TYPHOID FEVER (ENTERIC FEVER)

By: Ma. Noela Jessette L. Arcega 2NUR1

C O N T A M I N A T I O N

ETIOLOGY
Typhoid fever, also known as typhoid, is a common worldwide bacterial disease, an infection, and an acute illness accompanied by fever caused by gram negative bacilli called as Salmonella typhi (S. typhi) which is the most virulent serotype of Salmonella.

EPIDEMIOLOGY
With an estimated 1633 million cases of typhoid fever annually resulting in 216,000 600,000 deaths in endemic areas, the World Health Organization identifies typhoid as a serious public health problem. Its incidence is highest in children and young adults between 5 and 19 years old. In the Philippines recent outbreak declared in Tuburan, Cebu City after recording 924 cases of typhoid and three deaths. The Department of Health presumed that the residents contaminated water was the source of the disease.

MODE OF TRANSMISSION
Fecal-oral route Those carriers can then be a cause for future outbreaks of typhoid fever especially if there is improper sanitation and handling of food and poor hygiene. Furthermore, flying insects that feed in feces can spread the bacteria in unhygienic places such as public areas.

MODE OF TRANSMISSION
Many carriers of typhoid were locked into an isolation ward never to be released to prevent further typhoid cases. These people often deteriorated mentally, driven mad by the conditions they lived in. TYPHOID MARY

INCUBATION PERIOD
Average of 2 weeks (14 days); usual range 1 to 3 weeks May persist as long as 60 days

PATHOGENESIS
The pathogenesis of enteric fever depends on a number of factors including the infecting species and infectious dose. Ingested organisms survive exposure to gastric acid before gaining access to the small bowel, where they penetrate the epithelium, enter the lymphoid tissue, and disseminate via the lymphatic or hematogenous route. A chronic carrier state is established in an estimated 1 to 5 percent of cases.

1. Ingestion of food or water contaminated with Salmonella typhi 2. The bacteria adheres and invades the gut wall of the gastrointestinal tract 3. It enters the distal ileum (Peyers patches) 4. S.typhi has a Vi capsular antigen that avoids neutrophil- based inflammation. It induces host macrophages to attract more macrophages. 5. The bacteria enters the macrophages cellular machinery for their own reproduction which is carried through the mesenteric lymph nodes.

6. It enters the thoracic duct then the lymphatic system and then through the tissues of the liver, spleen, bone marrow, and lymph nodes. 7. The bacteria continue to multiply until it reached a critical density (1,000,000 to cause an infection). 8. It then induces apoptosis of the macrophages and leaking into the blood stream (bacteremia) and to the rest of the body.

PATHOPHYSIOLOGY
TYPHOID FEVER The gallbladder is infected through extension of infection of bacteria or via bacteremia S.typhi reinvades the gastrointestinal tract as well as the Peyers patches The bacteria that does not re- infect the host is shed into the stool The bacteria that remained present in the system of the host pauses and continuos to multiply which makes the host as carrier for a long time.

PATHOGNOMONIC SIGNS
1. ladder like fever 2. rose spots 3. splenomegaly

MANIFESTATIONS
a. Gradual Onset Headache, malaise, poor appetite Chills and fever Rose spots- skin eruptions seen on abdomen, chest, back (within 3-4 days) Splenomegaly in some cases

b. Second week Fever remains consistently high Abdominal distention Constipation and later on diarrhea Lethargy Intestinal bleeding and perforation (after 2-3 weeks) c. Gradual decline in fever and symptoms subsides, too.

SIGNS AND SYMPTOMS

Fever as high 40 C (104 F) Headache Stomach pain Weakness Diarrhea or constipation Loss of appetite and severe weigh loss Rash with flat rose-colored spots

TESTS
A complete blood count (CBC) will show a high number of white blood cells. A blood culture during the first week of the fever can show S. typhi bacteria. A stool culture on the second week

NURSING INTERVENTIONS
Health Teaching Teach members of the family how to report all symptoms to the attending physician especially when patient is being cared for at home Teach, guide and supervise members of the family on nursing techniques which will contribute to the patients recovery Interpret to family nature of disease and need for practicing preventive and control measures.

Management
Demonstrate to family how to give bedside care such as tepid sponge, feeding changing of bedlinen,use of bedpan and mouth care Any bleeding from the rectum, blood in stools sudden acute abdominal pain restlessness, falling of temperature should be reported at once to the physician or the patient should be brought at once to the hospital. Take vital signs and teach patient family member how to take and record same.

MEDICAL TREATMENT
Chlorampenicol 3-4 gm per day PO in 4 divided doses for 14 days or Co-Trimoxazoleforte or double -strength tab twice a day PO for 14 days or Amoxyxillin 4-6 gm per day PO in 3 divided doses for 14 days The most effective antityphoidal drugs are quinolones or third generation cephalosphorins.

PREVENTION
Vaccines Water treatment Waste disposal Protecting the food supply from contamination Carriers of typhoid must not be allowed to work as food handlers.

FIGURES

FIGURES

REFERENCES
Public Health Nursing in the Philippines 10th edition Typhoid fever, its cause, transmission and prevention by S.N. Khosla http://www.uptodate.com/contents/pathogenesisof-typhoid-fever RNSpeak.com Tortora, G.J., Funke, B.R., Case, C.L. (2007). Microbiology: An introduction. 9th edition. Singapore: Benjamin Cummings Mosbys Pocket Dictionary of Medicine, Nursing and Health Professions 6th edition

By: kem eng