This document discusses typhoid fever, caused by Salmonella typhi bacteria. It is characterized by prolonged fever and can cause intestinal bleeding or perforation. Infection occurs through ingestion of contaminated food, water, or contact with infected humans or animals. Diagnosis involves blood or bone marrow cultures. Treatment consists of antibiotics like chloramphenicol or fluoroquinolones for 2 weeks. Prevention focuses on handwashing, sanitation, safe food/water handling, and vaccination.

1. Dr Anzar Farooq Shaikh
lecturer Community Medicine
TYPHOID

2. • Typhoid fever is one of the commonest cause of pyrexia of
unknown origin.
• It is characterized by prolonged fever abdominal pain diarrhoea
delirium rose spots splenomegaly and complicated sometimes by
intestinal bleeding and perforation

3. ETIOLOGY
• Typhoid fever is caused by salmonella typhi.
• Paratyphoid fever is caused by salmonella paratyphoid A, S ,
paratyphoid B (S. Scottmuelleri) and S paratyphoid C +S.
Hirschfeld
• Salmonella organisms are gram negative bacilli .

4. EPIDEMIOLOGY
• Adults and children of all ages and both sexes are equally susceptible
to infection . Most cases occur in school age children and young adults .
• Major reservoirs for salmonella are animals(poultry, pets) ,
contaminated water , infected fruits and vegetables and infected
humans .
• S typhi is resistant to drying and cooling ,thus allowing bacteria to
survive prolonged periods in dried sewage , water , food and ice .

5. TRANSMISSION
• Infection is transmitted by ingestion of contaminated food milk
water or contact with an infected animal
• Person to person spread occurs by fecal oral transmission.
• For a clinical disease to occur 10⁵ - 10⁶ viable organisms must be
ingested .

6. OUTBREAK
• Outbreak of disease may occurr by contaminated water and
ingestion of contaminated eggs. The source of the domestically
acquired typhoid is usually a person who is chronic career of
salmonella typhi.

7. INCUBATION PERIOD
• Incubation period of enteric fever is usually 7 to 14 days
(ranges 3 to 30 days it depends upon the size of injusted
inoculum and immune status of the host

9. CLINICAL FINDINGS
• In infants it may cause mild gastroenteritis or severe sepsis.
Vomiting diarrhoea and abdominal distention are common. fever is
continuous and high-grade and may cause febrile fits . There
maybe anorexia weight loss jaundice And hepatosplenomegaly.

10. • The older child presents with high grade continuous fever .
headache is common with malaise and anorexia lethargy
abdominal pain and tenderness. The typical patient has an
extremely to Toxic look with long face and furred tongue the child
is pain looking and has lost weight . he may have cough with
scattered rhonchi or Crepitation giving suspicion of
pneumonia .Rarely jaundice maybe present from septicaemia
involving liver the paradoxical relationship of high temperature and
low pulse rate may not be seen in children.

11. • Maculopapular rash(rose spots) 1 -5
mm on upper abdomen and lower
chest .
• Rose spots are slightly raised lesions
and blanch on pressure

14. DIAGNOSIS
• Consider typhoid fever if a child presents with fever and any of the
following:
•
constipation, vomiting, abdominal pain, headache, cough, transient
rash, particularly if the fever has persisted for ≥ 7 days and malaria
has been excluded.

15. • On examination, the main diagnostic features of typhoid are:
• Fever with no obvious focus of infection
• No stiff neck or other specific sign of meningitis, or negative lumbar
puncture for meningitis (Note: children with typhoid can occasionally
have a stiff neck).
• Signs of systemic upset, e.g. Inability to drink or breastfeed,
convulsions, lethargy, disorientation or confusion, or vomiting
everything

16. • Pink spots on the abdominal wall may be seen in light-skinned
children.
• Hepatosplenomegaly, tender or distended abdomen.

17. DIAGNOSIS
• Isolation of causative organism .
1. Blood culture (positive early during the first 2 weeks of illness ) .
2. Culture of bone marrow
3. Urine culture
• Bone marrow culture is the most sensitive procedure .

18. • PCR
it gives the results within a few hours and is more specific and
sensitive than blood culture.

19. • Supportive tests
1. CBC
Leukopenia
Leucocytosis
Normochromic normocytic anaemia
Thrombocytopenia
1. LFTs may be deranged with involvement of liver .

20. COMPLICATIONS
• Intestinal perforation
• Intestinal hemorrhage
• Toxic encephalopathy
• Acute cholecystitis
• Pneumonia
• Pyelonephritis

21. • Meningitis
• Osteomyelitis
• Sepsis
• Septic arthritis
• Toxic myocarditis
• Fatal bone marrow suppression

22. MANAGEMENT
• Choice of antibiotic should be according to the culture reports and
antibiotic resistance
1. Chloramphenicol 50-75 mg/kg/24 hrs PO or 75 mg/kg/24 hrs IV in
4 divided doses (maximum 3 g/day ) for 14-21 days .
2. Amoxicillin 100mg/kg/24 hrs PO in 3 divided doses for 14 days
3. Fluoroquinolones (eg ofloxacin or ciprofloxacin )are effective .
Ciprofloxacin is given 15-20mg/kg/24 hrs PO for 10-14 days

23. • Ceftriaxone 60mg/kg /day in 2 doses IV for 14 days .
• Azithromycin 10-20mg/kg/day orally for 7 days .
• Cefotaxime 80mg/kg/day IV divided in three doses for 14 days .
• Cefixime 20mg/kg/day orally for 7 to 14 days .

24. SUPPORTIVE
• Corticosteroids
A short course of dexamethasone improves the survival rate of
patients presented with shock or coma .
Dexa : 3mg/kg , followed by 1mg/kg every 6 hrs for 48 hrs .
• Blood transfusions
In anemia and intestinal bleed
• Adequate nutrition

25. • Hydration
• Electrolyte balance
• Surgical intervention if intestinal perforations
• Platelet transfusion if thrombocytopenia.

26. PREVENTION
• Preventing measures
1. Handwashing
2. Improved personal hygiene
3. Sanitary habits
• Protective health measures
1. Provision of clean water
2. Adequate sewage disposal
3. Control of flies .

27. • Adequate temperature for cooking . Eggs should be thoroughly
cooked never eaten raw.
• Avoid preserving food at warm temperatures and reheating food.
• Passive immunization with vaccination.

28. THANK YOU