Typhoid Fever

Definition
Caused by
Salmonella
typhi or
Salmonella
paratyphi
Only found in
human hosts
Rare in
developed
nations

 Similar to
typhus, from
the Greek
typhos
Gramnegative, rodshaped, nonspore-forming,
facultatively
anaerobic
bacilli

Synonyms
Enteric fever
Salmonellosis
Tipus Lagnat

Mode of
Transmission
Indirectly by
vehicle
transmission
Ingestion of
contaminated
food or water
Neglecting
hand-washing

Pathophysiology
Ingestion

Stomach

Small
Intestine

Pathophysiology
Macrophages

Mesenteric
lymph nodes

Reticuloendothel
ial tissues

Pathophysiology
Bloodstream

Gallbladder

Stool

Incubation Period
10-14 days but ranges from 3 to
21 days

Clinical
Manifestation

Clinical Horizon: Symptoms

Prolonged fever (38.8-40.5C)
Gastrointestinal symptoms (S.
Paratyphi A- milder)
Anorexia
Abdominal pain
Nausea
Diarrhea
Constipation
Headache

Clinical
Manifestation

Clinical Horizon: Symptoms

Chills
Cough
Sweating
Myalgias
Malaise
Arthralgia
Physical Findings:
Coated tongue
Splenomegaly
Abdominal tenderness

Clinical
Manifestation
Early Disease Stage
Rash (rose
spots)
Hepatosplenome
galy
Epistaxis
Bradycardia

Clinical
Manifestation

Advanced Disease Stage

Gastrointestinal bleeding
Intestinal perforation
Neurologic manifestations:
Meningitis
Guillain-Barr syndrome
Neuritis
Neuropsychiatric symptoms:
Muttering delirium
Picking at bedclothes or imaginary
objects

Clinical
Manifestation
Complications

Disseminated intravascular coagulation

Hematophagocytic syndrome
Pancreatitis
Hepatic and splenic abscesses and
granulomas
Endocarditis
Pericarditis
Myocarditis
Orchitis

Clinical
Manifestation
Complications

Hepatitis
Glomerulonephritis
Pyelonephritis
Severe pneumonia
Arthritis
Osteomyelitis
Parotitis

Clinical
Manifestation

Period of Communicability
Feces- 3 months
Chronic asymptomatic carriage>1 year

Diagnosis

No specific lab test is

diagnostic for enteric fever
Leukopenia
Leucocytosis
Moderately elevated liver function
tests
Muscle enzyme levels

Definitive diagnosis of enteric

Diagnosis
fever
Isolation of s. Typhi or S. Paratyphi from:
Blood
bone marrow
other sterile sites
rose spots
stool
intestinal secretions
Sensitivity
90% during the first week of infection
50% by the third week

Definitive diagnosis of enteric

Diagnosis
fever
Centrifugation of
blood and culture
of the buffy coat
Bone marrow
culture remains
highly sensitive
despite 5 or less
days of antibiotic
therapy

Definitive diagnosis of enteric

Diagnosis
fever
Culture of intestinal secretions (by
noninvasive duodenal string test)

Diagnosis
Serologic tests
Widal test for
febrile
agglutinins

Treatment

Fluoroquinolones drug-susceptible
typhoid fever
Ciprofloxacin
Short-course ofloxacin- nalidixic
acid-susceptible strains
Ceftriaxone
nalidixic acid
Azithromycin
resistant (NAR)
High-dose ciprofloxacinS. Typhi

Treatment

Ceftriaxone
MDR enteric fever,
including NAR and
Cefotaxime
fluoroquinolone resistant
Oral cefixime
strains
Parenteral 3rd generation cephalosporin
and fluoroquinolone for patients with
persistent vomiting, diarrhea, and/or
abdominal distension; therapy should be
administered for at least 10 days or for 5
days after fever resolution
Dexamethasone (3-mg initial dose followed
by eight doses of 1 mg/kg every 6h) with
chloramphenicol- critically-ill patients

Treatment

Oral amoxicillin
Norfloxacin
chronic carriage of
susceptible
Ciprofloxacin
organisms
Trimethoprimsulfamethoxazole (TMP-SMX)
In cases of anatomic abnormality
(eg. Biliary or kidney stones),
eradication often requires both
antibiotic therapy and surgical
correction

Preventive
Measures
Vaccination

Travellers to developing countries

should be advised to monitor their
food and water intake carefully
and to consider vaccination
Currently, there is no licensed
vaccine for paratyphoid fever

Preventive
Measures
Vaccination

Ty21a an oral
attenuated S. Typhi
given on days
1, 3, 5, and 7,
with a booster
every 5 years
minimal age is
6 years

Preventive
Measures
Vaccination

Vi CPS a
parenteral vaccine
consisting of purified
Vi polysaccharide from
the bacterial capsule
given in 1 dose,
with a booster every
2 years
minimal age is 2
years