Typhoid fever is the result of systemic infection mainly by S.Typhi found only in man. The disease is clinically characterized by a typical continuous fever for 3 to 4 weeks, relative bradycardia with involvement of lymphoid tissues and considerable constitutional symptoms.

1. TYPHOID FEVER
NAME : SUHA SERI BINTI AMBUSELVAN
ID : 2103-3330
COMMUNITY MEDICINE

2. DEFINITION
Typhoid fever is the result of systemic infection mainly by S.Typhi found only in man. The disease is
clinically characterized by a typical continuous fever for 3 to 4 weeks, relative bradycardia with
involvement of lymphoid tissues and considerable constitutional symptoms. The term “enteric fever”
includes both typhoid and paratyphoid fevers. The disease may occur sporadically epidemically or
endemically.

3. EPIDEMIOLOGICAL DETRERMINANT
1. Agent Factors
- Major cause : Bacterium Salmonella Typhi
- Minor cause : S Para A, S Para B
- Man is the only known Reservoir, viz cases and carriers.
2. Host
Human
- Age : Most vulnerable between 5 years to 19 years of age group
- Sex : More in male than female, but carrier is higher in females.
- Resistance: Gastric acidity, local intestinal immunity
3. Environmental factors
- Enteric fever observed all year.
- Peak : July to September : Coincides with rainy season and an increase in fly population.
-Environmental source of infection : contaminated water, foods, milk, soil.
-Typhoid bacilli cant multiply in water, may perish in 48 hours, some survive for about 7 days
- Ice/ Ice cream :Over a month
-70 days in soil irrigated with sewage water under moist winter conditions.

4. Epidemiology in world

5. Epidemiology in Malaysia
• Typhoid fever is a common foodborne disease in Malaysia.
• In Klang Valley, typhoid cases were higher in men (n = 272) at 55.6% than in women (n = 217) at 44.4%.
• The mean age of typhoid fever cases in Klang Valley was 29.80 years (±17.44).
• Most of the typhoid cases were detected among patients aged 21 to 30 years.
• From the Kelantan State’s Public Health Department registry, 1394 records of confirmed typhoid fever patients
admitted to various hospitals within the state from year 2004 to 2009 were retrieved
• The distribution of typhoid patients by demographic variables were
Malay 98.1% (n=1367)
Females 50.9% (n=709)
District of Kota Bharu 71.8% (n=1001).
An important observation here was the predominance of males in the age groups 5-14 and females in the age
group 20-35 and 45-60
The overall male to female ratio was 1:1

6. INCUBATION PERIOD
• Usually 10-14 days.
• It may be as shirt as 3 days or as long as 3 weeks depending upon
the dose of the bacilli ingested.

7. MODE OF TRANSMISSION
• Typhoid fever is transmitted via the faecal-oral route or urine-oral routes.
• This may take place directly through soiled hands contaminated with faeces or urine of cases or
carriers, or indirectly by the ingestion of contaminated water, milk and/or food, or through flies.
Dynamics of Typhoid fever transmission

9. Clinical features

11. Complications

12. INVESTIGATIONS
1. Microbiological Procedures
• Definitive diagnosis of typhoid fever depends on the isolation of
S.Typhi from blood, bone marrow and stools.
• Blood culture is the mainstay of diagnosis.
2. Serological Procedures
• Felix Widal Test (Moderate sensitivity and specificity)
3. New Diagnostic Tests
• IDL Tubex test – Detects IgM09 antibodies from patient.
• Rapid serological test known as Typhidot- Developed in Malaysia
and take 3 hours to perform.

13. Vaccination
Two typhoid fever vaccines are available
1. Oral vaccine :Can be given to people at least 6 years old. It consists of four pills taken every
other day and should be finished at least 1 week before travel.
2. Injectable vaccine : Can be given to people at least 2 years old and should be given at least 2
weeks before travel.
• Typhoid fever is common in places with poor sanitation and a lack of safe drinking water.
• Access to safe water and adequate sanitation, hygiene among food handlers and typhoid
vaccination are all effective in preventing typhoid fever.
PREVENTION

15. Treatment
•Activity – rest is helpful
•Medical care
 Antibiotics
 Corticosterois ( for severe typhoid fever)
 Antipyretics
•Diet
- fluid and electrolytes should be monitored.
-Soft digestible diet is preferable in absence of abdominal distension and ileus
• Surgical care – in cases of intestinal perforation

16. Thank you
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