The disease most likely to be transmitted through drinking water from this contaminated well is typhoid. Typhoid is caused by the bacterium Salmonella Typhi and is often spread through contaminated water or food. Flies can carry the bacteria from the unsanitary latrine to the nearby well water, allowing transmission of typhoid to those who drink the water.

2. Typhoid Fever
by
Dr Allah Yar Malik
M. Phil , PhD Scholar
AP Community Medicine
NMC Multan

5. A very ‘famous’
typhoid carrier for
many years. She was a
cook and infected
many hundreds of
people. Finally she was
put in jail

6. LEARNING OBJECTIVES
• By the end of lecture students should
be able to
• Know Introduction, Epidemiology.
• Know clinical features and its
complications.
• Know the ways to diagnose it and
how to treat it.
• Understand how to prevent Typhoid
fever.

7. IntroductionIntroduction
 Typhoid fever is a severe multi-Typhoid fever is a severe multi-
systemic illness characterized by thesystemic illness characterized by the
classic prolonged fever, sustainedclassic prolonged fever, sustained
bacteremia, and bacterial invasion andbacteremia, and bacterial invasion and
multiplication within the mononuclearmultiplication within the mononuclear
phagocytic cells of the liver, spleen,phagocytic cells of the liver, spleen,
lymph nodes, and Peyer patches.lymph nodes, and Peyer patches.

8. Typhoid feverTyphoid fever
Is an acute disease caused by S.Is an acute disease caused by S.
typhi.typhi.
It is seen world wide but moreIt is seen world wide but more
common in developing countriescommon in developing countries
with poor hygiene.with poor hygiene.
Typhoid fever is endemic in Pak.Typhoid fever is endemic in Pak.

9. EpidemiologyEpidemiology
 It is aIt is a global health problemglobal health problem
 areas with aareas with a high incidencehigh incidence include Asia, Africainclude Asia, Africa
and Latin America ( 80% in Asia )and Latin America ( 80% in Asia )
 Morbidity is 21 million worldwide
Mortality is 222 000 worldwide.
paratyphoid fever, is caused by Salmonella Para-typhi
A, B or C.

11. INCUBATION PERIODINCUBATION PERIOD..
 Incubation period – 1-2 weeksIncubation period – 1-2 weeks

12. Agent factorsAgent factors
 AgentAgent
S. typhi is main agentS. typhi is main agent
S. para-typhi A, B and C.S. para-typhi A, B and C.
(B is rare)(B is rare)

13.  Antigens:Antigens:
HH(flagellarantigen).(flagellarantigen).
OO (Somatic orcell wall antigen).(Somatic orcell wall antigen).
ViVi (polysaccharide virulence)(polysaccharide virulence)

14. HOST FACTORHOST FACTOR
 AGE:AGE: Occurs at any age but incidence is high bet 5-19 yrs.Occurs at any age but incidence is high bet 5-19 yrs.
 SEXSEX: Cases more in males than females but carrier rate is more: Cases more in males than females but carrier rate is more
in females.in females.
 In endemic areas, children aged 1-5 years are at the highest riskIn endemic areas, children aged 1-5 years are at the highest risk
because of waning passively acquired maternal antibody and abecause of waning passively acquired maternal antibody and a
lack of acquired immunity.lack of acquired immunity.

15. EnvironmentalEnvironmental
factorsfactors
common in areas with poorcommon in areas with poor
sanitation and Poor hygienesanitation and Poor hygiene

20. DiagnosisDiagnosis
 HistoryHistory
 Typical symptoms and signsTypical symptoms and signs
 Laboratory findings.Laboratory findings.

28. Fatal complicationsFatal complications::
intestinal hemorrhage orintestinal hemorrhage or
BleedingBleeding
intestinal perforationintestinal perforation
severe toxemiasevere toxemia

29. Other possible complications include:
toxic encephalopathy. Hemolytic uremic synd.
•Inflammation of the heart muscle (myocarditis)
•Inflammation of the lining of the heart and valves
(endocarditis)
•Pneumonia
•Inflammation of the pancreas (pancreatitis)
•Kidney or bladder infections
•Infection and inflammation of the membranes
and fluid surrounding your brain and spinal cord
(meningitis)
•Psychiatric problems, such as delirium,
hallucinations and paranoid psychosis

30. Laboratory findingsLaboratory findings
Routine examinations:Routine examinations:
white blood cell count is normal orwhite blood cell count is normal or
decreased.decreased.
LeukocytopeniaLeukocytopenia

31. Bacteriological examinations:Bacteriological examinations:
 Blood culture:Blood culture:
 Stool CultureStool Culture
 Urine CultureUrine Culture
 Bone marrow Culture ( mostBone marrow Culture ( most
sensitive test)sensitive test)

32. Serological tests:Serological tests:
 Widal testWidal test
 Typhidot testTyphidot test

34. TREATMENTTREATMENT
General treatmentGeneral treatment
 isolation and restisolation and rest
 good nursing caregood nursing care
 Semi-solid Diet and JuicesSemi-solid Diet and Juices
 waterand electrolyte balancewaterand electrolyte balance

35.  Symptomatic treatment:Symptomatic treatment:
forhigh fever:forhigh fever:
 physical measures firstlyphysical measures firstly
 antipyretic drugs such as aspirin should beantipyretic drugs such as aspirin should be
administrated with cautionadministrated with caution
 delirium,coma orshock,2-4mg dexamethasonedelirium,coma orshock,2-4mg dexamethasone
in addition to antibiotics reduces mortality.in addition to antibiotics reduces mortality.

36. Special treatmentSpecial treatment
1.Quinolones:1.Quinolones:
first choicefirst choice
it’s highly against S.typhiit’s highly against S.typhi
penetrate well into macrophages,and achieve highpenetrate well into macrophages,and achieve high
concentrations in the bowel and bile lumensconcentrations in the bowel and bile lumens
 Norfloxacin (0.1Norfloxacin (0.1 ～～ 0.2 tid0.2 tid ～～ qid/10qid/10 ～～ 14 days).14 days).
 Ofloxacin (0.2 tid 10Ofloxacin (0.2 tid 10 ～～ 14days).14days).
 ciprofloxacin (0.25 tid)ciprofloxacin (0.25 tid)
caution: not in children and pregnantcaution: not in children and pregnant

37. 3.Cephalosporines:3.Cephalosporines:
Only third generation effectiveOnly third generation effective
Cefoperazone and Ceftazidime.Cefoperazone and Ceftazidime.
22 ～～ 4g/day .10~14 days.4g/day .10~14 days.
4.Treatment of complication.4.Treatment of complication.
 Intestinal bleeding:Intestinal bleeding:
bed rest, stop diet,close observation T,P,R,BP.bed rest, stop diet,close observation T,P,R,BP.
intravenous saline and blood transfusion,andintravenous saline and blood transfusion,and
attention to acid-base balances.attention to acid-base balances.
sometimes,operative.sometimes,operative.

38. PREVENTIONPREVENTION

48. A well was present in a rural area where an
unsanitary bore-hole latrine with lots of flies was
present within 10 feet of distance. The disease more
likely to be transmitted through drinking this well
water is:
a)Leishmaniasis b) Typhoid
c) Dental caries d) Ancylostomiasis
e) Trachoma