TYPHOID

FEVER Infectious
Disease
 Content
Introduction
 History
 Morphology
 Classification
 Pathogenesis
 Epidemiology
 Symptoms
 Causes
 Mode of transmission
 Diagnosis
 Treatment
 Prevention
Introduction
 Typhoid word came up from the ancient Greek word
‘Typhos’ that means ‘Smoke or cloud’, which was belived to
cause disesse or madness.
 Typhoid fever is an acute illness associated with fever or
can say it is a potentially fatal multisystemic illness/
infection caused by Salmonella typhi bacteria.
 This illness is transmitted by the ingestion of contaminated
food or water by the bacteria.
 This disease is clinically characterised by atypical
continuous fever for 3-4 weeks, with relative bradycardia
with the involvement of lymphoid tissues of intestine.
 Now Typhoid fever is also called Eateric fever, bilious fever
and yellow gack.
 Here ‘Enteric fever’ is a collective term that refers to
typhoid and paratyphoid.
 Pratyphoid fever is a similar but often less sever disease
caused by Salmonella paratyphi
History
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
 Thomas Willis who is credited with the first
description of typhoid fever in 1659.
 French physician Pierre Charles Alexandre Louis
first proposed the name “typhoid fever’
 William Wood Gerhard who was the first to
differentiate clearly between typhus fever and
typhoid in 1837.
 Carl Joseph Eberth who discovered the typhoid
bacillus in 1880.
 Georges Widal who described the Widal
agglutination reaction‟ of the blood’ in 1896.
 Morpholoy of Salmonella typhi
 Gram- negative road
 Non- Capsulated ( except S. Typhi
)
 Non- Sporulated
 Peritrichous flagella (ensure
motility)
 Salmonellae live in the intestinal
tracts of warm and cold blodded
animals.
 Some species are ubiquitous.
 Other species are specially
adapted to a particular host
 In humans, Salmonella are the
cause of two diseases called
Salmonellosis:
-Enteric fever (Typhoid), resulting
Classification of Salmonella
typhi
 Kingdom: Bacteria
 Phylum: Proteobacteria
 Class: Gammaproteobacteria
 Order: Enterobacterales
 Family: Enterobacteriaceae
 Genus: Salmonella
 Species: S. enterica, S. bongori
S. enterica has 6 sub species
S. enretica subsp. arizonae
 S. enretica subsp. diarizonae
 S. enretica subsp. enterica
 S. enretica subsp. houtenae
PATHOGENESIS
 This bacteria are ingested orally and they survives
gastric acids and enters the duodenum which is
the first part of the small intestine.
 They penetrate into the epithelium and invade into
lymphoid tissue.
-Through M-Cell as part of the MALT system
-This bacteria can directly penetrate into the
epithelial cells.
 The Salmonella typhi bacteria once penetrates into
the epithelium, it proliferates in submucosa and
cause Peyer’s patch hypertrophy.
 Eventually the bacteria will disseminates via
lymphatics and hematogenously through blood .
 In 7-10 days through blood stream it infect liver,
gall bladder, spleen kidney, bone marrow.
 After multiplication bacilli passes again into the
blood causing secondary bacteria.
EPIDEMIOLOGY
Typhoid fever occurs worldwide, primarily in
developing nations.It is more common in
children and young adults and is associated
with low income areas in poor sanitation is
prevalent.
Approx 200 to 300 cases of Salmonella typhi
are reported in the United States each year.
In 2000,typhoid fever caused an estimated
21.7 million illness and 217,000 deaths and
paratyphoid fever caused an estimated
5.4million illness worldwide.
 symptoms
Signs and symptoms are likely to develop
gradually often appearing one to three
weeks after exposure to the disease.
Early illness
Signs and Symptoms include:
 Fever that starts low and increases daily,
possibly reaching as high as 104.92F (40.5c)
 Headache
 Weakness and fatigue
 Muscle aches.
SIGNS AND SYMPTOMS
Sweating
Dry cough
Loss of appetite and weight loss
Stomach pain
Diarrhea or constipation
Rash
Extremely swollen stomach
CAUSES
1. Caused by the bacterium Salmonella typhi.
2. Ingestion of contaminated food or water.
3. Contact with an acute case of typhoid fever.
4. Water is contaminated where indequate
sewerage systems and poor sanitation.
5. Contact with a chronic asymtomatic carrier.
6. Eating food or drinking beverages that
handled by a person carrying the bacteria.
 MODE OF
TRANSMISSION
Typhoid fever is transmitted through the faecal-oral
route or urine-oral routes.
This may take place directly through soiled hands
contaminated with faeces or urine of cases or
carriers or indirectly by the ingestion of
contaminated water,milk,food or through flies.
DYNAMICS OF
TRANSMISSION
CLINICAL FEATURES
Stage-1(1st WEEK)
Slowly rising of temperature for 4-5 days
Abdominal pain & myalgia
Malaise
Headache
Constipation
Relative bradycardia
End of 1st WEEK
Rose spots may appear on the upper abdomen & on
the back of sparse.
Cough
Splenomegaly
Abdominal distension with tenderness.
Diarrhea
Stage-2(2nd WEEK)
Signs and symptoms of 1st week progress
End of 2nd WEEK
Delirium,complications,then coma & death (if
untreated)

Fig: ROSE SPOTS( usually visible only on

white skin)
Stage-3(3rd WEEK)
Febrile become toxic & anorexic
Significant weight loss
Typhoid state
High risk (5-10%) of hemorrhage and perforation may
cause death
Stage-4(4th WEEK)
Recovery period
 If the individual survives to the fourth week, the
fever,mental state,and abdominal distension slowly
improve over a few days.
 Intestinal and neurologic complications may still occur in
surviving untreated individuals.
 Weight loss and debilitating weakness last months.
 Some survivors became asymptomatic S typhi carriers
and have the potential to transmit the bacteria
indefinitely.
 DIAGNOSI
S:-
It is the process of determining
the nature of a disease or
disorder and distinguishing it
from other possible conditions.

.
Over view of diagnosis of typhoid fever:
1. Infection with typhoid or
paratyphoid fever results in a
very low- grade septicaemia.
A single blood culture is
positive in only half of cases .
Stool culture is not usually
positive during the early
phase of the disease. Bone
marrow culture increases the
BACTERIOLOGICAL PROCEDURES
 Selective media ,such as Deoxycholatecitrate agar or
xylose –lysine Deoxycholate agar ,are used for the
isolation of Salmonella bacteria from faeces. Fluid
enrichment media, such as Tetrathionate or selenite
broth, are also useful to detect small numbers of
Salmonella in faeces, foods or enviromental samples.
 Suspicious colonies from the culture plates are
tested directly for the presence of Salmonella
somatic (o) antigens by slide agglutination and
subcultured to peptone water for the determination
of flagellar (H) antigen structure and further
biochemical analysis.
BACTERIOLOGICAL
PROCEDURES
A presumptive diagnosis of Salmonellosis
can be often be made within 24 hours of the
receipt of a specimen, alhtough confirmation
may take another day , and formal
identification of the serotype takes several
more days. A negative report must await the
result of enrichment cultures –at least 48
hours.
LABORATORY DIAGNOSIS OF TYPHOID FEVER
1 isolation of Bacilli. A Gold standard
2 Diagnosis for presence of antibodies,
Positive Blood culture –A gold standard
Isolation from Faeces and urine ?
Detection of antibodies Inconclusive.
Newer methods
BLOOD CULTURE
Bacteremia occurs early in the disease
Blood Cultures are positive in
1st week positive in 90%
2nd week positive in 75 %
3rd weeks positive in 25 %
CLOT CULTURE

Clot cultures are more productive in yielding

better results in isolation.
A blood after clotting ,the clot is lysed with
Streptokinase ,but expensive to perform in
developing countries.
SEROLOGY
WIDAL TEST: Tube agglutination test.
Detects O and H antibodies.
Diagnosis of typhoid and paratyphoid
Testing for H agglutinins in Dryers tubes, a
narrow tube floccules at the bottom
Testing for O agglutinins in felix tubes,chalky
Incubated at 37 degree calcious overnight
Why we still use Widal test?

The widal test is an old serologic assay for

detecting Igm and IgG to the O and H
antigens of Salmonella. The test is unreliable
but is widely in most developing countries
because of its low cost.
Newer Methods in diagnosis of typhoid Fever

The serum samples can be tested by using

newer methods Multi-Test Dip –S-
Ticks ,TyphiDot ,and TUBEX to detect
immunoglobulin G (IgG),IgG and IgM,
respectively.
Immunoassays in typhoid Fever
Iimmunoassays are also used for the
diagnosis.
EXPRIMENTAL AND MOLECULAR
METRHODS:
PCR and DNA probe method attempt to
employ S.typhi genes and hybridize them with
labelled specific genes probes were also used.
TREATMENT
Ciprofloxacin (first line)500 mg bid (PO) or
400 q12 hours (i/v)-(5-7 days )
Amoxicillin (second line) 1 g tid (PO) or 2 g
q6h (i/v)-(14 days )
Chloramphenicol 25mg/kg tid (PO or i/v)-(14 -
21 days)
Trimethoprin –sulfamethoxazole 160/800 mg
bid (PO)-(14 days)
 Prevention
 Wash your hands frequently and thoroughly.
 Practice proper body hygiene
 Drink purified water(boiled or untampered
bottled water)
 Only eat well cooked foods

 vaccinations
- There are two types of vaccines avaliable:
- The inactivated contains capsular
material and
parenterally(lasting 2-3 years)
- The live attenuated strain of S.typhi and
is
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