Typhoid fever
introduction
Caused by S. typhi.
The disease found only in man.
Enteric fever includes both typhoid &
paratyphoid fevers.
The disease may occurs sporadically,
epidemically or endemically.
Clinical features
Problem statement
Disease
occurs
where
sanitation
is poor
Lowest
incidence
of typhoid
in the
world-UK.
6 lakhs
deaths
world
wide
Resistant
strains
caused
outbreak
in India
10%
mortality if
not
treated.
India
Typhoid fever
is endemic in
India
1% of
children of
urban slum
suffer from
typhoid fever
every year.
417 deaths in
2005.
Epidemiological determinants
pathogenesis
Localization in
spleen, liver,
bone marrow,
sec. bacterimia
Circulation,
primary
bacterimia
Lymphatic
channel
Entry in GIT
Acute non-complicated
disease
Complicated disease
GIT: occult blood in
10-20% of patients,
and malena in up to
3%. Intestinal
perforation has also
been reported in up
to 3% of hospitalized
cases.
CNS:
Encephalopathy,
Typhoid meningitis,
encephalomyelitis,
Guillain-Barré
syndrome, cranial or
peripheral neuritis
and psychotic
symptoms
Others: Hepatitis,
myocarditis,
pneumonia,
disseminated
intravascular
Laboratory diagnosis of
typhoid
1)Microbiological procedure
• Isolation of bacilli from blood, bone marrow & stools
2)Serological procedure
• Felix-Widal test
3)New diagnostic tests
• IDL Tubex, typhidot,typhidot-M,
Treatment of uncomplicated
typhoid
Treatment of severe typhoid
Oral drugs
Control of typhoid fever
Relapse


5-20% of typhoid fever cases that have
apparently been treated successfully.
A relapse is heralded by the return of fever
soon after the completion of antibiotic
treatment. The clinical manifestation is
frequently milder than the initial illness.
Cultures should be obtained and standard
treatment should be administered.
Vaccination




Vi polysaccharide, is given in a single dose
Protection begins seven days after injection,
maximum protection being reached 28 days after
injection when the highest antibody concentration is
obtained.
Protective efficacy was 72% one and half years after
vaccination and was still 55% three years after a
single dose.
live oral vaccine Ty2la

three doses two days apart on an empty stomach.

Protection as from 10-14 days after the third dose.

> 5 years.

Antibiotics should be avoided for seven days before
or after the immunization
The future of typhoid
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