Typhoid fever
Definition
A systemic infectious disease characterized by high continuous fever, malaise and involvement of lymphoid tissues.
Infectious agent
Salmonella typhi
Salmonella enteritidis (rare cause)
Epidemiology
Occurrence- It occurs worldwide, particularly in poor socio- economic areas. Annual incidence is estimated at about 17 million cases with approximately 600,000 deaths worldwide. In endemic areas the disease is most common in preschool and school aged children (5-19 years of age).
Reservoir- Humans
Mode of transmission- By water and food contaminated by feces and urine of patients and carriers. Flies may infect foods in which the organisms then multiply to achieve an infective dose.
Incubation period –1-3 weeks
Period of communicability- As long as the bacilli appear in excreta, usually from the first week throughout convalescence. About 10% of untreated patients will discharge bacilli for 3 months after onset of symptoms, and 2%-5% become chronic carriers.
Susceptibility and resistance- Susceptibility is general and increased in individuals with gastric achlorhydria or those who are HIV positive. Relative specific immunity follows recovery from clinical disease, unapparent infection and active immunization but inadequate to protect against subsequent ingestion of large numbers of organisms.
Clinical manifestation
First week- Mild illness characterized by fever rising stepwise (ladder type), anorexia, lethargy, malaise and general aches. Dull and continuous frontal headache is prominent. Nose bleeding, vague abdominal pain and constipation in 10% of patients.
Second week- Sustained temperature (fever). Severe illness with weakness, mental dullness or delirium, abdominal discomfort and distension. Diarrhea is more common than first week and feces may contain blood.
Third week- Patient continues to be febrile and increasingly exhausted. If no complications occur, patient begins to improve and temperature decreases gradually.
Clinical manifestations suggestive of typhoid fever
Fever- Sustained fever (ladder fashion)
Rose spots- Small pallor, blanching, slightly raised
macules usually seen on chest and abdomen in the first
week in 25% of white people.
Relative bradycardia- Slower than would be expected
from the level of temperature.
Leucopoenia- White cell count is less than 4000/mm3 of
blood.
Diagnosis
Based on clinical grounds but this is confused with wide variety of diseases.
Widal reaction against somatic and flagellar antigens.
Blood, feces or urine culture.
Treatment
1. Ampicillin or co-trimoxazole for carriers and mild cases.
2. Chloramphenicol or ciprofloxacin or ceftriaxone for
seriously ill patients.
Nursing care
1. Maintain body temperature to normal.
2. Apply comfort measures.
3. Follow side effects of drugs.
4. Monitor vital signs.
5. Follow strictly enteric precautions: wash hands
wear gloves
teach all persons about personal hygiene
6. Observe the patient closely for sign and symptoms of
bowel perforation
erosion of intestinal ulcers
sudden pain in the lower right side of the abdomen abdominal rigidity
sudden fall of temperature and blood pressure
7. Accurately record intake and output.
8. Provide proper skin and mouth care.
Prevention and control
1. Treatment of patients and carriers
2. Education on handwashing, particularly food handlers,
patients and childcare givers
3. Sanitary disposal of feces and control of flies.
4. Provision of safe and adequate water
5. Safe handling of food.
6. Exclusion of typhoid carriers and patients from handling of food and patients
7. Immunization for people at special risk (e.g. Travelers to endemic areas)
8. Regular check-up of food handlers in food and drinking establishment
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