Typhoid Fever Group members:• Francis Epieli• Jemina Hetuka• Gabriella Kinaram• Bryan Pulayasi• Crystal Keiwaga• Yvette Dunstan• Jubilee Paru• Nathalie Apaya

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Case Scenario A mother brings her 4 year old child to

a physician with the complaints of fever, abdominal pain, vomiting and bloody diarrhea.

On history and examination the child had rose spots on the abdomen and a temperature of 38˚C.

A RDT test tested negative for malaria parasites

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Typhoid fever is a systemic infection cause by the bacterium Salmonella typhi or S.enterica

Gram-negative short bacillus

Incubation period 3-56 days

Live in humans and are spread through a person’s feces or urine

Etiology

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Transmission Both ill and carriers of the disease can

spread the typhoid bacteria through their feces.

Flies are known to help transmit the disease because when they land on human feces, it remain on their appendages and can be transmitted when they land on food or water.

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

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Pathophysiology (asymptomatic 7-14days)

If the bacteria survive acidity of the stomach, it reaches the small intestine and invades the Payer’s patches.

WBCs carry the disease to the liver, spleen and the bone marrow where it reproduces and re-enters the blood stream

The bacteria then invades the gallbladder, biliary system and the lymphatic tissue of the bowel.

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Symptomatic (after 2 weeks)

Progressive elevation of temperature and bacteremia in the 1st week

Abdominal pain, spleen enlargement and rose spots in 2nd week

Bacteria start causing necrosis of Payer’s patches which leads to perforation and hemorrhage in 3rd week

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Complications

Intestinal hemorrhage Due to bleeding in Payer’s Patches May bleed from several areas of

intestine/massive silent bleeding Occurs 14-21 days after onset of illnessSigns & Symptoms Hypovolemic shock Pale conjunctivae Hematemesis Bloody stool

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INES

TIN

AL H

EM

OR

RH

AG

E Intestinal Hemorrhage

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Intestinal perforation One of the most serious complications Occurs during 3rd week after onset of

infectionSigns & Symptoms Fever Presence of fluid in the abdomen (ascites) Absent bowel sounds Vomiting Tenderness and guarding

Complications

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Intestinal Perforation

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Other complications Toxic myocarditis Meningitis Encephalitis Hepatomegaly Splenomegaly Kidney failure

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Treatment Chloramphenicol for at least 2 weeks; 3

weeks if possible Stat: IMI 6 hourly Change to oral upon improvement Alternatives: ampicillin/amoxicillin for 3

weeks/cotrimoxazole for 2 weeks Anti-malarials Fluids Nutrition rehabilitation

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Prevention Get vaccinated against typhoid

fever There are 2 types of vaccines I. Inactive (killed) vaccine in a

shot (Vi capsular polysaccharide vaccine)

II. Live, attenuated (weakened) vaccine taken orally (Ty21a)

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Cont... Avoid risky foods and drinks Improve sanitation Access to safe drinking water Wash hands before handling

food Carriers of typhoid must not be

allowed to work as food handlers Proper waste disposal

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Conclusion

S. typhi and S. paratyphi are ingested through contaminated water or food and spreads through poor hygiene habits and public sanitation conditions, and also flying insects feeding on feces

Bacterium multiplies in the gallbladder, bile duct ,or liver and passes into the bowel.

Typical signs are fever(as high as 400 C), diarrhea, headache, abdominal pain and rashes

Treatments include fluids and electrolytes (oral and IV)

If not treated appropriately can lead to complications such as splenomegaly, hepatomegaly, toxic myocarditis and other systematic complications

A careful and proper history must be taken in order to make proper diagnosis

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ENDEMIC AREAS!!!!

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Reference Typhoid fever, (2005). Retrieved, August 6th, 2013, from

http://www.cdc.gov/nczred/divisions/dfbmd/diseases/typhoid-fever/

Bacterial defense against phagocytosis. (2013). Retrieved, August 6th , 2013, from http://www.textbookofbacteriology.net/antiphago.html

WHO. (2003). Background document: The diagnosis, treatment & prevention of typhoid fever. Retrieved , August 6th ,2013, from http://www.whqlibdoc.who.int/hq/2003/WHO_V&B_03.07.pdf

Typhoid fever in children. (2012). Retrieved, August 5th , 2013, from http://www.babycenter.in/a1050356/typhoid#ixzz2anyDsNH5 and http://www.babycenter.in/a1050356/typhoid#ixzz2anyNSLKF

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Remember to wash your hands after using the toilet!!!!Any Questions?