typhoid fever caused by salmonella typhi, enteric fever, salmonella typhus, clinical features of typhoid, lab diagnosis and investigations, widal test, treatment 3rd generation cephalosporins, prevention, immunization, complication, rose spots, transmission of typhoid, pathogenesis, etiology of typhoid fever, examination of typhoid, typhoid according to chugh medicine, images from google

1. By Shalu Thariwal

2. Contents
 Definition
 Etiology
 Pathogenesis
 Clinical features
 Examination
 Investigations
 Lab diagnosis
 Treatment and prevention
 Complications

3. Define

4. Etiology
 Causative agent: Salmonella typhi
 Transmission : by feco- oral route
 Spread also by sexually.
 Incubation period: 10 to 14 days.

5. Pathogenesis
S.typhi
Infects payer’s
patches of small
intestine
Multiply and
bloodstream
Asymptomatic
bacteraemia
Viable bacteria
re-enter and
localized into
lymphoid tissue
and multiply
Bacteraemia for
days and weeks
Clinical features
and lesions are
produced
Ulcerate, bleed
and perforation
Systemic
manifestations
and Affect
other organs
a) Bacteraemia
b)Toxaemia
c)Septicaemia

6. Clinical features
• Remittent fever, headache, aches, malaise
• Constipation, leucopenia, relative
bradycardia
Early during
first 5 to 7
days
• Rose spots, splenomegaly, bronchitis
• Abdominal pain, abdominal distension,
diarrhea
Between 1st
and 2nd week
• Confusion, delirium, encephalopathy
• Coma, death occur if untreated.
Beyond 2nd
week

7. Examination
 High grade fever
 Relative bradycardia
 Leucopenia
 Neutropenia
 Rose spots on trunk at the end of 1st
week( red in color, small macules 2-4
mm)

8. Investigations

9. Diagnosis
 Positive blood culture
 Anaemia, leucopenia
 Positive widal test
 Positive stool culture
 Positive urine culture

10. Treatment
Fluoroquinolones(drug
of choice)
Antipyretics
Supportive

11. Cont…..
 3rd generation cephalosporins
 Cotrimoxazole 960mg, 2 tab b.i.d
 Ciprofoxacin 500mg b.i.d
 Ofloxacin 400mg b.i.d
 Azithromycin 500mg daily
 Amoxycillin 500mg 6 hourly
 Supportive – fluid maintenance

12. Prevention
 Hygiene
 Water
 Immunization
 Multi dose oral at 1,3, 5, 7 yrs of age
 Single dose parentral in 2 yr

13. Complications
• Hemorrhage
• Perforation
• Paralytic ileus
• Peritonitis
Intestinal
complications
• Meningitis, encephalopathy,
pneumonia
• Bone and joint infections,
myocarditis
• Granulomatous hepatitis,
nephritis
Extraintestinal
complications