Typhoid fever
RESEARCH ON
Outlines
Introduction Definition Incidence
Pathophysiology Causes
Signs & Symptoms Diagnosis
Treatment Prevention
Complications
Nursing role
Salmonella enterica serotype typhi is a gram-negative bacterium that is responsible for typhoid fever and has been a burden on developing
nations for generations. In 1829, Pierre Louis was the first to coin the term “typhoid fever” after identifying lesions in the abdominal lymph nodes of patients who had died from “gastric fever.” [1] The term was derived from the Greek word “typhus” which meant “smoky” and was used to describe the delirium that patients would exhibit with the
disease.
Introduction
Typhoid is an acute infectious illness characterized by fever and caused by bacterium salmonella typhi
Definition
Typhoid fever occurs worldwide, primarily in developing nations whose sanitary conditions are poor.
It is endemic in Asia, Africa, Latin America, the Caribbean, and Oceania, but 80% of cases come from Bangladesh, China, India, Indonesia, Laos, Nepal, Pakistan, or Vietnam . Within these countries, typhoid fever is the most common in underdeveloped areas.
Typhoid fever infects roughly 21.6 million people (incidence of 3.6 per 1,000 population) and kills an estimated 200,000 people every year (Medscape).
In 2011, 1.06 million cases and 346 deaths were reported in India. The prevalence rate is 88 cases / lac population and death rate is 0.029 / lac population.
Incidence
1. Salmonella typhi in stomach and survives in its acidity.
2. Invasion of intestinal peyer's patches.
3. Bacterium inside the macrophages and survives.
4. spreads via lymphatics.
5. Access to reticuloenothelial system , liver spleen, gallbladder and bone marrow.
6. Emergence of the signs and symptoms ( fever abdominal pain spleen enlargement and spots).
7. necrosis of peyer's patches.
8. Intestinal perforation and bleeding.
9.death
Pathophysiology
1. The causative organism of typhoid salmonella typhi, is present only in human beings and it's transmission occurs through contaminated food or water.
2. People who are infected carry the bacteria in their intestines as well as the bloodstream, and those who have recover from the disease could still have the bacterium in their the system; they are known as ( carriers) of the disease. both the infected people and the carriers shed salmonella typhi in their stool.
3. infection is usually spread when food or water is handled by a person who is shedding bacterium or leakage of sewage into water or food that is then consumed by a healthy persons. so this disease is common in areas where proper hand washing techniques are not followed.
Causes
1.Step ladder fever (between 103 and 104°F).
2. Rashes (flat, rose-coloured spots).
3. Vomiting.
4. Loss of appetite.
5. Headache.
6. Fatigue and malaise.
7.In severe cases intestinal perforation and internal bleeding.
Signs & Symptoms
Diagnosis A CBC will show a high number of white blood cells (WBCs). A blood culture during the first week of the fever can show S. typhi bacteria, Other tests that can help diagnose this condition include :
1. ELISA urine test to look for the bacteria that cause typhoid fever.
2. Fluorescent antibody study to look for substances rhar specific to typhoid bacteria.
3. Platelet count (platelet count may be low).
4.Stool culture.
The Widal test was the mainstay of typhoid fever diagnostive for decades . the Widal test is no longer an acceptable clinical method.
Diagnosis
1, Typhoid fever is treated with antibiotics that kill the Salmonella bacteria.
With appropriate antibiotic therapy, there is usually improvement within 1-2 days and recovery within 7-10 days.
2. antibiotics are effective for the treatment of typhoid fever.
Chloramphenicol was the original drug of choice for many years. because of rare serious side effects has been replaced by other effective antibiotics.
If relapses Occur, patients are retreated with antibiotics.
3. Those who become chronically ill (about 3-5% of those infected) can be treated with prolonged antibiotics. Often, removal of the gallbladder, the site of chronic infection, provides a cure.
Treatment
-The Ty21a vaccine is administered intramuscularly and require the patient to take a booster shot after 5-years.
- in order to avoid contracting typhoid:
1. Do not eat food cooked on the road side.
2. Do not eat fruits and raw vegetables that have been precut.
3. Always drink either bottled water or boiled water.
4. Do not have ice or popsicles prepared locally.
5. Wash hands well before cooking meal or eating.
Prevention
1.gastrointestinal haemorrhage 2.intestinal perforation
3.relapse ( secondary infection) 4.typhoid encephalopathy
5.Death
Complications
1. Monitor vital signs.
2. Monitor the status of hydration.
3. Assess for weight loss, nausea, and vomiting.
4. Monitor intake of food and liquids, provide selected food. and involve the family in meeting the nutritional needs.
5. Collaborate with other medical teams for IV fluids administration
6. explain the purpose of bed rest to prevent complications and the speed up the healing process
7. Assess the level of pain , location and characteristics of the pain . 8. Give warm compresses on the area of pain
9. Provide analgesics as prescribed by the physician
10. Give health Education about the disease and the treatment
