Enteric Fever

Typhoid fever
 Continuous fever for 3-4weeks

 Relative bradycardia with involvement of

lymphoid tissue

 Considerable constitutional symptoms

 Occurs sporadically, Epidemically &

endemically
 World
 Affects about 6 million people / year
 Kills about 600,000 people / year
 Case fatality rate is 10%
 Uncommon in Developed countries

 INDIA

 Endemic in India
 Affects3,00,000 people / year
Agent factors

 Salmonella Typhi , S. paratyphi A & B

 S. typhi 3 antigens
-H , O , Vi
- 80 phage types

Killed by
- Common disinfectents, Drying
- Pasturization
 Reservoir of infection
 Man the only reservoir

 Cases 1. Clinical cases

2. Sub clinical cases

 Carriers 1. Temporary - Incubatory

- Convalescent
2. Chronic >1year

 Source of Infection
Primary - faeces & urine of cases& carriers
Secondary - contminated water, food, fingers & flies
 Host factors
 Occurs in 5-19 years
 Male > Female
 Immunity
-Antibody to ‘O’ antigen is high in Natural infection
-Antibody to ‘H’ antigen is high in immunization
 No solid immunity after natural infection
 Second attacks occur when challenged with high
dose of infection
 Gastric acidity & local immunity are protective
 Environmental & Social factors
 Season
 Environmental factors
 Pollution
 Habits

Index of general sanitation

 Modes of Transmission
Social factors
 water

Soil Mouths
Faeces FOOD of
Cultural well Economic
factors factors
& Flies persons

Urine Fingers

Quality of life
Incubation period 10-14 days

 Clinical features
-High fever, malaise, headache,
- cough & sore throat with
- abdominal pain & constipation, rash
 Physical findings
-abdominal distension & tenderness,
- Spleenomegaly, bradycardia
Complications
 Intestinal hemorrhage
 Intestinal perforation
 Urinary retention
 Pneumonia
 Thrombophlebitis
 Myocarditis
 Cholecystitis
 Nephritis
 osteomyelitis
 Control of Typhoid fever

 I. Control of reservoir

 II. Control of sanitation

 III. Immunization
 I. Control of
reservoir
 CASES
 a) Early diagnosis -Culture of blood & stool
 b) Notification
 c) Isolation - till 3 bacteriologically –ve
stool & urine results
 d) Treatment Chloramphinicol & Ciprofloxacin
 e) Disinfection 5% cresol x 2 hours
 f) Follow-up By stool & urine examination x 1yr
I. Control of reservoir
 CARRIERS

 a) Identification - Culture & serology

 b) Treatment - Ampicillin 4-6gm/d &

probenecid 2g/d x 6weeks

 c) Surgery Cholecystectomy + Ampicillin

 d) Surveillance
 e) Health education
 Control of sanitation
 Drinking water
 Food
 Health education
 Immunization
 No 100% protection
 Age above 1year
 Recommended to certain group of people
 Vaccines
- Monovalent vaccine
- Bivalent vaccine
- TAB vaccine
 Monovalent vaccine – (1000M/ml) S.typhi. AKD

 Bivalent vaccine - (1000M) S.typhi & (500M)

S.paratyphi A /ml. Heat killed or AKD

 TAB vaccine - (1000M) S.typhi, (500-750M)

S.paratyphi A & (500-750M) S.paratyphi B/ml.
 Vaccination
 Primary immunization
- 2 doses
- 0.5 ml s/c (children 1-10yrs – 0.25ml)
- 4-6weeks apart
- Protection starts in 10-21 days & lasts for 3 yrs
 Booster
- every 3 year
 Reaction…….
 Storage – 2-4 deg not frozen.
 Live oral Ty 21a vaccine
 Ty 21a Swiss
 541 Ty US

 Typhoral – enteric coated capsule of lyophilized

vaccine, registered in many countries including India
 Age - >6 years
 Day1, 3 & 5 (1 hr before meal with lukewarm milk or
water)
 Protection starts in 2 weeks after last capsule & lasts
for 3 yrs Booster (same 3 doses) every 3 years
Thank you