Enteric fever is caused by Salmonella Typhi and Paratyphi bacteria. It is a major health problem globally with over 21 million cases reported annually, especially in India. The bacteria are transmitted through contaminated food or water via the fecal-oral route. Clinical features include fever, abdominal pain, and complications like intestinal bleeding or perforation. Diagnosis involves blood or stool culture and serological tests. Treatment involves antibiotics and supportive care. Prevention focuses on hand washing, water treatment, and vaccination.

1. BY FG OFFR ADITYA PASUMARTHY

2. INTRODUCTION
• Collective term used for typhoid and paratyphoid fevers.

3. HISTORY
• First decribed by Thomas Willis in 17th century.
• Feco oral route established in 1856.
• Causative bacillus isolated in 1880.
• Earliest vaccine developed in 1896.
• Paratyphoid species isolated in 1902.

4. DISEASE BURDEN
• Global burden of 21 million cases every year. (WHO 2004)
• Estimated deaths of >2.16 lakhs per annum.
• Enteric fever- endemic in india.
• with an incidence of 214.2/1 lakh/ yr.

5. STATISTICS

6. ETIOLOGY
• Agent –

7. TRANSMISSION

8. MAN- ONLY RESERVOIR
• CASES- mild, missed, severe
• CARRIERS- temporary / chronic
• Paratyphi B and C
RESERVOIR
CARRIERS
INCUBATORY CONVALESCENT
CASES

9. PATHOGENESIS

10. CLINICAL FEATURES
• Mean age of onset- 10 years
• Spectrum ranging from a mild illness to a severe clinical pictures with
complications.
• More dramatic in younger groups with higher rate of complications
and hospitalization.

11. DISEASE PROGRESSION

12. 1st week
• Vomiting
• Diarrhea ( pea soup diarrhea) / constipation is rarer.
• Step ladder pyrexia
• Mild cough
• Relative bradycardia
• Expressionless and toxic facies
• Coated tongue
• Tender, doughy abdomen

13. 2nd WEEK
• Continuous high grade fever
• Worsening of cough
• Abdominal pain and tenderness.
• Soft hepatosplenomegaly
• Rose spots

14. 3rd week
• In absence of acute complications symptom start resolving at 2-4
weeks
• Associated with malnutrition in children
• Or progresses to- intestinal bleeding/perforation, peritonitis, septic
shock, altered sensorium.

15. COMPLICATIONS

16. INVESTIGATIONS
• BLOOD CULTURE-
 90% cases- FIRST WEEK
 75% cases- SECOND WEEK
 60% cases- THIRD WEEK
• ANTIGEN IN URINE/ SERUM
 Sensitised Staphylococcal coagglutination test
 PCR
• Other samples that can be used- bone marrow, feces, bile, CSF,
sputum.
• CBC shows relative leucocytopenia, leukocytosis in children,
thrombocytopenia in DIC.

17. CHOICE OF INVESTIGATION

18. WIDAL TEST
• Described by Georges Widal in 1896.
• Sero-agglutination test measuring- H and O
agglutinins.
• Demonstrating a rise holds more value than a
single test.
• Titres of more than 1/100 of O agglutinins and
1/200 of H is significant.
• May also be positive in previous infections,
subclinical infections, immunization.

19. Other tests to detect antibodies
• ELISA- Tyhpidot- type of dot ELISA.
 Detects IgM, IgG
 Positive within 2-3 days of infection.
 Only a qualitative test.
• Counterimmunoelectrophoresis
• Indirect hemagglutinin

20. DIFFERENTIAL DIAGNOSIS
• Malaria
• Influenza
• Bacillary dysentery
• Typhus, rickettsial infections
• Abdominal tuberculosis

21. TREATMENT
• Majority may be treated at home with oral antibiotics with follow up
for complications
• Persistent vomiting, severe diarrhea, abdominal distension may
require hospitalization and parenteral antibiotics.
oSUPPORTIVE THERAPY-
 Adequate bed rest
 Adequate hydration
 Correct fluid and electrolytes.
 Antipyretics – PCM- 10-15 mg/kg.

22. DRUG THERAPY

23. SEVERE ENTERIC FEVER

24. CARRIERS
• Chronic carrier if asymptomatic and continues
to have positive stool or rectal swab cultures a
year following recovery.
• Treatment- Ciprofloxacin 750 mg BD
• Avoid child care facilities and food handling.
• Epidemiological studies.

25. PREVENTIVE STRATEGIES
• Wash your hands.
• Drink treated water.
• Wash raw fruits and vegetables.
• Prevent infection spread-
• Complete antibiotic dose.
• Wash hands often.
• Avoid handling food.
• Vaccination

26. VACCINES
• Vi- capsular polysaccharide vaccine
 >2 years of age
 Single dose- s.c. or i.m.
 Revaccination- 3 years
 No immune memory below 2 years.
 Protection after 7 days of vaccination.
• Live oral vaccine
 >6 years
 3 doses, alternate doses
 Provides herd immunity.