This Presentation is made by Dr. Ashok Jaisingani for study purpose, if any one like this than give comments.

1. By DR. ASHOK JAISINGANI

2. Typhoid fever is the result of the infection mainly by the S – typhi
The disease is mainly characterized by the typical continuous fever
for three – four weeks
Relative bradycardia with involvement of the lymphoid tissues and
considerable constitunal symptoms
Enteric Fever: The term enteric fever involve both the typhoid and
paratyphoid fever

3. The Disease may occur
Sporadically
Epidemically
Endemically

4. Salmonella Typhi:
A gram – negative rod motile bacteria, is a major cause of the
fever
Other relatively less common are
Salmonella typhi A & B
Salmonella typhi has three antigens
O, H, Vi

5. Man is host of the disease man may in the form of the
a) Cases
b) Carrier
Cases: In cases age group involve 5 – 19 years more prone,
after the 20 years of the age the infection falls probably
Males are affected more than female
Carrier: These may
Temporary carrier
Chronic carrier

6. Man is the only known reservoir of the infection via cases or carrier
Cases:
The case may be mild, missed or severed a case (carrier) is infectious
as long as bacilli appears in the stool or urine
Carrier:
The carrier may be temporary, incubatory, convalescent or chronic

7. 1) Feco – oral route
2) Urine – oral route ( Rare)
Source Of The Infection:
The primary source:
Faces and urine of the cases and carriers
Secondary Sources:
Contaminated water, foods, finger and flies
There is no evidence that typhoid bacilli are excreted in sputum or
milk

8. Enteric fever observe all through the years
The peak incidences are observed during the July and September,
this period coincides with the rainy season and an increase in fly
population
Outside the humane body the bacilli are found in the water, ice,
milk, foods and soil for the varying period of the time
The typhoid bacilli do not multiply in the water, many of them
perish within the 48 hours, but some survive for about 7 – days
The typhoid bacilli survive for over month in the ice and ice-cream

9. Typhoid bacilli survive for up to 70 – days in soil irrigated with the
sewage under the moist winter conditions and about half of that period
in drier summer conditions
Food being a bed conductor of the heat, provide the shelter to the
bacilli, which may multiply and survive for the some time in food
Typhoid bacilli grow rapidly in milk without altering its test or
appearance in any way
Vegetables grown in sewage form or washed in contaminated water
are a positive health hazards
These factors are compounded by the such social factors as pollution
of the drinking water supply

10. Incubation period is usually 10 – 14 days
But the incubation period may be as short as 3 – days
It may be as long as 3 – weeks thus depending on the dose of the
bacilli ingested

11. The onset is usually insidious but in children may be abrupt with
Chills and high fever
Prodromal Stage: There is
Malaise
Headache
Cough and sore throat often with the abdominal pain and
constipation, this fever ascend in stepladder fashion
After 7 – 10 days the fever reach a plateau and the pt looks toxic,
exhausted and often prostrated

12. In early stages there may be marked constipation or “pea group”
diarrhea
Abdominal distension
Lukopenia
There is blood, urine and stool cultures are positive for the
salmonella typhi
If there are no complications the pts conditions improve over the 7 –
10 days
Relapses may occurs for up to 2 weeks after termination of the
therapy

13. Complication occurs in about 30% of the untreated cases and
accounts for the 75% of the all deaths in typhoid fever
Intestinal hemorrhage is manifested by the sudden drop in
temperature and sign of the shock followed by the dark or fresh
blood in stool
Intestinal perforation is most likely to occurs during the third week
Less frequent complications are urinary retention, pneumonia,
thrombophlebitis, myocarditis, psychosis, cholecystitis, nephritis
and osteomyelitis

14. The control or elimination of the typhoid fever is well within the
scope of the modern public health, this is an accomplished fact
in many developed countries, there are generally three lines of
the defense against the typhoid fever
a) Control of the reservoir
b) Control of sanitation
c) Immunization
The weakest link in the chain of the transmission is sanitation
which is amenable to control

15. The usual method of the control of the reservoir are their
Identification (Identify either case or carrier)
Isolation
Treatment
Disinfections

16. Early Diagnosis: This of the vital importance as the early symptoms
are non-specific, culture of the blood and stools are important,
investigation in the diagnosis of the cases
Notification: This should be done where such notification is
mandatory
Isolation: Since typhoid fever is infectious and has prolong course,
the cases are better transmitted to the hospitals for the proper
treatment as well as to prevent the infection
As a rule cases should be isolated till three bacteriologically
negative stools and urine report are obtained on 3 separate days

17. Chloramphenicol remains the drug of the choice if the bacilli are
sensitive to it
For the adult the dose is 500mg (approx. 50mg/kg of body
weight/day), 4 – hourly while febrile and thereafter 500mg 6 –
hourly for a total period of the 14 – days
Cotrimoxazole, Amoxcillin and trimethoprim are equally effective,
resistance to these drugs now rise
Ciprofloxcin is now the drug of the choice
Patient seriously ill and profoundly toxic may be given an injection
of the hydrocortisone 100mg daily for 3 – 4 days

18. Stool and urine are sole source of the infection, they should be
received in closed container and disinfected within 5% cresol for at
least 2 –hours
All soiled clothes and linen should be socked in the solution of the
2% chlorine and steam – sterilized
Nurses and doctor should be not forgated to disinfected their hands

19. Examination of the stool and urine should be done for the S- typhi 3
– 4 months after the discharge of the patient and again after the 12 –
months to prevent the development of the carrier state
With the early diagnosis and appropriate treatment mortality been
reduced to about 1% as compared to the about 30% of the untreated
cases

20. Protection and purification of the drinking water supplies
Improvement of the basic sanitation and promotion of the food
hygiene are essential measure to interrupt transmission of the
typhoid fever
Typhoid fever never were major clinical problem when there is a
clean domestic water supply
Sanitary measures are not followed by the health education may
produce only temporary result
When sanitation is combined with the health education, the effect
tend to be cumulative, resulting in a steady reduction of the typhoid
fever morbidity

21. Immunization is complimentary approach to prevention
Immunization is only specific preventive measures
Immunization against the typhoid fever does not give 100%
protection but definitely lower the incidences and seriousness of the
infection, it can be given at any age upward of the one year
It is recommended to
Those living in endemic areas, household contact, groups at risk of
the infection such as school children and hospital staff, traveler
proceeding to the endemic areas

22. The anti-typhoid vaccine currently available as
Monovalent anti-typhoid vaccine
Bivalent anti-typhoid vaccine
TAB vaccine

23. The vaccine of the choice is naturally the monovalent typhoid
vaccine, which is an agar grown, heat killed and phenol preserved
vaccine, containing 1000 million of the S – typhi per ml
It also be prepared by the inactivation of the organisms with the
acetone and the vaccine is known as AKD (Acetone killed and
dried) anti-typhoid vaccine

24. The bivalent vaccine contain s-typhi and s-paratyphi A in the
proportion of the 1000 million and 500million organisms
respectively
The organisms are killed and preserved by the heating at 540C for
one hour and by addition of the 0.5% phenol
The bivalent vaccine may also be prepared by the inactivation of the
organisms with the acetone and dried form (AKD vaccine)

25. The traditional TAB vaccine contain S – typhi (1000 million), S –
paratyphi A (500 – 700 million) & S – paratyphi B (500 – 750
million) organisms per liter
The paratyphoid antigens in the vaccine are not only thought to be
of the doughtful effectiveness, but there presence enhanced reaction
caused by the extra-protein of the paratyphoid A & B components
Therefore the traditional TAB vaccine has fallen in to disfavor
The WHO recommended that the TAB vaccine should be
discontinue