typhoid fever
DESCRIPTION
ppt presentation of typhoid fever, pathophysiology of the disease, definition and its managementTRANSCRIPT
Typhoid Fever
Presented by: Dave Jay S. Manriquez, BSN, RN
Other names:
•Enteric Fever•Bilious Fever•Yellow Jack
Causative Agent
Salmonella Typhi
3 main antigenic factors:
•the O, or somatic antigen•the Vi, or encapsulation
antigen•the H, or flagellar antigen
Epidemiology
•World: 17 million cases per year
•U.S.: 400 cases per year (70% in travelers)
•Philippines: (Nov 2006) 478 in Agusan del Sur; (May 2004) 292 in Bacolod City
Incidence of Typhoid Fever red - strongly endemic; orange – endemic;
gray - sporadic cases
Mode of Transmission
Ingestion of contaminated food or water; rarely from person to person transmission through fecal-oral route.
Incubation Period
First 7-14 days after ingestion
Symptoms
•Diarrhea may occur •Active infection •Severe Headache •Generalized Abdominal Pain•Anorexia
Symptoms
•Fever [usually higher in the evening]- Intermittent Fever initially - Sustained Fever to high temperatures later
Symptoms
Severe cases•ulcers on the intestinal wall•shock•delirium•stupor
Pathognomonic Sign
• Rose SpotsBlanching pink macular spots 2-3 mm over trunk
Complications
Intestinal perforation, gastrointestinal hemorrhage and peritonitis may occur in the 3rd and 4th week of illness; rarely pancreatitis, hepatic and splenic abscesses, disseminated intravascular coagulation, myocarditis, meningitis, encephalitis.
PathophysiologySalmonella Typhi
survives the acidity of the stomach
invades the Peyer’s Patches of the intestinal wall
macrophages (Peyer’s Patches)
the bacteria is within the macrophages and survives
bacteria spreads via the lymphatics while inside the macrophages
Pathophysiologyaccess to Reticuloendothelial system, liver, spleen,
gallbladder and bone marrow
First week: elevation of the body temperature
Second week: abdominal pain, spleen enlargement and rose spots
Third week: necrosis of the Peyer’s Patches
leads to perforation, bleeding
and, if left untreated, death is imminent
Diagnostics
CBC (normal WBC despite fever), platelet count
Tourniquet Test
Diagnostics
Typhi dot test (if illness is 4 days or longer)
Interpretation:Ig M Ig G(+) (- ) Acute infection(+) (+) Recent infection(- ) (+) Equivocal: Past
infection or acute infection
Diagnostics
Malarial smear (Differential diagnosis)
Chest X-ray
Urinalysis
Diagnostics
First Week of illness: Blood C/S
Second Week of illness: Urine G/S, C/S
Third Week of illness: Stool C/S
Management
A. Prevention:•Choose foods processed for
safety•Prepare food carefully•Foods prepared by others
(avoid if possible)
Management
•Keep food contact surfaces clean
•Eat cooked food as soon as possible
•Maintain clean hands
Management
•Steam or boil shellfish at least 10 minutes
•All milk and dairy products should be pasteurized
•Control fly populations
Management
B. AntibioticsFor uncomplicated cases, use Conventional
Therapy:1. Chloramphenicol 3-4 gm per day PO in 4
divided doses x 14 days (50-100 mg/kg BW) except it with low WBC.
2. Co-trimoxazole forte or double-strength tab BID PO x 14 days
3. Amoxicillin 4-6 gm per day PO in 3 divided doses x 14 days
Management
For cases with complications, presence of severe symptoms, or clinical deterioration despite conventional therapy, use Empiric Therapy for Suspected Resistant Typhoid Fever:
1. Ceftriaxone (Rocephin) 3 gm IV infusion OD x 5-7 daysCeftriaxone may be used for pregnant women and children.
2. Fluoroquinolones:Ciprofloxacin (Ciprobay) 500 mg tab PO BID x 7-10 daysOfloxacin (Inoflox) 400 mg tab PO BID x 7-10 daysPerfloxacin (Floxin) 400 mg tab PO BID x 7-10 days
Management
C. Vaccines
5 years1 capsule every other day, total of 3 capsules
Oral6 yearsTy21 a, live
3 years0.5 mlSubcutaneous2 yearsVi CPS
3 years0.5 ml (0.25 ml for
children < 10y)x 2 times,4 weeks apart
Subcutaneous5 yearsKilled whole-cell vaccine
RevaccinationDosageRouteAgeVaccine
Management
D. Public Health Nursing Responsibility
- Teach members of the family how to report all symptoms to the attending physician especially when patient is being cared for at home.
Management
- Teach, guide and supervise members of the family on nursing techniques which will contribute to the patient’s recovery.
Management
- Interpret to family nature of disease and need for practicing preventive and control measures.
Management
E. Nursing Care- Demonstrate to family how
to give bedside care, such as tepid sponge bath, feeding, changing of bed linen, use of bedpan and mouth care.
Management
- Any bleeding from the rectum, blood in stools, sudden acute abdominal pain, restlessness, falling of temperature should be reported at once to the physician or the patient should be brought at once to the hospital.
Management
- Take TPR, I&O and teach family members how to take and record same.
Historical Background
Mary Mallon (September 23, 1869 – November 11, 1938)
Thank you!