Typhoid fever is caused by the Salmonella typhi bacteria and is spread through contaminated food or water. It remains prevalent in developing countries with poor sanitation. Symptoms include sustained high fever, abdominal pain, and diarrhea. Diagnosis involves blood tests and cultures to detect the bacteria. Treatment uses antibiotics to kill the bacteria along with IV fluids. Vaccines are recommended for travel to areas where typhoid is common. The case study describes a 17-year old girl who contracted typhoid fever in India and was successfully treated with antibiotics.

1. Case Study: Typhoid Fever
Biochemistry 460
Jacquelyn Sertic

2. Introduction
• Typhoid fever is principally due to the
problem of unsafe drinking-water,
inadequate sewage disposal and flooding.
It remains a serious health threat in
developing countries. This disease is often
associated with poor sanitation and
hygiene because the salmonella typhi
bacteria.

3. Signs and Symptoms
• Early symptoms include fever, general ill-feeling, and
abdominal pain.
• High fever and severe diarrhea occur as the disease
gets worse.
• Some people develop a rash called “rose spots” on the
abdomen and chest.
• Other symptoms include abdominal tenderness,
agitation, bloody stools, chills, confusion, attention
deficit, fluctuating mood, hallucinations, nosebleeds,
severe fatigue, sluggish feeling, weakness

4. Diagnosis
• A complete blood count will show an elevated number of
white blood cells
• A blood culture during the first week can
showSalmonella typhi bacteria.
• An ELISA urine test can help look for the bacteria
• Fluorescent antibody studies look for substances specific
to Typhoid bacteria
• There might be a low platelet count
• A stool culture can also help determine diagnosis

5. Treatment
• Antibiotics are given to kill the bacteria.
• Fluids and electrolytes may be given by IV.
Or the patient may be asked to drink
uncontaminated water with electrolyte
packets.

6. Prevention
• A vaccine is recommended for travel
outside of the U.S. to places where there
is typhoid fever.
• When traveling, drink only boiled or bottled
water and eat well-cooked food.

7. Initial Diagnosis
• A 17-year-old girl is admitted to a Sanford.
She has a one-week history of intermittent
high-grade fever, abdominal pain, and
nausea.
• The physical examination revealed
tenderness in the upper abdomen.
• The girl had recently returned from her
one month mission in India

8. Tests
• Ultrasonogram of the abdomen revealed no
abnormalities in the gall bladder, bile ducts, pancreas,
and kidney.
• Lymph nodes and spleen size was enlarged.
• A complete blood count revealed a white blood count of
7,000 within the normal range (3,500-10,000).
• Lymphocytes were slightly elevated at 51.9%
• Blood cultures were negative with no history of
antimicrobial therapy within the previous seven days

9. Treatment
• The patient received certriaxone
intravenously at 750mg per day along with
Ranial and Pantoprazole in two divided
dozes, and oral calpol syrup once every
four hours until the axiliary temperature
remained below 100° F for at least 24
hours.
• The therapy was then maintained for an
additional 5 days.

10. Examination
• Response to treatment what assessed for
improvement in symptoms and signs of
typhoid fever.
• After three days of treatment, all
symptoms disappeared.
• There were no adverse effects

11. Salmonella typhia
• This bacteria is the causative agent of Typhoid fever.
• It is an obligate parasite that has no known reservoir outside of
humans.
• This gram-negative bacillus belongs to the family
Enterobacteriaceae.
• It is susceptible to various antibiotics.
• Currently, 107 strains of this organism have been isolated.
• Diagnostic identification can be attained by growth on MacConkey
and EMB agars
• The bacteria is strictly non-lactose fermenting.
• It produces no gas when grown in TSI media

12. cont.
• S. typhi is an effecting pathogen.
• It produces and excretes a protein known
as “invasin” that allows non-phagocytic
cells to take up the bacterium, where it is
able to live intracellularly.
• It is able to inhibit the oxidative burst of
leukocytes, making innate immune
response ineffective.

13. Invasin Protein
• Invasin is an outer membrane protein that mediates the
internalization of bacteria by Hep-2 cells and fibroblasts.
• Invasin-bearing bacteria initially bound the filopodia and
the leading edges of cultured cells
• Multiple points of contact between the bacterial surface
and the surface of the cell ensued and led to the
internalization of the bacterium with an endocytic
vacuole
– The same multi-step process could be induced by an inert
particle coated with invasion-containing membranes.

14. References
• https://www.ncbi.nlm.nih.gov/pubmed/1730744
• http://www.nytimes.com/health/guides/disease/ty
phoid-fever/overview.html
• http://web.uconn.edu/mcbstaff/graf/Student%20p
resentations/Salmonellatyphi/Salmonellatyphi.ht
ml
• www.jidc.org/index.php/journal/article/download/
21045376/445