Typhoid fever is caused by the bacterium Salmonella Typhi. It affects 17 million people worldwide each year. The presentation summarized the causative agent, epidemiology, symptoms, diagnosis, treatment, prevention and nursing care for typhoid fever. Key points include that it is transmitted through contaminated food or water and symptoms include sustained fever, abdominal pain and rose colored spots. Diagnosis involves blood and stool cultures. Treatment involves antibiotics like chloramphenicol or fluoroquinolones for 2-4 weeks. Prevention requires safe food handling and sanitation. Nursing care focuses on bedside care, monitoring symptoms and educating family.

1. Presentation on
Typhoid Fever

2. Other names:
• Enteric Fever
• Bilious Fever
• Yellow Jack

3. Causative Agent
Salmonella Typhi

4. 3 main antigenic factors:
• the O, or somatic antigen
• the Vi, or encapsulation
antigen
• the H, or flagellar antigen

5. Epidemiology
• World: 17 million cases per
year
• U.S.: 400 cases per year
(70% in travelers)
• Philippines: (Nov 2006) 478
in Agusan del Sur; (May
2004) 292 in Bacolod City

6. Incidence of Typhoid Fever
red - strongly endemic; orange – endemic;
gray - sporadic cases

7. Mode of Transmission
Ingestion of
contaminated food or
water; rarely from person
to person transmission
through fecal-oral route.

8. Incubation Period
First 7-14 days after
ingestion

9. Symptoms
• Diarrhea may occur
• Active infection
• Severe Headache
• Generalized Abdominal
Pain
• Anorexia

10. Symptoms
• Fever [usually higher in the
evening]
- Intermittent Fever initially
- Sustained Fever to high
temperatures later

11. Symptoms
Severe cases
• ulcers on the intestinal
wall
• shock
• delirium
• stupor

12. Pathognomonic Sign
• Rose Spots
Blanching pink macular spots
2-3 mm over trunk

13. Complications
Intestinal perforation,
gastrointestinal hemorrhage
and peritonitis may occur in the
3rd and 4th week of illness;
rarely pancreatitis, hepatic and
splenic abscesses,
disseminated intravascular
coagulation, myocarditis,
meningitis, encephalitis.

14. Pathophysiology
Salmonella Typhi
survives the acidity of the stomach
invades the Peyer’s Patches of the intestinal wall
macrophages (Peyer’s Patches)
the bacteria is within the macrophages and survives
bacteria spreads via the lymphatics while inside the
macrophages

15. Pathophysiology
access to Reticuloendothelial system, liver, spleen,
gallbladder and bone marrow
First week: elevation of the body temperature
Second week: abdominal pain, spleen enlargement and rose spots
Third week: necrosis of the Peyer’s Patches
leads to perforation, bleeding
and, if left untreated, death is imminent

16. Diagnostics
CBC (normal WBC despite
fever), platelet count
Tourniquet Test

17. Diagnostics
Typhi dot test (if illness is 4 days or
longer)
Interpretation:
Ig M Ig G
(+) (- ) Acute infection
(+) (+) Recent infection
(- ) (+) Equivocal: Past
infection or acute
infection

18. Diagnostics
Malarial smear (Differential
diagnosis)
Chest X-ray
Urinalysis

19. Diagnostics
First Week of illness: Blood
C/S
Second Week of illness: Urine
G/S, C/S
Third Week of illness: Stool
C/S

20. Management
A. Prevention:
• Choose foods processed
for safety
• Prepare food carefully
• Foods prepared by others
(avoid if possible)

21. Management
• Keep food contact surfaces
clean
• Eat cooked food as soon as
possible
• Maintain clean hands

22. Management
• Steam or boil shellfish at
least 10 minutes
• All milk and dairy
products should be
pasteurized
• Control fly populations

23. Management
B. Antibiotics
For uncomplicated cases, use
Conventional Therapy:
1. Chloramphenicol 3-4 gm per day PO in
4 divided doses x 14 days (50-100
mg/kg BW) except it with low WBC.
2. Co-trimoxazole forte or double-strength
tab BID PO x 14 days
3. Amoxicillin 4-6 gm per day PO in 3
divided doses x 14 days

24. Management
For cases with complications, presence of severe
symptoms, or clinical deterioration despite
conventional therapy, use Empiric Therapy for
Suspected Resistant Typhoid Fever:
1. Ceftriaxone (Rocephin) 3 gm IV infusion OD x 5-7
days
Ceftriaxone may be used for pregnant women and
children.
2. Fluoroquinolones:
Ciprofloxacin (Ciprobay) 500 mg tab PO BID x 7-10
days
Ofloxacin (Inoflox) 400 mg tab PO BID x 7-10 days
Perfloxacin (Floxin) 400 mg tab PO BID x 7-10 days

25. Management
C. Vaccines
5 years
1 capsule
every other
day, total
of 3
capsules
Oral
6 years
Ty21 a, live
3 years
0.5 ml
Subcutaneous
2 years
Vi CPS
3 years
0.5 ml (0.25 ml
for
children <
10y)
x 2 times,
4 weeks apart
Subcutaneous
5 years
Killed
whole-cell
vaccine
Revaccination
Dosage
Route
Age
Vaccine

26. Management
D. Public Health Nursing
Responsibility
- Teach members of the family
how to report all symptoms
to the attending physician
especially when patient is
being cared for at home.

27. Management
- Teach, guide and
supervise members of the
family on nursing
techniques which will
contribute to the
patient’s recovery.

28. Management
- Interpret to family nature
of disease and need for
practicing preventive and
control measures.

29. Management
E. Nursing Care
- Demonstrate to family
how to give bedside care,
such as tepid sponge
bath, feeding, changing of
bed linen, use of bedpan
and mouth care.

30. Management
- Any bleeding from the
rectum, blood in stools,
sudden acute abdominal
pain, restlessness, falling of
temperature should be
reported at once to the
physician or the patient
should be brought at once to
the hospital.

31. Management
- Take TPR, I&O and teach
family members how to
take and record same.

32. Historical Background
Mary Mallon
(September 23, 1869 – November 11, 1938)

33. Thank you!