A 25 year old female patient was admitted to the female medicine ward with complaints of fever with chills since 1 and 1/2 months, bod ache, cough with expectoration since 10-15 days, weakness with giddiness.

1. A CASE STUDY ON
TYPHOID
(SOAP)
- AJITA SADHUKHAN
- PHARM D. 3RD YEAR
- ROLL NO. : 1
- ENROLMENT NO. : 150821207001
1

2. DEFINITION
• Typhoid or Enteric Fever is an infectious feverish disease caused by the
bacterium Salmonella typhi (Salmonella enterica Serovar Typhi ) and less
commonly by Salmonella paratyphi.
• Acute generalized infection of the reticulo-endothelial system, intestinal
lymphoid tissue and the gall bladder.
• The infection always comes from another human, either an ill person or a
healthy carrier of the bacterium. The bacterium is passed on with water and
foods and can withstand both drying and refrigeration.
2

3. PATIENT DEMOGRAPHICS:
• Patient I.P. No..: 17014140
• Patient O.P. No.: 17161688
• Age: 25 years
• Sex: Female
• Department: Female Medicine Ward
• Unit: 2
3

4. • Reason For Admission: - Fever with chills since 1½ months
- body ache
- Cough with expectoration since 10-15 days
- Weakness with giddiness
- Enteric fever
• Past Medical History: NAD
• Past Medication History: NAD
• Family and social history: NAD
4

5. OBJECTIVES
PHYSICAL EXAMINATION:
• GENERAL: Decreased appetite, poor nutrition, disturbed sleep, urine: 4-5 times a day
• CVS: S1 S2 clear
• RS: AEBE clear
• CNS: Conscious
• BP: 100/60 mm Hg
• PR: 84/min
• TEMP: Normal
• RESPIRATION: 18/min
• PA: Soft
5

6. LAB. INVESTIGATION REPORTS [FIRST DAY]
LABORATORY PARAMETERS OBSERVED VALUE NORMAL RANGE UNIT
Hb 11.6 11.5-18 g%
WBC 4630 4000-11000 Cells/cu mm
Neutrophils 70 40-70 %
Eosinophils 05 1-6 /cu mm
Lymphocytes 22 20-40 /cu mm
Monocytes 03 2-10 /cu mm
Basophils 00 0-1 /cu mm
RBC 4.88*10^12 3.8-5.8*10^12 /cu mm
ESR 10 1-20 mm/hr
PCV 37.1 40-54 %
Platelets 149000 1.5-4 /cu mm
MCHC 31.3 33-36 g/dL
AST 30 <40 IU/L
ALT 25 <40 IU/L
Ser. ALP 58 <270 U/L
Bili. Total 0.3 0.2-1.1 Mg/dL
Bili. Direct 0.2 0-0.25 Mg/dL
Bili. Indirect 0.1 0.0-0.6 Mg/dL
Total Protein 4.4 6-8 Gm/dL
Albumin 6.6 3.5-5 Gm/dL
6

7. OTHERS
• Ser. Creatinine (0.4-1.5 mg/dL): 0.9 mg/dL
• PS for MP: Malarial parasite not seen
• AEC (Absolute Eosinophil Count): 330/cu mm (50-500)
• Thyroid Function test → TSH: 2.64 uIU/ml (0.3-5.0)
• Globulin: 2.2 g/dL (2.7-3.5 g/dL)
• Albumin : Globulin Ratio: 2.0
• Widal Test: Positive
• USG of Abdomen (2nd day): Normal
7

8. ASSESSMENT:
PROVISIONAL DIAGNOSIS: Enteric Fever
8

9. • A 25 year old female patient was admitted to Med. ward-2 with complaints
of fever with chills since 1½ months, body ache, cough with expectoration
since 10-15 days, weakness with giddiness, enteric fever.
• Based on lab report, patient’s Hb (Borderline), Platelets, MCHC, Ser. Globulin
levels are abnormally decreased. Widal Test is Positive. Hence, patient was
diagnosed with enteric fever.
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10. FINAL DIAGNOSIS:
Enteric Fever
10

11. GOALS OF TREATMENT:
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• To reduce fever with chills.
• To reduce body ache.
• To reduce cough with expectoration.
• To reduce weakness with giddiness.
• To reduce cough and cold.

12. DAY 1
2:00 p.m.
• Temperature: Normal
• Pulse: 80/min
• SPO2: 96%
• B.P.: 100/60 mm Hg
• CVS: NAD
• CNS: NAD
• RS: NAD
3:45 p.m.
• Temperature: 100.2 F
7:30 p.m.
• Temperature: Normal
• Pulse: 100/min
• SPO2: 98%
• B.P.: 110/70 mm Hg
• CVS: NAD
• CNS: NAD
• RS: NAD
12

13. MEDICATION CHART (DAY 1)
DRUG NAME ROUTE DOSE FREQUENCY INDICATION
Inj. Paracetamol I.V. 1 amp. Stat Analgesic, anti-
pyretic
Inj. Ceftriaxone + 100 ml
NS
I.V. 2 g Stat To treat enteric
fever
Tab. Azithromycin P.O. 500 mg 1-0-0 enteric fever
Inj. Pantoprazole I.V. 40 mg TDS GERD
Inj. Ondanstron + Inj.
DNS/NS
I.V. 4 mg + I pint TDS Nausea and
vomiting
Inj. Calcium Pantothenate
+ Cyanocobalamin + Folic
acid + Niacinamide +
Pyridoxine + Thiamine
(Optineuron)
I.V. 3 ml 1-0-0 Calcium and
Vitamin B complex
supplement
Tab. Monteleukast P.O. 10 mg 0-0-1 For hypersensitivity
Syp. Chlorpheniramine +
Phenylephrine
P.O. 2 tsf 2-0-2 Cough and cold
13

14. DAY 2
8:15 a.m.
• Pulse: 85/min
• SPO2: 98%
• B.P.: 100/70 mm Hg
• CVS: NAD
• CNS: NAD
• RS: NAD
• Stool not passed.
• Urine passed.
• c/o: cough and cold.
9:30 a.m.
• Adv.: USG abdomen
7:00 p.m.
• Temperature: Normal
• Pulse: 94/min
• SPO2: 97%
• B.P.: 110/70 mm Hg
• CVS: NAD
• CNS: NAD
• RS: NAD
14

15. MEDICATION CHART (DAY 2)
15
DRUG NAME ROUTE DOSE FREQUENCY INDICATION
Inj. Paracetamol I.V. 1 amp. Stat Analgesic, anti-
pyretic
Inj. Ceftriaxone + 100 ml
NS
I.V. 2 g Stat To treat enteric
fever
Tab. Azithromycin P.O. 500 mg 1-0-0 enteric fever
Inj. Pantoprazole I.V. 40 mg TDS GERD
Inj. Ondanstron + Inj.
DNS/NS
I.V. 4 mg + I pint TDS Nausea and
vomiting
Inj. Calcium Pantothenate
+ Cyanocobalamin + Folic
acid + Niacinamide +
Pyridoxine + Thiamine
(Optineuron)
I.V. 3 ml 1-0-0 Calcium and
Vitamin B complex
supplement
Tab. Monteleukast P.O. 10 mg 0-0-1 For hypersensitivity
Syp. Chlorpheniramine +
Phenylephrine
P.O. 2 tsf 2-0-2 Cough and cold

16. DAY 3
8;30 a.m.
• Temperature: Normal
• Pulse: 79/min
• SPO2: 99%
• B.P.: 120/70 mm Hg
• CVS: NAD
• CNS: NAD
• RS: NAD
• Patient feels better.
16

17. MEDICATION CHART (DAY 3)
17
DRUG NAME ROUTE DOSE FREQUENCY INDICATION
Inj. Paracetamol I.V. 1 amp. Stat Analgesic, anti-
pyretic
Inj. Ceftriaxone + 100 ml
NS
I.V. 2 g Stat To treat enteric
fever
Tab. Azithromycin P.O. 500 mg 1-0-0 enteric fever
Inj. Pantoprazole I.V. 40 mg TDS GERD
Inj. Ondanstron + Inj.
DNS/NS
I.V. 4 mg + I pint TDS Nausea and
vomiting
Inj. Calcium Pantothenate
+ Cyanocobalamin + Folic
acid + Niacinamide +
Pyridoxine + Thiamine
(Optineuron)
I.V. 3 ml 1-0-0 Calcium and
Vitamin B complex
supplement
Tab. Monteleukast P.O. 10 mg 0-0-1 For hypersensitivity
Syp. Chlorpheniramine +
Phenylephrine
P.O. 2 tsf 2-0-2 Cough and cold

18. TREATMENT PLAN:
18

19. NON-PHARMACOLOGICAL TREATMENT:
Some common home remedies
 Mash a ripe banana along with 1 tablespoon honey and eat twice a day for
a few days.
Activity
• No specific limitations on activity are indicated.
• Rest is helpful, but mobility should be maintained if tolerable.
• The patient should be encouraged to stay home from work until recovery.
Diet
• Fluids and electrolytes should be monitored and replaced diligently.
• Oral nutrition with a soft digestible diet is preferable in the absence of
abdominal distension or ileus. 19

20. PHARMACOLOGICAL TREATMENT:
20

21. INTERVENTION/POINTS TO BE
COMMUNICATED WITH DOCTOR
SERIOUS → USE ALTERNATIVE
• Azithromycin + Ondansetron: Both increase QT interval
MONITOR CLOSELY
• Chlorpheniramine + Phenylephrine: Chlorpheniramine increases and
Phenylephrine decreases sedation.
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22. PATIENT COUNSELING:
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23. ABOUT DISEASE:
• It is a curable disease.
Two main typhoid fever prevention strategies:
1. Vaccination
✓Be vaccinated against typhoid while traveling to a country where typhoid is
common.
✓Need to complete your vaccination at least one week before travel.
✓Typhoid vaccines lose their effectiveness after several years so check with
your doctor to see if it is time for a booster vaccination.
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24. 2. Avoid risky food and drinks
✓Buy bottled drinking water or bring it to a rolling boil for one minute before
drinking it.
✓Ask for drinks without ice, unless the ice is made from bottled or boiled water.
Avoid Popsicles and flavored ices.
✓Eat food that have been thoroughly cooked and that are still hot and
steaming.
✓Avoid raw vegetables and food that cannot be peeled like lettuce.
✓When eat raw fruit and vegetables that can be peeled, peel yourself. Don’t
eat the peelings.
✓Avoid foods and beverages from street vendors.
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25. ABOUT MEDICATIONS:
• Dose of drugs
• Frequency of dose
• Route of administrations such as I.V, I.M., t/d, s/c, P.O., S/L.
• Counselling regarding overdose (may cause toxicity), underdose (submaximal or no response)
and missing of dose of medication. E.G. If a dose is missed, then the patient is to be advised
to go for the next dose, otherwise toxicity of drug may occur.
• Contraindications
• Drug interactions (drug-drug, drug-food)
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26. LIFE STYLE MODIFICATIONS:
SANITORY MEASURES:
• Sanitary disposal of human faeces and maintain fly-proof latrines.
• Provision of safe chlorinated water and avoid possible back-flow connections between water and sewer systems.
• Educate the community regarding the importance of hand washing especially after defecating.
• Control of flies by screening, spraying with insecticides, and use of insecticidal baits and traps.
• Control fly breeding by frequent collection and disposal of garbage, and fly-control measures in latrine
construction and maintenance.
• Use scrupulous cleanliness in food preparation and handling; refrigerate as appropriate. Particular attention should
be directed to the proper storage of salads and other foods served cold. These provisions apply equally to home
and public eating places.
• If uncertain about sanitary practices, select foods that are cooked and served hot, and fruits peeled by the
consumer.
• Pasteurize or boil all milk and dairy products. Supervise the sanitary aspects of commercial milk production, storage
and delivery.
• Enforce suitable quality-control procedures in industries that prepare food and drink for human consumption.
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27. FOOD SAFETY:
• Contaminated food is another important vehicle for typhoid fever transmission.
• Appropriate food handling and processing is paramount and the following basic hygiene measures must be implemented or
reinforced during epidemics:
• Washing hands with soap before preparing or eating food;
• Avoiding raw food, shellfish, ice; eating only cooked and still hot food or re-heating it.
NATURAL REMEDIES:
• Complete bed rest is essential.
• Patient should be kept on a liquid diet of orange, barley juice and milk.
• Orange juice especially hastens recovery as it increases energy, promotes body resistance and increases urinary output.
• Administer warm water enema regularly.
• Apply cold compress to head if temperature rises above 1030F
• Wrap the body and legs twice with a sheet wrung in cold water and then cover it with a warm material.
• The pack should be kept for an hour and renewed after every 3 hours.
• Hot water bottles may be applied to the sides of the body and feet.
• Fresh fruits and easily digestible foods can be given after temperature comes down to normal.
• Plain water or unsweetened lemon water can be used for drinking.
• Gradually start a well-balanced diet.
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