- At the end of the session participants will be able to know :
- Clinical Manifestation
- Prevention and control of enteric fever
What is Typhoid Fever? :-
Enteric Fever Enteric fever is an acute, febrile illness, caused by bacterium Salmonella typhi which may become sometimes life-threatening.
Typhoid Fever Cause:-
Typhoid Fever Etiologic agent-
Typhoid Fever / Enteric fever is caused by Salmonella typhi and S. Paratyphi bacteria. Enteric fever caused by S. Typhi is more severe and frequent. (Commonly called as typhoid).
Typhoid Fever Epidemiology:-
How Typhoid Spreads?
Man is the only natural reservoir of S. Typhi. Ingestion of food or water contaminated with human feces is the most common mode of transmission. S. Typhi is present for about 1-2 months in the stools of patients.
Carriers are important epidemiologically because they are mainly responsible for the spread of typhoid in the community. Complete antimicrobial therapy reduces the chances of the carrier stage.
Typhoid Fever Symptoms and Signs:-
Typhoid Fever Clinical manifestations:-
- After an incubation period of 10-14 days, typhoid fever has an insidious onset characterized by
- Malaise, Chills, and Myalgia.
- Abdominal distention and tenderness are generally present.
- If untreated, fever increases up to 40 degrees Celsius and fatigue, anorexia, abdominal symptoms, and cough may appear with an increase in severity.
- Nausea and vomiting in the second and third weeks suggest complications.
Typhoid Fever Diagnosis:-
S. Typhi is most frequently isolated from blood during the first week of illness. Collect blood samples of suspected enteric fever cases before starting antibiotics.
Widal test for Typhoid Fever:-
which measures antibody response to H and O antigens, can only suggest a diagnosis of enteric fever. Widal test results are not definitive and must be interpreted with care because Enteric Fever being an endemic titer may be elevated without enteric fever.
If the Widal test is performed, repeat the test after 10 days. A four-fold rise in antibody titer of the second sample should be used for diagnosis rather than a single test result.
Sample for Blood culture should be collected aseptically for a confirmed diagnosis. (Ref – Laboratory Manual of IDSP)
Typhoid Fever Treatment:-
- Effective antimicrobial therapy reduces morbidity and mortality from typhoid fever. Without therapy, an illness may last for 3 to 4 weeks, and there could be 12-30% deaths.
- Multi-drug resistant typhoid fever is reported from many places in the state. Therefore presently drug of choice for typhoid fever is Ciprofloxacin 500-750 mg twice a day for 15 days.
- Alternatively, Ceftriaxone and Cefaperazone can be used if resistance to Ciprofloxacin is documented.
Control of Typhoid outbreak:-
Following steps should be carried out for confirmation of diagnosis of fever outbreak
Confirmation of diagnosis:-
- Start a survey of the affected area. Decide whether cases are clearly in excess than expected fever cases from the village. If yes inform DHO about the fever outbreak and you’re clinical diagnosis of cases.
- First, collect and examine PBS of all fever cases for malaria even if your clinical diagnosis is not malaria. Exclude malaria on the basis of negative PBS results.
- Once malaria is excluded try to differentiate fever cases on the basis of clinical examination into viral fever or typhoid fever. Diagnostic features of typhoid fever are atypical fever pattern, coated tongue, relative bradycardia, tender splenomegaly, and relative leucopenia.
- If you suspect typhoid, collect 5 ml blood for culture, inoculate on enriched media (available at District Public health laboratory) and send it to District Public Health Laboratory by special messenger. Keep the media at room temperature during transportation.
- Alternatively, you can request DHO to send Public health laboratory microbiologist for blood culture examination. Also, request laboratory for antibiotic sensitivity pattern.
- Do not declare epidemic as of typhoid on the basis of serological examination such as the Widal test as this test is not confirmed of Typhoid fever.
- If you are confident about the clinical diagnosis then start antibiotic after collection of blood for culture.
- Once you get results of blood culture, and if blood culture is positive for S. Typhi, then label epidemic as of Typhoid fever. Change antibiotics suitably if investigations indicate the resistance of S. Typhi to Ciprofloxacin.
Q.1) Typhoid is Contagious?
Ans – Yes
Q.2) How long does a typhoid vaccination last?
Ans- Injection Typhoid Vaccine give protection for 3yrs
Q.3) where to get a typhoid vaccine?
Ans- At Doctors office, Vaccination center, Hospitals, Pharmacy
Q.4) Typhoid Vaccine Schedule?
Ans- Injection Typhoid Vaccine can be taken every 3 yearly
Q.5) Typhoid Vaccine schedule for child?
Ans- Child age more then 2 yrs can take Injectable Typhoid Vaccine.
Q.6) How much does Typhoid Vaccine cost?
Ans- its not costly its Price ranges from 3$ to 7$.
Q.7) Typhoid incubation period?
Ans- 10 to 14 days
Q.8) Is Typhoid Curable?
Q.9) Is Typhoid deadly?
Ans– Yes, If not Treated timely its found to be deadly in some patients.
Q.10) Is Typhoid vaccine necessary?
Ans- Yes, If you live in an area where Typhoid fever found then yes its Necessary.