Typhoid fever is caused by the bacterium Salmonella typhi. It is transmitted through the fecal-oral route by ingesting food or water contaminated by the feces or urine of infected individuals. Clinical features include a sustained high fever over 2-3 weeks along with relative bradycardia and abdominal tenderness. Diagnosis is confirmed through blood or stool cultures. Treatment involves antibiotics such as fluoroquinolones. Control relies on identifying and treating carriers, improving sanitation and access to clean water, and administering vaccines to at-risk populations.

1. TYPHOID

2. TYPHOID
• Typhoid fever is due to
systemic infection mainly
by Salmonella typhi
• Salmonella typhi
infection is found only
in men

3. • The disease is clinically
characterized by a typical
continuous fever for 2-3
weeks, with relative
bradycardia with
involvement of lymphoid
tissues and considerable
constitutional symptoms

4. • The term “ENTERIC
FEVER” includes both
typhoid and para typhoid
fevers
• The disease may occur
sporadically,
epidemically or
endemically

5. EPIDEMIOLOGICAL
DETERMINANTS
• AGENT:
1. Salmonella typhi is the major
cause of entric fever
2. S.para A & S.para B are
relatively infrequent

6. TYPHOID BACILLI

7. • S.typhi has three main
antigens : O, H & Vi and a
number of phage types
• S.typhi survives intra
cellularly in the tissues of
various organs

8. • It is readily killed by drying,
pasteurization and common
disinfectants
• The factors which influence the
onset of typhoid fever in man are the
infecting dose and virulence of the
organism

9. • RESERVOIR OF INFECTION: Man
is the only known reservoir of
infection (via cases & carriers)
• CASES: A case is infectious as
long as bacilli appears in stools
or urine

10. • CARRIERS: The carriers may be
temporary (incubatory,
convalescent) or chronic
• Convalescent carriers excrete bacilli
for 6-8 weeks (after which their
numbers diminish rapidly by the end
of three months)

11. • Persons who excrete bacilli
for more than one year are
after clinical attack are
called chronic carriers

12. • In most chronic carriers the
bacilli exists in gall bladder
and in the billiary tract. A
chronic carrier may excrete
the bacili for several years
(may be as long as 50
years)

13. • A famous case of “Typhoid
Mary” who gave raise to 1300
cases in her life time is an
example for a chronic carrier
state
• Faecal carriers are more common
than urinary carriers

15. SOURCE OF INFECTION
• The primary sources of
infection are faeces and
urine of cases or carriers
• The secondary sources
include contaminated water,
food, fingers and flies

16. HOST FACTORS
• AGE: Typhoid fever may
occur at any age
• GENDER: Males are
more affected than
females

17. • IMMUNITY: All ages are
susceptible to infection
• The host factors that contributes to
resistance to the bacilli are
gastric acidity & local intestinal
immunity

18. ENVIRONMENTAL & SOCIAL
FACTORS
• Enteric fevers are observed all
throughout the year
• The peak incidence is reported
during July-September

19. • Vegetables grown in sewage
farmlands or washed in
contaminated water are
positive health hazard

20. • Typhoid bacilli grow rapidly
in milk without altering in
taste or appearance in
anyway, in which case
ingestion of such raw milk
poses a threat to the
consumer

21. • These factors are
compounded by such social
factors as pollution of
drinking water supplies,
open air defecation and
urination, low standards of
food and personal hygiene
and health ignorance

22. • Therefore typhoid fever
may be regarded as an
index of general sanitation
in any country

23. INCUBATION PERIOD
• Usually 10-14 days
• But the it can be as short
as 3 days or as long as 3
weeks, depending on the
dose of bacilli ingested

24. MODE OF TRANSMISSION
• Typhoid fever is
transmitted via the faecal-
oral route or urine- oral
routes

25. • This may take place
directly through soiled
hands contaminated with
faeces or urine of cases or
carriers or indirectly by
the ingestion of
contaminated water, milk,
food or through flies

26. DYNAMICS OF
TRANSMISSION

28. CLINICAL FEATURES
• The onset is insidious,
but in children may be
abrupt with chills and
high fever

30. • During the prodromal stage ,
there is malaise, headache,
cough and sore throat often
with abdominal pain and
constipation
• The fever ascends in step
ladder fashion

31. • After about 7-10 days, the fever
reaches a plateau and the patient
looks toxic appearing exhausted
and often prostrated
• There may be marked constipation,
especially in the early stages or
“pea soup diarrhoea”

32. • There is marked
abdominal distension
• There is leukopenia and
blood, urine and stool
culture is positive for
salmonella

33. • If there are no
complications the patient’s
condition improves over 7-
10 days
• However relapse may occur
for up to 2 weeks after
termination of therapy

34. • During early phase, physical
findings are few
• Later splenomegaly,
• abdominal distension and
tenderness,
• relative bradycardia,

35. • The rash (rose
spots)commonly appear
during the second week of
the disease
• The individual spot , found
principally on the trunk, is a pink
papule 2-3 mm in diameter that
fades on pressure. It disappears
in in 3-4 days

36. ROSE SPOTS

39. • Serious complication occur
in up to 10 percent of
patients (especially those
who have been ill for longer
than 2 weeks and who have
not received proper
treatment)

40. • Intestinal haemorrhage is
manifested by a sudden drop in
temperature and signs of shock,
followed by dark or fresh blood
in the stool
• Intestinal perforation is most
likely to occur during the third
week

41. Less frequent complications
• urinary retention,
• pneumonia,
• thrombophlebitis,
• myocarditis,
• psychosis,
• cholecystitis,
• nephritis
• oeteomyelitis

42. LABORATORY DIAGNOSIS
• MICROBIOLOGICAL PROCEDURES
The definitive diagnosis of
typhoid fever depends on the
isolation of the bacilli from
blood, bone marrow and stools.
Blood culture is the mainstay of
diagnosis of this disease

43. SEROLOGICAL PROCEDURE
• Felix-Widal test measures
agglutinating antibody levels
against O & H antigens
• Usually “O” antibodies appear on day
6-8 and “H” antibodies on day 10-12
after the onset of disease

44. • The test is usually
performed on an acute
serum (at first contact with
the patient)

45. • It can be negative up to 30% of
culture – proven case of typhoid
fever
• This may be because of prior
antibiotic therapy, that has
blunted the antibody response

46. NEW DIAGNOSTIC TESTS
• The IDL tubex test can detect specific
IgM antibodies in samples to S. Typhi

47. DIAGNOSIS REGIMEN

48. CONTROL OF TYPHOID
FEVER
• The control or elimination of
the typhoid fever is well
within the scope of modern
public health

49. • There are generally three
lines of defence against
typhoid fever:
• 1. Control of reservoir
• 2. Control of sanitation
• 3. Immunization

50. CONTROL OF RESERVOIR
• The usual methods of
control of reservoir are
their identification,
isolation, treatment &
disinfection

51. • CASES: EARLY DIAGNOSIS –This
is of vital importance as the early
symptoms are non-specific
• Culture of blood and stools are
important investigations in the
diagnosis of cases

52. NOTIFICATION:
Notification must be done in areas
where it is mandatory
ISOLATION:
Since typhoid is an infectious
disease the cases are to be
transferred to hospital

53. • As a rule cases should be
isolated till three
bacteriologically negative
stools and urine reports are
obtained on three separate
days

54. TREATMENT
• Flouroquinolones are widely
regarded as the drug of choice for
the treatment of of typhoid fever

55. TREATMENT

56. • Patients seriously ill and profoundly
toxic should be given Inj of
hydrocortisone 100 mg daily for 3-4
days
• DISINFECTION: stools and urine are the
sole sources of infection. They should
be received in in closed containers and
disinfected with 5% cresol for at least 2
hours

57. • Allsoiled clothes and
linen should be soaked in
a solution of 2% chlorine
and be stream sterilized
• Doctors and nurses
should disinfect their
hands

58. FOLLOW UP
• Examination of stools and urine
should be should be done for
S.typhi 3-4 months after
discharge and again 12 months
to prevent development of carrier
state

59. CARRIERS:
• Since carriers are the ultimate
source of infection, their
identification and treatment is one of
the most radical ways of controlling
typhoid fever
• The following are the measures
recommended:

60. • IDENTIFICATION: Carriers are identified
by cultural and serological
examinations.
• Duodenal drainage establishes the
presence of salmonella in the biliary
tract of carriers
• The antibodies are present in about
80% of chronic carriers

61. TREATMENT OF CARRIERS:
• The carriers should be given an
intensive course of ampicillin or
amoxycillin (4-6 g a day) together
with probenecid (2g/day) for 6 weeks

63. • These drugs are concentrated in
the bile and may achieve
eradication
• Chloromycetin is considered
worthless for clearing the carrier
state

64. SUREGERY
• Cholecyctectomy with
concomitant ampicillin
therapy has been
regarded as the most
successful approach to the
treatment of carriers

65. • SURVEILLANCE:
• The carriers should be kept
under surveillance. They should
be prevented from handling
food, milk or water for others

66. HEALTH EDUCATION
• Health education regarding
washing of hands with soap
after defecations or
urination and before
preparing food is an
essential element

67. • In short, the
management of carriers
continues to be an
unsolved problem
• This is the crux of the
problem, in the
elimination of typhoid

68. CONTROL OF SANITATION
• Protection and purification of drinking
water supplies, improvement of basic
sanitation and promotion of food
hygiene are essential measures to
interrupt transmission of typhoid fever

69. IMMUNIZATION
• Immunization is a
complimentary approach in the
prevention of typhoid
• It yields the highest benefit to
the money spent

70. • Immunization against typhoid
does not give 100% protection,
but it definitely lowers both the
incidence and seriousness of the
infection
• It can be given at any age
upwards 2 years

71. • Immunization is recommended to
those who live in endemic areas,
house hold contacts and groups at
risk of infection such as school
children and hospital staff, travellers
proceeding to endemic areas and
those attending melas and yatras

72. ANTI TYPHOID VACCINES
• Two vaccines are available:
1. Vi polyssaccharide vaccine
2. The Type 21a vaccine

74. • The vaccine is administered sub
cutaneously or intra muscularly .
The target value of each single
human dose is about 25 micro gram
of antigen
• The vaccine is stable for 6 months at
370 C and for 2 years at 220 C

75. • The recommended storage
temperature is 2-8oC.
• Only one dose is required and the
vaccine confers protection after 7
days of vaccination
• To maintain protection
revaccination is recommended
every three years.

76. • There are no contra
indications to the vaccine
other than previous
hypersensitivity reaction to
vaccine components

77. TYPE 21 a
VACCINE

78. • The vaccine has to be
stored at 2-80C, it retains
potency for approximately
14 days at 250 C
• The capsules are licensed
for use in individuals aged
above 5 yrs

79. • The vaccine is administered
every other day (on 3 and 5
day) a 3-dose regimen is
recommended
• Protective immunity is
achieved 7 days after the
last dose

80. • The recommendation is to
repeat the series every 3
years for people living in
endemic areas and every
year for individuals
travelling from non
endemic to endemic areas

83. THANK
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