Typhoid Fever

Definition

Typhoid fever (also called slow fever or typhoid) is a bacterial infection transmitted by
contaminated water, milk, or other food. It is an infection of the GIT affecting the lymphoid tissues
(Peyer’s patches) of the small intestines.

Causative Agent

The disease is caused by an organism Salmonella typhosa/typhi.

Sources of Infection

1. A person who recovered from the disease or one who took care of a patient with Typhoid and was
infected can be considered a potential carrier.

2. Ingestion of shellfish (oysters) taken from waters contaminated by sewage disposal can be source of
infection.

3. Stool and vomitus of infected individual are sources of infection.

Mode of Transmission

1. The disease can be passed from one person to another through fecal-oral transmission.

2. Organism can be transmitted through the five (5) Fs.

3. The disease can be transmitted through the ingestion of contaminated food, water, and milk.

Incubation Period

The incubation period is from five to forty days with a mean of ten to twenty days.

Period of Communicability

The period of communicability is variable. As long as the patient is excreting the microorganism,
he is still capable of infecting others.
Pathophysiology (Diagram)

Predisposing Factors Precipitating Factors

Age: infants and youths/elderly Improper food handling

Prevalent in temperate climates Contaminated water supply

High accidence in fall Living in overcrowded areas/poor housing

Poor hygiene/ hand washing

Low gastric acidity (use of antacids)

Ingestion of food or water contaminated

with Salmonella typhi

The bacteria adhere and invades the gut wall

of the gastrointestinal tract and enter the
bloodstream

Carried by WBCs in the liver, spleen, and

bone marrow

Multiply and reenter the bloodstream

Bacteria invade the gallbladder, biliary

system, and the lymphatic tissue of the
bowel and multiply in high numbers

Then pass into the intestinal tract and can be

identified for diagnosis in cultures from the
stool tested in the laboratory

TYPHOID FEVER
Clinical manifestations

1. Onset

a. Headache, chilly sensation, aching all over the body

b. Nausea, vomiting, and diarrhea

c. By the 4th and 5th, all symptoms are worst.

d. Fever is higher in the morning than it was in the afternoon.

e. Breathing is accelerated, the tongue is furred, the skin is dry and hot, abdomen is distended
and tender.

f. Rose spots appear on the abdominal wall on the 7th to 9th day.

g. On the second week symptoms become more aggravated. Temperature remains in uniform
level. Rose spots become more prominent.

2. Typhoid State

a. Intense symptoms decline in severity.

b. The tongue protrudes, becomes dry and brown.

c. Teeth and lips accumulate a dirty-brown collection of dried mucus and bacteria known as
sordes (preventable by good nursing care).

d. Patient seems to be staring blankly (Coma vigil).

e. Twitching of the tendon sets in especially the wrist (subsultus tendinum).

f. Patient mutters deliriously and picks up aimlessly at bedclothes with his fingers in continuous
fashion (Carphologia).

g. There is constant tendency for the patient to slip down to the foot part of the bed.

h. In severe cases rambling delirium sets in, often ending in death.

Diagnostic Procedure

1. Thyphidot - confirmatory

2. ELISA

3. Widal

4. Rectal swab

Modalities of Treatment

1. Chloramphenicol – drug of choice

2. Ampicillin
3. Co-trimoxazole

4. Ciprofloaxacin or Ciftriaxone

5. If the patient does not respond to Chloramphenicol, 3rd and 4th generation drugs are administered.

Nursing Management

1. Maintain or restore fluid and electrolyte balance.

2. Monitor patient’s vital signs.

3. Prevent further injury (fall) of patient with typhoid psychosis.

4. Maintain good personal hygiene and mouth care.

5. Cooling measures are necessary dur

6. Watch for signs of internal bleeding.

Source:

Handbook of Common Communicable and Infectious Diseases, Dionesia Mondejar-Navales,

2006