Typhoid is a life-threatening bacterial infection caused by Salmonella typhi. It occurs primarily in developing countries with poor sanitation. Symptoms include sustained high fever, weakness, stomach pain, and rash. It is transmitted through contaminated food or water. Treatment involves antibiotics, fluids, and rest. Prevention focuses on vaccination, proper handwashing, and safe food/water handling.

1. TYPHOID
PRESENTED BY :
V.RAMYA,
TUTOR

2. TYPHOID

3. TYPHOID
 Typhoid, also known as typhoid
fever, is a life-threatening disease
that is caused due to an infection by
a bacteria named Salmonella typhi.

4. Epidemiology
 Typhoid fever occurs worldwide, primarily in developing nations whose sanitary
conditions are poor.
 It is endemic in Asia, Africa, Latin America, but 80% of cases come from
 Bangladesh , China, India, Indonesia, Nepal, Pakistan,
 Within these countries, typhoid fever is the most common in underdeveloped
areas.
 Typhoid fever infects roughly 21.6 million people (incidence of 3.6 per 1,000
population) and kills an estimated 200,000 people every year (Medscape).
 In 2011, 1.06 million cases and 346 deaths were reported in India. The
prevalence rate is 88 cases/lac population and death rate is 0.029/lac population.

5. Etiology
 The causative organism of typhoid, Salmonella typhi, is
present only in human beings and its transmission occurs
through contaminated food or water.
 People who are infected carry the bacterium in their
intestines as well as the bloodstream, and those who have
recovered from the disease could still have the bacterium
in their system; they are known as "carriers" of the
disease.

6. Etiology
 Both the infected people and the carriers shed Salmonella
typhi in their stool.
 Infection is usually spread when food or water is handled by a
person who is shedding the bacterium, or leakage of sewage
into water or food that is then consumed by healthy persons.
 So this disease is common in areas where proper hand
washing techniques are not followed.

7. Pathophysiology
 Salmonella typhi
 Enters stomach and survives in its acidity
 Invasion of intestinal Peyer's patches
 Bacterium enters the macrophages and survives
 Spreads via lymphatics
 Access to reticuloendothelial system, liver, spleen, gallbladder, and bone marrow
 Emergence of the signs and symptoms (fever, abdominal pain, spleen enlargement, and
spots)
 Necrosis of Peyer's patches
 Perforation and bleeding
 Death

8. Clinical Manifestations
 Once the bacterium is ingested by a person, it quickly
multiplies within the parts of the body, for example,
stomach, Iiver or gallbladder, and finally enters the
bloodstream causing symptoms such as fever (usually
between 103°F and 104"Th rashes (fat, rose-colored
spots), vomiting, loss of appetite , headaches, general
fatigue, and malaise.

9. Clinical Manifestations
 In severe cases, may suffer from intestinal perforations or
internal bleeding diarrhea, or constipation.
 One of the characteristic features of typhoid is a "step
ladder fever."
 This means that the fever gradually fluctuates between
very high and low-degree fever for a short period of time,
till it peaks at 103-104°F.

10. Clinical Manifestations
In patients without any complication, the
condition subsides in about 3-4 weeks after
its onset.
In about 10% of people , the condition
relapses after about 1 week of
convalescence.

11. DIAGNOSIS
 A CBC will show a high number of white blood cells (WBC S)
 A blood culture during the first week of the fever can show Salmonella typhi
bacteria.
 Other tests that can help diagnose this condition include :
 ELISA urine test to look for the bacteria that cause typhoid fever
 Fluorescent antibody study to look for substances that are specific to typhoid
bacteria
 Platelet count (platelet count may be low)
 Stool culture

12. DIAGNOSIS
 The Widal test was the main stay of typhoid fever
diagnosis for decades.
 It is used to measure agglutinating antibodies against
Medical Management
 Hand O antigens of S. typhi.
 Neither sensitive nor specific, the Widal test is no longer
an acceptable clinical method.

13. MEDICAL MANAGEMENT
 Typhoid fever is treated with antibiotics that kill the Salmonella bacteria.
 With appropriate antibiotic therapy- there is usually improvement within 1-2 days and
recover within 7-10 days.
 Several antibiotics are effective for the treatment of typhoid fever.
 Chloramphenicol was the original drug of choice for many years.
 Because of rare serious side effects, chloramphenicol has been replaced by other effective
antibiotics.
 If relapses occur, patients are retreated with antibiotics.
 Those who become chronically ill (about 3-5% of those infected) can be treated with
prolonged antibiotics.
 Often, removal of the gallbladder, the site of chronic infection, provides a cure.

14. MEDICAL MANAGEMENT
 Chloramphenicol was the original drug of choice for many years.
 Because of rare serious side effects, chloramphenicol has been
replaced by other effective antibiotics.
 If relapses occur, patients are retreated with antibiotics.
 Those who become chronically ill (about 3-5% of those infected)
can be treated with prolonged antibiotics.
 Often, removal of the gallbladder, the site of chronic infection,
provides a cure.

15. Supportive Therapy
 Other treatment steps aimed at managing symptoms include: 1.
Drinking fluids-this helps to prevent the dehydration that results
from a prolonged fever and diarrhea.
 In case of severe dehydration, IV fluids must be administered. .
 Eating a healthy diet—nonbulky , high-calorie meals can help
replace the nutrients being lost from the body during the course of
the disease.

16. Nursing Management
 Monitor vital signs
 Monitor the status of hydration.
 Assess for weight loss, nausea, and vomiting.
 Monitor intake of food and liquids, provide selected food, and involve the family
in meeting the nutritional needs.
 Instruct the patient to enhance the intake of protein and vitamin C.
 Provide assistance to meet daily needs such as food and drink, change clothes,
and watch oral hygiene, hair, genitalia, and nails.
 Collaborate with other medical teams for IV fluid administration.

17. Nursing Management
 Explain the purpose of bed rest to prevent complications and speed up the
healing process
 Assess the level of pain, location, duration, intensity, and characteristics of pain.
 Review the factors that increase pain and decrease pain.
 Give warm compresses on the area of pain.
 Provide analgesics as prescribed by the physician.
 Assess the extent of knowledge of the patient about his or her illness.
 Give health education about the disease and treatment.

18. prevention
 If someone has suffered from typhoid, they should ideally
not discontinue their medication abruptly or as soon as
they feel better because typhoid has a high rate of relapse.
 It is important that the patient continues his/her
medication until the doctor asks to stop.
 The patient must also ensure washing hands well with an
antibacterial soap after going to the toilet and before
touching any food or water.

19. prevention
 Today, there are vaccines that can protect from
contracting typhoid.
 The Ty21a vaccine is administered intramuscularly and
requires the patient to take a booster shot after 5 years.
 Even if a person has taken the vaccine, they should not
expose themselves to possible infectious agents.

20. prevention
 Apart from the vaccine, there are some basic things that one can
take care of in order to avoid contracting typhoid
 Do not eat food cooked on the road side.
 Do not eat fruits and raw vegetables that have been pre cut.
 Always drink either bottled water or boiled water.
 Do not have ice prepared locally.
 Wash hands well before cooking a meal or eating .

21. REFERENCES
 Brunner and Suddarth’s Textbook of Medical- Surgical Nursing ,South Asian
 Edition , Volume II , Published by Wolters Kluwer . Page reffered to 1528- 1529.
 https://www.slideshare.net/hanasheque/typhoid-disease
 https://www.slideshare.net/sapanathakor/typhoid-fever-ppt-124654652
 https://www.slideshare.net/kuldeepvyas370/typhoid-232227753