VIANZON, REYNALDO JR., M.

BSN IV

Definition
Typhoid Fever is a bacterial infection transmitted by contaminated water,
milk, shellfish and other foods. It is an infection of the GIT affecting the
lymphoid tissues of the small intestines called Peyers patches.
Incubation Period
The incubation period is from 5-40 days, with a mean of 10-20 days.
Sources of Infection
1. A person who has just recovered from the disease or has recently
taken care of a patient with typhoid fever and was infected is
considered a potential carrier.
2. Ingestion of shellfish (oyster) taken from waters contaminated with
sewage disposal can be a source of infection.
3. The stools and vomitus of an infected individual are sources of
infection.
Mode of Transmission
1. The disease can be passed from one person to another through fecaloral transmission
2. The organism can be transmitted through the 5 Fs (Finger, feces, flies,
food & fluid, Fomite)
3. The disease can be transmitted through the ingestion of contaminated
food, water and milk.
Clinical Manifestations
1. Onset
a. Headache, chilly sensation and aching all over the body.
b. Nausea, vomiting and diarrhea
c. During the 4th and 5th days, all symptoms are at their worst.
d. Fever is higher in the morning than in the afternoon
e. Breathing is accelerated, the tongue furred, the skin dry and hot,
and the abdomen distended and tender.
f. Rose spots appear in the abdominal wall on the 7 th to the 9th days.
(Pathognomonic Sign)
g. On the second week, symptoms become more aggravated.
Temperature becomes stable. Rose spots become more prominent.
2. Typhoid State
a. Symptoms decline in severity
b. The tongue protrudes, becoming dry and brown.

c. Teeth and lips accumulate a dirty-brown collection of dried mucus

and bacteria known as sordes .
d. Patient seems to be staring blankly (coma vigil)
e. Twitching of the tendons sets in, especially those of the wrist.
f. Patients mutters deliriously and picks up aimlessly at bedclothes
with his finger in a continuous fashion
g. There is as constant tendency for the patient to slip down to the
foot part of the bed.
h. In sever cases rambling delirium sets in, often ending to death.
Complications
1. Hemorrhage or perforation the two most dreaded complications
2. Peritonitis
3. Bronchitis and pneumonia
4. Meteorism or excessive distention of the bowels
5. Thrombosis and embolism
6. Early heart failure
7. Typhoid spine or neuritis
8. Septicemia
9. Reiters syndrome joint pain, eye irritation and painful urination that
can lead to chronic arthritis.
Diagnostic Procedure
1. Typhidot
2. ELISA (Enzyme-Linked ImmunoSorbent Assay)
3. Widal Test
4. Rectal Swab
5. SEIA (Salmonella Enzyme Immuno-Assay)
Treatment
1. Chloramphenicol (drug of choice)
2. Ampicillin
3. Co-trimoxazole
4. Ciprofloxacin or ciftriaxone
5. If the patient does not respond to chloramphenicol, 3 rd and 4th
generation drugs are administered.
Prevention and Control
1. Sanitary and proper disposal of excreta
2. Proper supervision of food handlers
3. Enteric isolation
4. Provision of adequate amounts of safe drinking water supply
5. Reporting of cases to health authorities
6. Detection and monitoring of typhoid carriers
7. Education of the general public on the mode of transmission