medical mngt.pptx

7/27/2019 medical mngt.pptx

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TYPHOID

FEVER(ENTERIC FEVER)


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INTRODUCTION

PATHOPHYSIOLOGY

DIAGNOSTIC/LABORATORY EXAM

PHARMACOLOGICAL MANAGEMENT

NURSING MANAGEMENT /PREVENTION
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DIAGNOSTIC/LABORATORY EXAM

Blood culture- during the

prodromal stageUrine Culture

Stool CultureBone marrow cultures ( Highly

Sensitive )


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In slideagglutination tests aknown serum and

unknown cultureisolate is mixed,clumping occurswithin few minutes


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Clot cultures are more productive inyielding better results in isolation.

A blood after clotting, the clot is lysedwith Streptokinase ,but expensive toperform in developing countries.


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Widal Test

In 1896 Widal A professor ofpathology and internalmedicine at the Universityof Paris (191129), he

developed a procedure fordiagnosing typhoid feverbased on the fact thatantibodies in the blood ofan infected individualcause the bacteria to bindtogether into clumps (theWidal reaction).
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Widal test to determine the antigen left by themicroorganism

a. Antigen O presently infected

b. Antigen H - has been exposed before or

has received toxin


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Typhidot test that detectspresence of IgM and IgG in onehour.


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Bactek and Radiometric based

methods are in recent use

Bactek methods inisolation of Salmonellais a rapid and sensitive

method in earlydiagnosis of Entericfever.

Many MicrobiologyDiagnostic

Laboratories areupgrading to Bactekmethods
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ANTIBIOTICS

ANTIMICROBIAL

THERAPY


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Antibiotics, such as ampicillin,chloramphenicol, fluoroquinolonetrimethoprim-sulfamethoxazole,

Amoxicillin and ciprofloxacin etcused to treat typhoid fever.Prompt treatment of the disease

with antibiotics reduces thecase-fatality rate to

approximately 1%.


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Fluroquinolones- attain excellent

tissue penetration, kill S. typhi in its

intracellular stationary stage in

monocytes/macrophages and achievehigher active drug levels in the gall

bladder and other drugs.

ANTIMICROBIAL THERAPY


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Commonly prescribed antibiotics

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

Ciprofloxacin (Cipro). In the United States, doctors often prescribethis for nonpregnant adults.

Ceftriaxone (Rocephin). This injectable antibiotic is an alternative forwomen who are pregnant and for children who may not becandidates for ciprofloxacin. Third-generation cephalosporin withbroad-spectrum gram-negative activity against gram-positiveorganisms; Excellent in vitro activity against S typhi and othersalmonellae.


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Azithromycin (zithromax)- Treats mild to moderate microbial infections.Administered PO at 10 mg/kg/d (not exceeding

500 mg), appears to be effective to treatuncomplicated typhoid fever in children 4-17 y earsold.

Levofloxacin- For pseudomonal infections and infections due tomultidrug-resistant gram-negative organisms

Cefotaxime (claforan)- Third-generation cephalosporin with gram-negative spectrum. Lower efficacy against gram-

positive organisms. Excellent in vitro activityagainst S typhi and other salmonellae and hasacceptable efficacy in typhoid fever.


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IV Dexamethasone- patients withchanges in mental status,

characterized by delirium,

obtundation and stupor.



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Surgical consultation- for suspected

intestinal perforation.

Metronidazole and gentamicin or

ceftriaxone should be administeredbefore and after surgery.

Supportive measures- Oral & IV

hydration, antipyretic, nutrition &

blood transfusion (if indicated)

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