For the student of medical field. Details of typhoid fever in brief.

1. TYPHOID
SUB:- PRACTICE OF MEDICINE
TOPIC:- INFECTIOUS DISEASES
BY
VIDHI BAJANIYA
ROLL NO.:-05
4TH B.H.M.S
L.R.SHAH HOMOEOPATHY COLLEGE

2. DEFINITION
• It is an acute systemic illness characterized by fever,
headache and abdominal discomfort.
• Enteric fever:- includes both
typhoid and paratyphoid fever.

3. CAUSETIVE AGENT
• Caused by salmonella typhi and salmonaella
paratyphi.
• Typhoid fever :- caused by infection with salmonalla
typhi (Also known as salmonella enterica serovar
typhi).
• Paratyphoid fever:- clinically similar but milder disease
caused by salmonella paratyphi (salmonella enterica
serovar paratyphi A, B or C.

4. SOURCE OF INFECTION
• Humans are only natural reservoir and include:
1) Patient suffering from disease:- infected urine,
feces or other sections from patients.
2) chronic carriers of typhoid fever:- s.typhi and
s.paratyphi colonizes in the gallbladder, urinary
bladder or billiary tree.

5. MODE OF TRANSMISSION
From person to person contact.
1) Ingestion of contaminated water and food.
chronic carriers, often food handlers transmit the
disease.
2) Direct spread:- rare by finger to mouth contact
with feces (fecal-oral route), urine or secretions are
rare.

6. INCUBATION PERIOD
• Usually 10-14 days and for
paratyphoid it is shorter.

7. PATHOGENESIS
• Ingested through contaminated food and water.
• Able to survive in gastric acid of stomach and reach mucosa of small intestine.
• Penetrate the ileal mucosa, reach the submucosa and are phagocytosed by the macrophages in the
Peyer’s patches.
• Carried to the mesenteric lymph node via lymphatic and enter the blood stream via thoracic duct
causing bacteremia.
• They colonize reticuloendothelial tissue (liver, gallbladder, spleen and bone marrow), and multiply
further and re-enter blood stream causing massive bacteremia (occurs towards the end of incubation
period) and disease clinically manifest.
• They causes inflammation and necrosis which results in characteristic oval typhoid ulcers.

9. CLINICAL FEATURES
• Onset:- gradual and non specific.
• Patient usually present with fever, anorexia,
headache, abdominal pain, bloating, nausea and
vomiting.
• Fever:- the temperature rises in a step ladder
fashion (step ladder fever) to a 40-41° for 4 or 5
days in some cases.

12. PHYSICAL FINDINGS
• Abdominal tenderness
• Hepatosplenomegaly
• Lymphadenopathy
• Rose spots or Rose red spot:- small , 2-4 mm, pale-red maculopapular
lesions on the skin that fade/ blanch on pressure appear on the chest and
abdomen which occur during first week and usually last only 2-3 days. They
result from bacterial embolism and salmonella can be cultured from the
biopsy of these lesions.

13. • Relative bradycardia:- pulse is often slower than
would be expected from the height of fever.
• Intestinal manifestation:- by the end of first week,
constipation is succeeded by diarrhoea and
abdominal distension. Stool are loose and greenish
in colour and characteristically described as “pea-
soup”.

14. COMPLICATIONS
• General:- toxemia, dehydration, peripheral circulatory failure, and
DIC.
• intestinal:- perforation of typhoid ulcer and hemorrhage from
the ulcer may occur at the end of the second week or during the
third week of illness.
• extra intestinal:- muttering delirium, meningitis, seizures,
myocarditis, cholecystitis.

15. INVESTIGATION
• TLC:- leucopenia with relative lymphocytosis. Eosinophils are
usually absent.
• isolation of bacilli:
1) blood culture:- “gold standard” investigation. Positive in
First week of fever in 90% of patients.
2) stool culture:- becomes positive in third week.
3) urine culture:- seen in approximately 25% of patients by third
week.

16. • Widal test:- measures agglutinating antibodies against O, H and
Vi Antigens of s.typhi and H antigen of s.paratyphi A and B.
• Lacks sensitivity and specificity.
• Becomes positive from the end of first week till fourth week.
• There are many false positive and occasional false negative widal
reaction.
• molecular method:- pcr.

17. TREATMENT
• General management:- bed rest , isolation,
maintenance of nutrition and fluid Intake.
• Treatment of complications:- intestinal perforation
and hemorrhage should be treated accordingly.

18. PREVENTION
• Improved sanitation and living conditions:- good hygiene, clean
water, proper sewage disposal and proper water treatment.
• Travellers are advised to avoid drinking untreated water, ice in
drinks and eating ice creams.
• Boiling or chlorination of water and pasteurization of milk destroy
the bacilli.
• Vaccination:- 1) inactivated injectable
• 2) oral live attenuated vaccines

19. HOMOEOPATHIC THERAPEUTICS
• Baptisia
• Muriatic acid
• Arnica
• Rhus tox
• Arsenic alb

20. BAPTISIA
• Tongue:- red papilla, dry and yellow – brown in center later dry cracked ulcerated.
• Great prostration, with disposition to decomposition of the fluids.
• Ulceration of mucous membrane.
• All discharge and exhalation fetid, especially in typhoid or other acute disease,
breath, stool, urine, perspiration, ulcers.
• Dysentery of old people, diarrhea of children, especially when very offensive.
• Face flushed dusky dark red, with a stupid, besotted drunken expressions.

21. • In whatever position the patient lies, the parts upon feel sore and
bruised .
• Stupor falls asleep while being spoken to or in the. Midst of his
answer .

22. MURIATIC ACID
• Typhoid or typhus ;deep stupid sleep; unconscious while awake ; loud
moaning or muttering ; tongue coated at edges, shrunken, dry, leather
like, paralyzed, involuntary fetid stools while passing urine ; sliding down ;
pulse intermittent every third beat.
• Ulceration with fungus like growths and pseudo like membrane deposit of
intestine tract.
• Mouth and anus are chiefly affected, tongue and sphincter ani are
paralysed.
• Great debility ; as soon as he sits down his eye close, lower jaw hangs
down, slide down in bed.

23. ARNICA
• Febrile symptoms closely related to typhoid.
• Shivering over whole body. Head and redness of head, with coolness of rest of the body.
Internal heat: feet and hands cold.
• Nightly sour sweats.
• Unconsciousness; when spoken to answers correctly but unconsciousness and delirium at
once return. Says there is nothing the matter with him.
• Involuntary evacuation from bowels and bladder.
• Blood vessels are relaxed causing ecchymosis, blue black spots; with tendency to. Bruised
sore feeling all over the body.

24. RHUS TOX
• The effect on the skin, rheumatic pains, mucus membranes affections and a typhoid type of
fever makes this remedy frequently indicated.
• Fever adynamic , restless, trembling.
• Typhoid tongue dry and brown. Bowel loose.
• Great restlessness.
• Intermittent chill with dry cough and restlessness.
• During heat urticaria. Chilly as if cold water were poured over him followed by heat and
inclination to stretch the limbs.
• Pulse quick, weak, irregular, intermittent. Great thirst with dry mouth and throat.

25. ARSENIC ALB
• This is one of the remedies for typhoid fever when the case begins to look bad it’s hardly
ever indicated in the beginning of the disease.
• Terrible prostration so characteristic of the drug is accompanied by an irritability and
anxiety.
• Patient is faint and week, exhausted, perhaps with cold sweat and delirium.
• the mouth is sore, there is diarrhoea of dark, offensive stools, intense fever and great
thirst, drinks often but little at a time.
• Prostrated restlessness.
• Worse after midnight. Extremely red hot tongue.

26. Thank you.