A 4 year old child presented with fever, abdominal pain, vomiting and bloody diarrhea. Examination found rose colored spots on the abdomen and a temperature of 38°C. Testing was negative for malaria. Typhoid fever is a systemic infection caused by the Salmonella typhi bacteria, which has an incubation period of 3-56 days. It is spread through contaminated food, water, or flies carrying the bacteria from infected feces. Typical signs are fever, diarrhea, headache and abdominal pain. Treatment involves antibiotics like chloramphenicol for at least two weeks as well as fluids and nutrition support. Complications can include intestinal bleeding or perforation if not treated properly.

2.  A mother brings her 4 year old child to a
physician with the complaints of fever,
abdominal pain, vomiting and bloody
diarrhea.
 On history and examination the child
had rose spots on the abdomen and a
temperature of 38˚C.
 A RDT test tested negative for malaria
parasites
2

3.  Typhoid fever is a
systemic infection
cause by the
bacterium Salmonella
typhi or S.enterica
 Gram-negative short
bacillus
 Incubation period 3-56
days
 Live in humans and are
spread through a
person’s feces or urine
3

4.  Both ill and carriers of the disease can
spread the typhoid bacteria through
their feces.
 Flies are known to help transmit the
disease because when they land on
human feces, it remain on their
appendages and can be transmitted
when they land on food or water.
 Hand-to-mouth transmission after using a
contaminated toilet and neglecting
hand hygiene
4

5.  If the bacteria survive acidity of the
stomach, it reaches the small intestine and
invades the Payer’s patches.
 WBCs carry the disease to the liver, spleen
and the bone marrow where it reproduces
and re-enters the blood stream
 The bacteria then invades the gallbladder,
biliary system and the lymphatic tissue of
the bowel.
5

6. 6
 Progressive elevation of temperature and
bacteremia in the 1st week
 Abdominal pain, spleen enlargement and
rose spots in 2nd week
 Bacteria start causing necrosis of Payer’s
patches which leads to perforation and
hemorrhage in 3rd week

7.  Intestinal hemorrhage
 Due to bleeding in Payer’s Patches
 May bleed from several areas of
intestine/massive silent bleeding
 Occurs 14-21 days after onset of illness
Signs & Symptoms
 Hypovolemic shock
 Pale conjunctivae
 Hematemesis
 Bloody stool
7

8. Intestinal Hemorrhage
8

9.  Intestinal perforation
 One of the most serious complications
 Occurs during 3rd week after onset of
infection
Signs & Symptoms
 Fever
 Presence of fluid in the abdomen (ascites)
 Absent bowel sounds
 Vomiting
 Tenderness and guarding
9
Complications

10. Intestinal Perforation
10

11.  Toxic myocarditis
 Meningitis
 Encephalitis
 Hepatomegaly
 Splenomegaly
 Kidney failure
11

12.  Chloramphenicol for at least 2 weeks; 3
weeks if possible
 Stat: IMI 6 hourly
 Change to oral upon improvement
 Alternatives: ampicillin/amoxicillin for 3
weeks/cotrimoxazole for 2 weeks
 Anti-malarials
 Fluids
 Nutrition rehabilitation
12

13.  Get vaccinated against typhoid
fever
 There are 2 types of vaccines
I. Inactive (killed) vaccine in a
shot (Vi capsular
polysaccharide vaccine)
II. Live, attenuated (weakened)
vaccine taken orally (Ty21a)
13

14.  Avoid risky foods and drinks
 Improve sanitation
 Access to safe drinking water
 Wash hands before handling food
 Carriers of typhoid must not be
allowed to work as food handlers
 Proper waste disposal
14

15.  S. typhi and S. paratyphi are ingested through
contaminated water or food and spreads through
poor hygiene habits and public sanitation conditions,
and also flying insects feeding on feces
 Bacterium multiplies in the gallbladder, bile duct ,or
liver and passes into the bowel.
 Typical signs are fever(as high as 400 C), diarrhea,
headache, abdominal pain and rashes
 Treatments include fluids and electrolytes (oral and IV)
 If not treated appropriately can lead to complications
such as splenomegaly, hepatomegaly, toxic
myocarditis and other systematic complications
 A careful and proper history must be taken in order to
make proper diagnosis
15

16. 16

17.  Typhoid fever, (2005). Retrieved, August 6th, 2013, from
http://www.cdc.gov/nczred/divisions/dfbmd/diseases/typhoid-
fever/
 Bacterial defense against phagocytosis. (2013). Retrieved, August 6th
, 2013, from http://www.textbookofbacteriology.net/antiphago.html
 WHO. (2003). Background document: The diagnosis, treatment &
prevention of typhoid fever. Retrieved , August 6th ,2013, from
http://www.whqlibdoc.who.int/hq/2003/WHO_V&B_03.07.pdf
 Typhoid fever in children. (2012). Retrieved, August 5th , 2013, from
http://www.babycenter.in/a1050356/typhoid#ixzz2anyDsNH5 and
http://www.babycenter.in/a1050356/typhoid#ixzz2anyNSLKF
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18. 18
Remember to wash your
hands after using the toilet!!!!
Any Questions?