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GROUP OF ONE

DEFINITION
Typhoid fever is a bacterial disease, caused by Salmonella typhi. It is transmitted through the ingestion of food or drink contaminated by the faeces or urine of infected people.(World Health Organization) Typhoid fever is a systemic infection with the bacterium Salmonella enterica serotype typhi. This highly adapted, human-specific pathogen has evolved remarkable mechanisms for persistence in its host that help to ensure its survival and transmission.(The New England Journal of Medicine)

The data are obtained to estimate the burden of disease in this region are difficult to obtained, since many hospitals lack facilities for blood culture and up to 90 percent of patients with typhoid are treated as outpatients. Community-based studies have consistently shown higher levels of typhoid than public health figures suggest. Annual incidence rates of 198 per 100,000 in the Mekong Delta region of Vietnam and 980 per 100,000 in Delhi, India, have recently been reported. According to the best global estimates, there are at least 16 million new cases of typhoid fever each year, with 600,000 deaths.

HISTORY OF TYPHOID FEVER


Thomas Willis who is credited with the first description of typhoid fever in 1659.

Antonius Musa, a Roman physician who achieved fame by treating the Emperor Augustus 2,000 year ago, with cold baths when he fell ill with typhoid.

French physician Pierre Charles Alexandre Louis first proposed the name typhoid fever

In the late 19th century, typhoid fever mortality rate in Chicago averaged 65 per 100,000 people a year. The worst year was 1891, when the typhoid death rate was 174 per 100,000 people.

The best known carrier was "Typhoid Mary; Mary Mallon was a cook in Oyster Bay, New York in 1906 who is known to have infected 53 people, 5 of whom died. Later returned with false name but detained and quarantined after infect typhoid outbreak. She died of pneumonia after 26 years in quarantine. In 1909, Frederick F. Russell, a U.S. Army physician, developed an American typhoid vaccine and two years later his vaccination program became the first in which an entire army was immunized.

SIGN AND SYMTOMPS


Poor appetite Headaches Lethargy Nosebleeds Cough Diarrhea or Constipation Sweating Enlarged spleen and liver Have a sustained fever as high as 39 to 40 degrees Celsius Severe or mild vomiting, slow heartbeat Chest aches in many patients, abdominal pain and discomfort are common

1st week of illness


Once signs and symptoms do appear, you're likely to experience:

Fever, that starts low and increases daily, often to as high as 39.4 or 40 C
Headache Weakness and fatigue

Dry cough
Loss of appetite Abdominal pain

Diarrhea or constipation
Rash

2nd week of illness If you don't receive treatment for typhoid fever, you may enter a second symtomps during which you become very ill and experience: Continuing high fever Either diarrhea or severe constipation Considerable weight loss Extremely distended abdomen

3rd week of illness Become delirious Lie motionless and exhausted with your eyes half-closed in what's known as the typhoid state Life-threatening complications often develop at this time.

4th week of illness Improvement may come slowly during the fourth week. Your fever is likely to decrease gradually until your temperature returns to normal in another week to 10 days. But signs and symptoms can return up to two weeks after your fever has subsided.

CAUSES
Caused by the bacterium Salmonella Typhi . Ingestion of contaminated food or water or eating food prepared outside the home . Contact with an acute case of typhoid fever. Contact with a chronic asymptomatic carrier. Sometimes also by flying insects feeding on feces. Use of antimicrobial drugs. Poor housing with less inadequate facilities for personal hygiene. Water is contaminated where inadequate sewerage systems and poor sanitation. Eating food or drinking beverages that handled by a person carrying the bacteria. Salmonella enteriditis and Salmonella typhimurium are other salmonella bacteria, cause food poisoning and diarrhoea.

THE BACTERIUM
THE GENOM

SALMONELLA ENTERICA SEROVAR TYPHIMURIUM


Scientific classification

Member of the genus Salmonella. Infects cattle, poultry, domestic cats,hamsters, humans etc. Refrigeration and freezing substantially slow or

Kingdom:
Phylum: Class: Order: Family: Genus: Species:

Eubacteria
Proteobacteria Gamma Proteobacteria Enterobacteriales Enterobacteriaceae Salmonella S. enterica

halt their growth.


Foods prepared in the home from raw eggs can spread salmonella if not properly cooked before

consumption.

Subspecies: Enterica

PATHOGENESIS

ANTIMICROBIAL RESISTANCE

CLINICAL FEATURES

DIAGNOSIS
Diagnosis of typhoid fever is made by :

Blood, bone marrow, or stool cultures test

Widal test (demonstration of salmonella antibodies against


antigens O-somatic and H-flagellar) Slide agglutination Antimicrobial susceptibility testing

WIDAL TEST
" A test involving agglutination of typhoid bacilli when they are mixed with serum containing typhoid antibodies from an individual having typhoid fever, used to detect the presence of Salmonella typhi and S. paratyphi.- Suridar Rao P.N

TREATMENT
Diet : Fluids and electrolytes should be monitored and replaced diligently. Oral nutrition with a soft digestible diet is preferable in the absence of abdominal distension or ileus.

Activity : No specific limitations on activity are indicated. Rest is helpful, but mobility should be maintained if tolerable. The patient should be encouraged to stay home for a while from work until recovery.

Consultations :

An infectious disease specialist or surgeon should be consulted.

Surgical Care : Usually indicated in cases of intestinal perforation. Most surgeons prefer simple closure of the perforation with drainage of the peritoneum. Small-bowel resection is indicated for patients with multiple perforations. If antibiotic treatment fails to eradicate the hepatobiliary carriage, the gallbladder should be resected. Cholecystectomy is not always successful in eradicating the carrier state because of persisting hepatic infection.

PREVENTION
Prevention strategies : 1. Vaccination First type of vaccine: Contains a live but weakened strain of the Salmonella bacteria that causes typhoid fever. Taken by mouth. Be vaccinated against typhoid while traveling to a country where typhoid is common. Need to complete your vaccination at least one week before travel. Typhoid vaccines lose their effectiveness after several years so check with your doctor to see if it is time for a booster vaccination.

Second type of vaccine: Contains killed Salmonella typhi bacteria with a shot.

2. Avoid risky food and drinks


Buy bottled drinking water or bring it to a rolling boil for one minute before drinking it. Ask for drinks without ice, unless the ice is made from bottled or boiled water.Avoid Popsicles and flavored ices. Eat food that have been thoroughly cooked and that are still hot and steaming. Avoid raw vegetables and food that cannot be peeled like lettuce. When eat raw fruit and vegetables that can be peeled, peel yourself. Dont eat the peelings. Avoid foods and beverages from street vendors.