TYPHOID FEVER

Typhoid fever

Introduction

A form of enteric fever with over million of new cases per year all over the world and more than 100,000 death case per year. It is very common in developing region of the world and reduction in developed countries.

Presenting Complaint;

Typhoid Fever complaints

Abdominal pain,

Elevated temperature,

   Headache

Definition of Enteric fever

It is an acute systemic disease characterized by fever, headache and abdominal discomfort. The enteric fever has the following forms; 

Typhoid fever, a typical form and most commonly encounter enteric fever worldwide and is caused by salmonella typhi, while the less commonly encounter and of less severity form are the paratyphoid A, B, C. Man is the only natural host and transmitted via contaminated food and water with the incubation period of 10 -14 days.

Mechanism of acquiring Typhoid Fever (summary)

Start my ingestion of the bacteria via contaminated food and water , leading to bacterial invasion of the small bowel via peyers’ patches and spread to a regional lymph node and then to the blood.  Is a major human pathogenic thriving in a region of poor sanitation, crowding and social chaos with advance stage resulting in cloudy of level of consciousness.

Mode of transmission of Typhoid Fever

Typhoid Fever carriers

Asymptomatic carrier, a carrier that has no symptoms but shed the bacteria in their stool

Convalescent carrier, a carrier that excretes the organism for more than several months following recovery from the illness

Chronic Carriers are carrier of typhoid for more than a year with usual site being gall bladder and these people do associate with the presence of gall stone

Risk Factor for Typhoid Fever

Risk Factors for Typhoid Fever

Oral transmission via food or beverages

Hand to mouth transmission after using a contaminated toilet neglecting hand hygiene

Oral transmission via sewage contaminated water or shellfish

Paratyphoid infection from street food vendor

Acid blocker such as cimentidine, an anti-ulcer agent

HIV/AID

Mechanism of acquiring Typhoid Fever 

Clinical Manifestation of Typhoid Fever

Typhoid fever begins 7 – 14 days after ingestion of the organism, fever characterized by a rising temperature over the course of each days that drop at the subsequent morning.

 The classical presentation is fever, diffuse abdominal pain, malaise, constipation.

Other are dry cough, and dull frontal headache, delirium in severe cases; abdominal distention and soft spleen enlargement on examination.

Febrile individual grows more toxic and anorexic (loss of appetite) with significant weight loss, conjunctivitis, foul green yellow stool, apathy, confusion and  psychosis,  bowl perforation, peritonitis and intestinal hemorrhage

Various presentation of typhoid fever in children, AID/HIV, immunocompromised and few immunocompetent are diarrhea instead of constipation, isolated severe headache, acute lobar pneumonia , isolated arthralgias, urinary symptoms, severe jaundice or fever alone, osteomyelitis , and abscess.

Systemic manifestation includes

Fever pattern of insidious onset/ acute high fever and Chills and rigors

Malaise, insomnia, delirium and anorexia, coated tongue, sore throat, and mild cough

Pneumonia, constipation, gall bladder pain, jaundice, liver enlargement and body rashes.

Complications of Typhoid Fever

Meningitis

Lobar pneumonia

Intestinal perforation

Osteomyelitis

Intestinal hemorrhage

Delirium /psychosis

Diagnosis of Typhoid Fever

Blood culture and Stool culture are the reliable way

Widal reaction, despite its reduction in usage as a mode of diagnosis for typhoid universally, some still prefers it as a form of diagnosis especially when there is a financial constraint. It is reported as significant once it is more than 1/80 by titer. It is cheaper and avoidable for patients; I see it as quantification test

Full blood count read elevated white blood cells

Treatment and Management of Typhoid Fever

It depends on severity and associated complications

Severe cases with complication needs hospital admission and better evaluation/management by your doctor to rule out other causes and likely complication type.

Keep a good hygiene, especially regular hand washing after toileting

Adequate washing of fruits prior to consumption

Avoidance of food VENDOR

Environmental sanitation of the surroundings in case of small children

HAART in case AIDS/HIV combine with appropriate antibiotics.

Proper preparation and cooking of foods

Proper treatment of water before consumption e.g. boiling, chlorinated and alum treatment of well water prior to consumption

Medications

Prior to hospital presentation, most patients would have taken different combination of antibiotics such as amoxicilline est. 

This kind of self medication has cause drug resistance and this tell the reason why culture is generally preferable.

Culture states the types of infection involve and the most sensitive drug to tackle the infection. 

All medications taken for 5 -14 days depending on severity and if no improvement please see your doctors for better evaluation.

For culture sensitivity, combination of sensitive injection plus tablet is more preferable

TAB CIPROFLOXACIN 500MG TWICE DAILY

TAB MOXIFLOXACIN 400MG DAILY

TAB CEFUROXIME 500MG TWICE DAILY FOR ADULT AND

TAB CEFUROXIME 250MG TWICE DAILY FOR CHILDREN

TAB CEFIXIME 400MG DAILY

SYRUP/TAB AUGMENTINE PREFERABLY FOR SMALL CHILDREN

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