stage, this stage is a period of convalescence
• Temperature drops to normal and patient recovers gradually

14. Complications
Toxemia
Hyperpyrexia
Peripheral circulatory coagulation
Thrombophlebitis
Relapse
Drug toxicity especially chloramphenicol

15. GIT
Abdominal distention
Diarrhea
Perforation
 Bleeding
Toxic hepatitis
Neurological
Coma
Meningitis
Peripheral neuritis
Deafness

16. Skin and appendages
Bed sores
Alopecia
• Others
Myocarditis
Pyelonephritis
Glomerulonephritis
Osteomyelitis
Arthritis

17. Differential diagnosis
Malaria
Hepatitis
Tuberculosis
Infective endocarditis
Urinary infection
Rheumatic fever
Lymphomas
Acute HIV infection

18. Diagnosis
• Positive cultures
Blood cultures in the first week
Agglutination ( Widal test –an advanced way to check for antibodies that
the body makes against the salmonella . It looks for O and H antibodis in a
patients serum ) in the second week
Stool cultures in the third week
Urine culture in the fourth week
Tracing of contacts
Investigating epidemics

19. Treatment
Bed rest
Proper nursing care to prevent bed sores and oral sepsis
Maintenance of nutrition , fluid and electrolyte balance
Diet that is easily digestible and 2-3litres of fluids per day
Fever and headache give paracetamol
Constipation administer glycerin enema

20. treatment
• Specific drugs
Ciprofloxacin 500mg oral BD for 10 days
Ofloxacin 10-15mg/kg BD for 2-3 days
Dexamethasone in severe cases
Oral amoxicillin 1g TDS for2 weeks
Third generation cephalosporins

21. Treatment of complications
1. Typhoid state
 correct fluid , electrolytes
adequate antibiotic therapy
short causes of corticosteroids
2. Intestinal perforation
surgical intervention
antibiotics

22. 3. Intestinal hemorrhage
Transfusion
Parenteral antibiotics
Manage toxemia
4. Relapse- similar to primary attack
5. Treatment of carriers
Ampicillin, cotrimoxazole and add probenecid to improve eradication rate
Ciprofloxacin

23. General preventive measures
Avoid food contamination
 Good personal hygiene
Provision of water supply