TYPHOID FEVER

(ENTERIC FEVER)

INTRODUCTION
PATHOPHYSIOLOGY

DIAGNOSTIC/LABORATORY EXAM

PHARMACOLOGICAL MANAGEMENT

NURSING MANAGEMENT /PREVENTION

DIAGNOSTIC/LABORATORY EXAM

Blood culture- during the prodromal stage

Urine Culture Stool Culture Bone marrow cultures ( Highly Sensitive )

In slide agglutination tests a known serum and unknown culture isolate is mixed, clumping occurs within few minutes

Clot cultures are more productive in yielding better results in isolation. A blood after clotting, the clot is lysed with Streptokinase ,but expensive to perform in developing countries.

Widal Test
In 1896 Widal A professor of pathology and internal medicine at the University of Paris (191129), he developed a procedure for diagnosing typhoid fever based on the fact that antibodies in the blood of an infected individual cause the bacteria to bind together into clumps (the Widal reaction).

Widal test to determine the antigen left by the

microorganism a. Antigen O presently infected b. Antigen H - has been exposed before or has received toxin

Typhidot test that detects presence of IgM and IgG in one hour.

Bactek and Radiometric based methods are in recent use

Bactek methods in isolation of Salmonella is a rapid and sensitive method in early diagnosis of Enteric fever. Many Microbiology Diagnostic Laboratories are upgrading to Bactek methods

 ANTIBIOTICS ANTIMICROBIAL

THERAPY

Antibiotics, such as ampicillin, chloramphenicol, fluoroquinolone trimethoprim-sulfamethoxazole, Amoxicillin and ciprofloxacin etc used to treat typhoid fever. Prompt treatment of the disease with antibiotics reduces the case-fatality rate to approximately 1%.

ANTIMICROBIAL THERAPY

Fluroquinolonesattain excellent tissue penetration, kill S. typhi in its intracellular stationary stage in monocytes/macrophages and achieve higher active drug levels in the gall bladder and other drugs.

Commonly prescribed antibiotics Chloramphenicol -most widely used antibiotic to treat typhoid fever. Binds to 50S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. Effective against gramnegative and gram-positive bacteria.

Ciprofloxacin (Cipro). In the United States, doctors often prescribe this for nonpregnant adults.
Ceftriaxone (Rocephin). This injectable antibiotic is an alternative for women who are pregnant and for children who may not be candidates for ciprofloxacin. Third-generation cephalosporin with broad-spectrum gram-negative activity against gram-positive organisms; Excellent in vitro activity against S typhi and other salmonellae.

Azithromycin (zithromax) - Treats mild to moderate microbial infections. Administered PO at 10 mg/kg/d (not exceeding 500 mg), appears to be effective to treat uncomplicated typhoid fever in children 4-17 y ears old. Levofloxacin - For pseudomonal infections and infections due to multidrug-resistant gram-negative organisms Cefotaxime (claforan) - Third-generation cephalosporin with gramnegative spectrum. Lower efficacy against grampositive organisms. Excellent in vitro activity against S typhi and other salmonellae and has acceptable efficacy in typhoid fever.

ANTIMICROBIAL THERAPY

IV Dexamethasone- patients with changes in mental status, characterized by delirium, obtundation and stupor.

ANTIMICROBIAL THERAPY

Surgical consultation- for suspected intestinal perforation. Metronidazole and gentamicin or ceftriaxone should be administered before and after surgery. Supportive measures- Oral & IV hydration, antipyretic, nutrition & blood transfusion (if indicated)