TYPHOID FEVER

Source:  TYPHOID FEVER    Tag:  prodromal stage of infection

Other Terms:
ü  Enteric fever
ü  Typhus abdominalis

It is a general infection usually affects the Digestive system by the bacterium salmonella Typhi, causing a generalized weakness, ladderlike fever, red spots on chest and abdomen, sweating, chills, delirium and in serious cases inflammation of the spleen and bone.
Typhoid fever also characterized by ulceration of the Peyer’s Patches that leads to erosion of the intestinal wall resulting to internal hemorrhage as manifested by the enlargement of the spleen (Spleenomegaly).

Despite the fact that the disease commonly affects the gastrointestinal system, the following body systems might as well be affected:
1.      Muscular System
2.      Genito-urinary system
3.      Cardio-pulmonary system

Mode of Entry – Fecal-oral route through infected urine and feces.

Principal Vehicles
1.      Feces
2.      Foods
3.      Foamites
4.      Flies
5.      Fingers

Causative Agent
1.      Salmonella Typhi
2.      Typhoid Bacillus
3.      Salmonella Typhosa


Mode of Transmission
            Typhoid Fever may be transmitted via Fecal-oral route through infected feces and urine of the patient.
ü  Eating of contaminated foods like meat, eggs, shellfish and other meat and poultry products.
ü  Ingestion of uncooked or undercooked foods.
ü  Hands of infected persons.
ü  Flies and other flying insects.
ü  Consumption of contaminated water, milk and other dairy products.
ü  Through convalescent carriers that continue to harbor organisms in their tissues for variable lengths of time


Source of infection: Contaminated food and water

Signs and Symptoms
1. Prodromal – stage wherein the patient may have a flulike symptom.
·         Fever, headache
·         Anorexia, lethargy
·         Constipation or diarrhea, vomiting
·         Abdominal pain due to ulceration of the Peyer’s patches
·         Feeling of unwellness
2. Fastigal
·         Ladder like curve body temperature
·         Rose spots – Maculopapular rashes appear on chest or abdomen of patient usually appear on 7 – 12 days.
·         Spleenomegaly
·         Typhoid state – A condition in which there is brain involvement resulting to “Typhoid Psychosis”.
1.      The patient could have altered level of consciousness.
2.      Coma state wherein the patient appears to stare without seeing and a vigil look.
3.      Locomotive disturbance carphologia through picking up of linens
4.      Sultus tendium observed through involuntary twitching of tendons part of wrist of the patient.
3. Defervescence
·         Fever gradually subsides – fever mild & symptoms subsides

Diagnostic exam
    1. Hemoculture – confirmatory of typhoid (+) organism after 1 week
    2. Widal’s test/ blood serum agglutination (+) end of 2nd week
    3. Fecalysis – Done by swabbing the rectal area.
ü   Advise the patient not to eat meat especially red meat 1-2 days prior to the test cause it may give a false positive internal bleeding result.
    1.  Typhi Dot test- new method on diagnosing typhoid fever to detect IgH, IgG

Nursing Care
  • Supportive care
  • Proper positioning
  • Use of enteric precautions
  • TSB for high fever
  • Increase fluid intake
  • Administration of prescribed medications
  • Monitor for possible complications


Prevention
  • Handwashing
  • Decontamination of water sources milk pasteurization,
Immunization – vaccine of C.T. cholera typhoid, oral vivotif .

Complications
           
    1. Perforation of the intestine
    2. Intestinal hemorrhage
    3. Thrombophlebitis
    4. Urinary infection
    5. Meningitis

Ø  Note that typhoid fever may relapse.

Treatment
  • Chloramphenicol – 14 days
  •  Amoxicillin – (oral) in case the patient is resistant to Chloramphenicol
ü  Monitor CBC to detect Chloramphenicol toxicity SE of Chloramphenicol : Bone depression
·         If with resistance to both, use trimethoprim-sulfamethoxazole as an alternative drug.


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