c



›
  
 
* Typhoid fever is a bacterial infection of the
intestinal tract and occasionally the
bloodstream.

* The disease rarely occurs in developed

countries. It is most commonly seen in
countries with poor sanitary conditions and
contaminated water supplies.

* Most of the cases are acquired during foreign

travel to underdeveloped countries.
ð utbreaks are rare.

ð The germ that causes typhoid is a unique

human strain of Salmonella called Salmonella
typhi.
h

ð It is caused by infection with þ




 
a bacteria found in infected animals and
transmitted to persons in contaminated food
or fluids. It is most often found in countries
with poor sanitary conditions or
contaminated water supplies. Boiling water
and thoroughly cooking food can kill the
microorganism. The infection can also be
spread asymptomatic carriers. These are
people who have the bacteria in their
gastrointestinal tract, but do not have
symptoms.
h



 
Virulence Factors: S. typhi has a
combination of characteristics that
make it an effective pathogen. This
species contains an endotoxin typical of
Gram negative organisms, as well as
the Vi antigen which is thought to
increase virulence. It also produces and
excretes a protein known as ´invasinµ
that allows non-phagocytic cells to
take up the bacterium, where it is able
to live intracellularly. It is also able to
inhibit the oxidative burst of
leukocytes, making innate immune
response ineffective.
Y
 






can be very dangerous if not taken care of properly.
-only live in the bloodstream or intestinal tract of
humans,
-but is also found in sewage.
Even though most people either die or use antibiotics
to stop the growth of these bacteria, a very small
percentage of the people who get typhoid fever
have certain antibodies that are able to restrict the
growth of salmonella typhi and therefore are able
to live.
These people plus the people that are cured through
antibiotics are called carriers because even though
they will have no more symptoms of typhoid fever,
they will still have the bacteria inside of them.
Since salmonella typhi is passed through bodily
fluids, you can contract it by eating some
food or a drink handled by a carrier. You can
also contract these bacteria by having food or
water that has been contaminated with
sewage containing salmonella typhi.

ð ›  

Y
ð
sually found contracted in the developing
nations of the world such as the Latin
American, African, and Asian countries. The
reason for this is that the water in these
countries is contaminated often with sewage
that on some occasions is carrying Salmonella
typhi.
Ê  
 




ð After the ingestion of contaminated food or water,
the Salmonella bacteria invade the small intestine
and enter the bloodstream temporarily. The
bacteria are carried by white blood cells in the liver,
spleen, and bone marrow. The bacteria then
multiply in the cells of these organs and reenter the
bloodstream. Patients develop symptoms, including
fever, when the organism reenters the bloodstream.
Bacteria invade the gallbladder, biliary system, and
the lymphatic tissue of the bowel. Here, they
multiply in high numbers. The bacteria pass into the
intestinal tract and can be identified for diagnosis in
cultures from the stool tested in the laboratory.
›   
 

ð Anyone can get typhoid fever but the

greatest risk exists to travelers visiting
countries where the disease is common.

ð ccasionally, local cases can be traced to

exposure to a person who is a chronic carrier.

ð Infants and persons over 60 usually have the

severest cases.
c

ð Ingestion of contaminated food

ð Typhoid germs are passed in the feces and, to

some extent, the urine of infected people.

ð The germs are spread by eating or drinking

water or foods contaminated by feces from
the infected individual.
?  
ð orld: 17 million cases per year
ð
.S.: 400 cases per year (70% in travelers)
ð PHILIPPINES
ð (Nov 2006) 478 in Agusan del Sur.
ð (May 2004) 292 in Bacolod City
ð


 
ð   



ð  

ð  
m

 

ð    





ð 

 

 

›

 
ð The symptoms may occur rapidly, particularly
in children.
ð However, in adults, they usually come on
slowly

ð elapses are common.

ð Fatalities are less than 1% with antibiotic

treatment.

ð Symptoms generally appear one to three

weeks after exposure.

ð Incubation (first 7-14 days after ingestion)
ð
sually asymptomatic
ð iarrhea may occur
ð Active infection
ð Severe Headache
ð Generalized Abdominal Pain
ð Anorexia
ð Constipation more common than iarrhea
ð Fever [usually higher in the evening] 103 F-
104 F (39 C-40 C).
ð Intermittent Fever initially
ð Sustained Fever to high temperatures later

ð   




ð  

 !"
ð #


$  % 

$
ð & 
'
()(!"

ð * 
 
#
 ()"
ð #+ 

ð 

 

 
   
+ 

   , 

-
p  


 
 
    
ð The carrier stage varies from a number of
days to years.
ð nly about 3% of cases go on to become
lifelong carriers of the germ and
ð This tends to occur more often in adults than
in children.


 ?

  h 
 c
 
 
 
 Ê  
 h 
 p
 
  !""#$
 

  ›
%c$
 & c

 c '(#$
   
 
 
 
  
  


 
) 
 

 


   
 

) 


 
   
$  
 *

 
 
     
  
   )   
 



 
 

 *

 h  

) 
 
  )
  

  
 
 


 
 
 
  

   
   
*

 p 
  
    


 

  *
   


   

ð A vaccine is available
ð but is generally reserved for people traveling
to underdeveloped countries where
significant exposure may occur.
ð Types of vaccines include:
ð  is a live attenuated bacterial vaccine
that protects against typhoid.It is one of two
typhoid vaccines currently recommended by
the orld Health rganization.The vaccine
offers between 33 and 78% protection. The
vaccine is most commonly used to protect
travellers to endemic countries, but there is no
reason why the vaccine could not be used in
large scale public prevention programmes.
ð The vaccine is given by mouth. The vaccine is
presented either as capsules or a liquid
suspension.
ð   
 
   
 


ð The vaccine is only 60 to 80% protective and

the traveller should still be warned to take all
usual precautions (careful hygiene, hand
washing and food preparation).
ð The vaccine is injected either under the skin or
into a muscle at least seven days before
traveling to the typhoid-affected area
(recommend 14 days). The vaccine is not
effective in children under the age of two.
ð To maintain immunity, the vaccine should be
repeated every three years.



þ
ifi antibiotis ar
oft
 us
 to tr
t
s
s of ty i.

ð Atibiti 
sist
is ir
sig

ð First-Li
: Flurquil
s
ð Alt
rtiv
tibitis (r
sist
is mm)
² Clrm 
il
² Amxiilli
² Trim
t rim-þlfm
txzl
(þ
tr)
& 
ð Choose foods processed for safety
ð Prepare food carefully
ð Foods prepared by others (avoid if possible)
ð eep food contact surfaces clean
ð Eat cooked food as soon as possible
ð Maintain clean hands
ð All milk and dairy products should be
pasteurized
ð Control fly populations
ð hen you drink water, buy it bottled or bring it to
a rolling boil for 1 minute before you drink it.
ð Ask for drinks without ice unless the ice is made
from bottled or boiled water. Avoid popsicles and
flavored ice that may have been made with
contaminated water.
ð Avoid raw vegetables and fruits that cannot be
peeled. Vegetables like lettuce are easily
contaminated and are very hard to wash well.
ð Avoid foods and beverages from street vendors. It is
difficult for food to be kept clean on the street, and
many travelers get sick from food bought from
street vendors.
ð Get vaccinated against typhoid fever.
ð  Y
ð The symptoms of typhoid fever can begin to
occur one to three weeks after the person has
contracted Salmonella typhi. These symptoms
then usually get the worst during the third
week of symptoms and then subside. By the
fourth week, many people do not have any
of the symptoms of typhoid fever.

ð 
  

ð Typhoid fever affects about 400 people in
the
nited States each year. f these 400
people, 70% of them got the Salmonella
typhi while traveling internationally. In
developing nations though, 12.5 million
people are affected by this disease each year.
ÿ h

   
I


t:
!Moitor ati
t t
m
ratur
ð†Fever pattern may aids in

gr

a att
rs. diagnosing underlying disease.

* bs
rv
for shakig chills a
rofus
ia hor
sis.
*ash has with ati-bact
rial
soa b
for
a aft
r
ach car
of
activity a
courag
ro
r
hygi

.
ð†Provide tepid sponge baths and
avoid the use of ice water and
alcohol.
ð†Chills often precede during high
temperature and in presence of
generalized infection.
ð†educes cross contamination and
prevents the spread of infection.
ð†May help reduce fever.
se of ice
water and alcohol may cause chills
and can elevate temperature.
ÿc?m
?ÿc+ÿ mc+ÿ?
ð†Monitor for signs of deterioration of ð†May reflect inappropriate antibiotic
condition or failure to improve with therapy.
therapy.

Collaborative:
ð†
sed to reduce fever by its central
ð†Administer antipyretics action
as on the hypothalamus.
prescribed.

ð†Administer antibiotics ð†To control the

as spread of
prescribed Infection.
 ?ÿ
ð Lay, Alfonso afael L.