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DEFINITION
Also known as enteric fever, an infection that causesdiarrheaand arash-most commonly due to a type of bacteria called Salmonella typhi(S. typhi). A bacterial infection of the intestinal tract and occasionally the bloodstream.
The disease rarely occurs in developed countries. It is most commonly seen in countries with poor sanitary conditions and contaminated water supplies.
a bacteria found in infected animals and transmitted to persons in contaminated food or fluids. Boiling water and thoroughly cooking food can kill the microorganism.
The infection can also be spread asymptomatic carriers. These are people who have the bacteria in their gastrointestinal tract, but do not have symptoms.
Incubation period: usually between 7-14 days Period of communicability: for as long as bacteria are in the stools
Mode of transmission: by food and water contaminated by stools and urine of patients or carriers. The vehicles are the 5 Fs: Feces, Food, Flies, Fomites, Fingers
Pathophysiology
Ingestion of contaminated food or water
Carried by white blood cells in the liver, spleen, and bone marrow
Pathophysiology
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
Diagnostic Exams Widal test to determine the antigen left by the microorganism a. Antigen O presently infected b. Antigen H- has been exposed before or has received toxin
Prodomal stage- for 3-4 days Dull headache; malaise Chills; fever; body aches Vomiting or diarrhea
Fastigeal/ pyrexial stage- during the second week Exanthem: rose spots- 4-5 pecular rose-colored macules or maculopapules seen on the 7th to the 12th day on the abdomen and chest (in adults) or on the face (infants) Ladder-like fever
Enlarged spleen
Typhoid psychosis a. Coma-vigil look- pupils dilate and patient appears to have blank stares or staring b. Difficulty putting out the tounge c. Carphologia- involuntary and aimless picking of linen d. Subsultus Tendinuminvoluntary twitching of the tendon of the wrists
Deferenscence stage- 3rd week Intestinal haemorrhagemicroorganism produces ulcers in the intestine.
Intestinal perforationspillage of fecal material in the peritoneum, causing peritonitis a. Persistence of fever
Lysis/ convalescence stagealthough signs and symptoms subside, patient should still be observed for relapses which could be fatal
Management
Prevention Immunization- CDT (Cholera, Dysentery, Typhoid) a. Given IM at the deltoid b. Children- 0.25 ml, Adults- 0.5 ml c. 6 months immunity
Vivotif q Capsule form q Given 1 hour before meal every other day for 3 doses q 3 years immunity q Control
Proper handwashing; clean environment Boil drinking water Avoid streetfoods and improperly washed or improperly cooked food
PHARMACOLOGIC MANAGEMENT
Antibiotics
Antibiotics, such as ampicillin, chloramphenicol, fluoroquinolone trimethoprim-sulfamethoxazole, Amoxicillin and ciprofloxacin etc used to treat typhoid fever.
Prompt treatment of the disease with antibiotics reduces the case-fatality rate to approximately 1%.
ANTIMICROBIAL THERAPY
Fluroquinolonesattain excellent tissue penetration, kill S. typhi in its intracellular stationary stage in monocytes/macrophages and achieve higher active drug levels in the gall bladder and other drugs.
ANTIMICROBIAL THERAPY
IV Dexamethasone- patients with changes in mental status, characterized by delirium, obtundation and stupor,
ANTIMICROBIAL THERAPY
Surgical consultation- for suspected intestinal perforation. Metronidazole and gentamicin or cefriazone should be administered before and after surgery. Supportive measures- Oral & IV hydration, antipyretic, nutrition & blood transfusion (if indicated)
PHARMACOLOGIC MANAGEMENT
nursing MANAGEMENT
Health Teaching Teach members of the family how to report all symptoms to the attending physician especially when patient is being cared for at home
nursing MANAGEMENT
Teach, guide and supervise members of the family on nursing techniques which will contribute to the patientsrecovery Interpret to family nature of disease and need for practicing preventive and control measures
nursing MANAGEMENT
Management Demonstrate to family how to give bedside care such as tepid sponge, feeding changing of bedlinen,use of bedpan and mouth care
nursing MANAGEMENT
Management Any bleeding from the rectum,blood in stoolssudden acuteabdominal painrestlessness, falling of temperature should be reported at once to the physician or the patient should be brought at once to the hospital.
nursing MANAGEMENT
Management Take vital signs and teach patient family member how to take and record same