Typhoid fever is a food and water borne bacterial infection caused by Salmonella typhi. It is endemic in areas with poor sanitation and access to contaminated food and water. The bacteria infects the small intestine and spreads to the liver, spleen, and bone marrow, causing systemic infection and symptoms like sustained fever, abdominal pain, and rose-colored spots on the skin. Diagnosis involves testing blood or stool samples and treatment consists of antibiotics and supportive care, while prevention focuses on access to safe food, water, hygiene and vaccination.

1. Typhoid fever

2. Introduction
• Food and water borne bacterial infection.
• Salmonella species
• Salmonella serotype typhi
• Also known as Enteric fever

3. Epidemiology
• Prevalence :
• Endemic
• Enteric infections account for significant morbidity and mortality in young children (most
dangerous in infants <3 months ).
• Agent :
• Food and water borne
• Reservoir:
• Man

4. Epidemiology
• Transmission:
• Contaminated food and water
• Incubation period
• 14 days ( 3-60 days)

5. Pathophysiology
• Ingestion
• Bacteria survive gastric pH
• Access to small intestine , penetrates trough the intestinal mucosa,
• Enters lymphoid tissue of ileum (Peyer’s patches) and proliferate there.
• Mucosal inflammation, edema, and microabcesses in small intestine.
• Perforation of small intestine, uptake of bacteria into draining lymph nodes
• Macrophages engulf bacteria and carry to circulation through thoracic duct
• Primary bacteremia occurs

6. Pathophysiology
• Subsequent invasion of liver, spleen and bone marrow (reticuloendothelial
system) where further multiplication occurs
• Secondary bacteremia
• Clinical features

7. Clinical features
• First week
• Step ladder pattern of fever
• Headache
• Vomiting
• Bradycardia
• Constipation or Diarrhea
• The child’s tongue is coated in center but
margins are clear
• Rose spots on the 6th day (anterior thorax, fade
on pressure)

8. • Second and third week
• Abdomen distension
• Hepatosplenomegaly
• Rales on the auscultation
• Intestinal perforation and Hemorrhage
• Typhoid state
• Altered sensorium
• Apathetic and stupor
• Muttering delirium

9. Diagnosis
• History
• Sources
• Signs
• Examination
• Lab investigations
• CBC: anemia, thrombocytopenia and
neutropenia.
• Culture
• Stool examination
• Blood chemistry: electrolytes
• Serological tests
• Widal test (IgG &IgM)
• Imaging studies

10. Management
• Home management
• Oral antibiotics
• Antipyretics
• High dose corticosteroids- complications
• Surgical
• Cholecystectomy

11. Prevention
• Safe food and water
• Personal hygiene
• Standard precautions
• Typhoid vaccine

12. Nursing management
• Discussion

13. Complications
• Non-typhoidal salmonellosis
• Bacteremia
• Meningitis
• Pneumonia
• Endocarditis/pericarditis
• Osteomyelitis
• Hepatic/splenic abscess
• Typhoid fever
• Intestinal perforation
• Hemorrhage
• Toxic encephalopathy
• Cerebral thrombosis
• Hepatitis
• Pancreatitis
• Arthritis
• Myocarditis

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