Typhoid Fever
Pua, Christian Franz A.
Quilala, Gian Mailo
What is Typhoid Fever
- It’s a fever
- Yes it’s bad
- It gets worse when left untreated
- It’s not typhus, that’s different (typhus is from fleas)
- Is it preventable? Yes
- Mary Mallon’s fault (ask the people of the 1900s)
History of Typhoid Fever
- Hippocrates (around 460 BC to 370 BC) - first identification of typhoid
- Thomas Willis (1643) - Treatise to Fevers
- Pierre Betronneau (1826) - intestinal lesions
- William Wood Gerard (1836) - typhoid vs. typhus
- Richard Pfeiffer (1885) and Ferdinand Hueppe (1886) - stool & urine samples
- Hans Chiari (1894) - gallbladder
- George Widal (1896) - Widal test
- Almorth Edward Wright (1896) and Frederick F. Russel (1909) - vaccine
Epidemiology
● Typhoid fever is caused by a gram-negative, facultative aerobic, non-spore
forming bacteria known as Salmonella enterica serotype typhimurium (or simply
S. typhi), which is transmitted through the fecal-oral route by consumption of
Salmonella typhi in Contaminated food or water.
● Salmonella typhi only affects humans.
● After recovery 3-5% will become carriers for up to more than 1 year and also
be asymptomatic.
● Incubation period: 1 week-1 month
Epidemiology
● Salmonella typhi lives in the ileum, transferred by WBC to the gallbladder
● Typhoid fever is a common occurrence due to:
- Increase in population
- Increase in urbanization
- Decrease in water supply
- Insufficient number of human waste processors
- Contact between infected people (through coitus), or through consumption of infected food and
water
- Polluted areas
● Kids within years 5-12 are most vulnerable to Typhoid Fever. Males have a higher chance of being
infected, while females are sought to be the primary carriers to the illness.
Cause of Typhoid Fever
Salmonella typhimurium (S. typhi)
Description:
- Gram negative
- aerobic
- has peritrichous flagella
How to get this:
- fecal - oral route
- infected food and water
Cause of Typhoid Fever
Salmonella typhimurium (S. typhi)
Description:
- Gram negative
- aerobic
- has peritrichous flagella
How to get this:
- fecal - oral route
- infected food and water
buti pa si Pilate marunong maghugas ng kamay
swim swim
di marunong magluto ayan nagkasakit
filter yo H2O boi
aspiring
rambutan
Signs and Symptoms
- Fever
- Malaise
- Epistaxis (bloody nose)
- Abdominal pains
- Rosy rashes within the chest & abdomen area
- Lethargy
- Joint pain
- Intestinal Hemorrhage (due to complications in the Peyer’s Patches)
- Confusion
- Hepatosplenomegaly
- Gastrointestinal perforation (in the event this happens, surgery is required)
Clinical stages
There are 4 stages in Typhoid fever, and are estimated that 1 week is needed to
proceed to the next stage.
● 1st stage
- Occasional fever, headache, dry cough and myalgia.
● 2nd stage
- Fever of 40-41 C° will now persist.
- Rose spots, and bradycardia may be noticed.
Clinical stages
● 3rd stage
- State of disorientation, delirium, and toxemia.
- Risk of intestinal hemorrhage if untreated.
● 4th stage
- Recovery where it can last up to two or more months. Even
after recovery the person may carry the bacteria as long as 1
year.
Diagnostic Tests
1. Microbial
- With the use of a Culture and observation of the sample under a microscope.
1. Complete Blood Count
- Excess White blood Cells might indicate Typhoid fever.
1. Stool or Urine Sample
- Salmonella typhi bacteria in stool, and pressence of antibodies in urine
sample.
Diagnostic Tests
4. Serological Diagnosis (Serodiagnosis)
- Unreliable and low cost.
5. Additional diagnostic tests
a. IDL Tubex
b. Typhidot
c. Widal Test
Treatment
Typhoid fever is caused by the Salmonella typhi bacteria, therefore it can be treated with
antibiotics for 7-14 days which is mainly dependent to its severity. Examples of antibiotics
commonly prescribed by Doctors:
- Chloramphenicol (currently not the best choice, due to its adverse effects)
- Amoxicillin
- Ampicillin
- 3rd generation cephalosporins (Ceftriaxone, Cefixime, etc.)
- Azithromycin
- Trimethoprim with sulfamethazole (AKA Co-trimoxazole)
- Fluoroquinolones (ciprofloxacin and ofloxacin)
Treatment
OPTIMAL THERAPY ALTERNATIVE EFFECTIVE DRUGS
SUSCEPTIBILITY ANTIBIOTIC DAILY DAYS ANTIBIOTIC DAILY DAYS
DOSE DOSE
mg/kg mg/kg
Fully sensitive Fluoroquinolones: 15 5-7 Chloramphenicol 50-75 14-21
Ciprofloxacin/Ofloxacin Amoxicillin 75-100 14
TMP-SMX 8-40 14
Multidrug resistance Fluoroquinolones or 15 5-7 Azithromycin 8-10 7
Cefixime 15-20 7-14 Cefixime 15-20 7-14
Quinolone Azithromycin or 8-10 7 Cefixime 20 7-14
resistance Ceftriaxone 75 10-14
Prevention
● Vaccination/Immunization
Prevention
● Eating thoroughly cooked food.
Prevention
● Always wash your fruits and vegetables
Prevention
● Boil your water or make sure it’s safe to drink
Prevention
● Practice proper hygiene
Vaccination
1. Purified Vi Polysaccharide vaccine
2. Attenuated Salmonella Typhi strain
Vaccination
1. Purified Vi Polysaccharide vaccine (Typhim Vi)
- Single dose from the bacterial capsule of Salmonella Typhi strain from
Ty21. The vaccine is allowed only for children who are at the age of 2
or more and is administered Intramuscularly and Subcutaneously.
Immunity of the vaccine will last for 3 years and the booster will come
right after.
- Efficacy rate is at 64-75%
Vaccination
2. Attenuated Salmonella Typhi strain
- Single dose from bacterial capsule of Salmonella Typhi strain of
Ty21a, lacking the enzyme UDP Galactose-4-epimerase. The
vaccine is allowed only for children who are at the age of 6 or more
and is administered Orally. Immunity of the vaccine will last for 3
years and the booster will come right after. Keep in mind that any
antibiotic is prohibited while taking the dose.
- Efficacy rate: 50-80%
Government Plans
1. R.A 9275 - Clean Water Act of 2004
2. R.A. 10611 - Food Safety Act of 2013
3. Food and Waterborne Diseases Prevention and Control programs
- Typhoid fever surveillance
- Public school vaccination programs
- Food and Water Disease Awareness