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Typhoid fever
[Contents & Participators]
INTRODUCTION: ABDUL RAFIQ
DIAGNOSIS: AZIZ ULLAH
SYMPTOMS: ZEESHAN HUSSAIN
TREATMENT: HAMZA AHMED BUTT
PREVENTION: MUHAMMAD ARSALAN
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INTRODUCTION
 Typhoid is a bacterial infection that can lead to a high fever,
diarrhea, and vomiting. It can be fatal.
 It is caused by the bacteria Salmonella typhi.
 Salmonella typhi is a gram- negative, rod-shaped, flagellated
bacterium whose only reservoir is the human body.
 It is a facultative anaerobe, meaning that it can survive in the
presence or absence of oxygen.
 Salmonellatyphi has a three-layer cell wall, consisting of an outer
membrane, a periplasm, and an inner membrane. The outer
membrane contains lipopolysaccharide (LPS), which is a major
virulence factor.
Carrying three types of antigens:
 Vi antigen: A capsular polysaccharide that protects Salmonella
typhi from the immune system.
● H antigen: A flagellar antigen that helps Salmonella typhi to
move.
● O antigen: A somatic antigen that is located on the surface of
the Salmonellatyphi cell wall.
Incubation period
10-15 days.
Transmission
 Spread through food, and drinking water that are contaminated
with infected fecal matter.
 Washing fruit and vegetables can spread it, if contaminated
water is used.
 It can spread through flies.
 Ingestion: The bacteria can be ingested through contaminated
food, water, or objects. Contaminated food can include raw or
undercooked meat, poultry, eggs, and dairy products.
Contaminated water can come from sources such as rivers,
lakes, and wells that are not properly treated. Contaminated
objects can include anything that has been in contact with the
feces of an infected person, such as utensils, dishes, and
doorknobs.
 Attachment: The bacteria attach to the lining of the small
intestine using a protein called fimbriae. The fimbriae help the
bacteria to adhere to the cells of the intestine.
 Multiplication: The bacteria multiply rapidly in the small
intestine. They can produce up to 1 billion new bacteria every 20
minutes.
 Release of toxins: The bacteria release toxins that damage the
lining of the intestine. These toxins can cause inflammation,
ulceration, and bleeding.
 Spread to other parts of the body: The bacteria can spread to
other parts of the body through the bloodstream. They can also
spread through the lymphatic system, which is a network of
vessels that carry lymph fluid throughout the body.
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History
 Ancient times: Typhoid fever has been around for centuries, and
it is believed to have been responsible for the plague that struck
Athens in 430 BC, killing one-third of the population.
 19th century: In 1837, William Budd, an English physician, was
the first to suggest that typhoid fever was spread through
contaminated water.
 1880: Karl Joseph Eberth, a German doctor, discovered the
bacterium that causes typhoid fever. The bacterium was named
Salmonella typhi.
 1884: Georg Gaffky, a German bacteriologist, isolated the
Salmonella typhi bacterium and grew it in a laboratory culture.
 1896: Almroth Edward Wright, an English bacteriologist,
developed the first typhoid vaccine.
 20th century: Typhoid fever was a major public health problem
in the early 20th century. However, improved sanitation and the
use of vaccines led to a significant decline in the incidence of the
disease.
 21st century: Typhoid fever is still a major public health problem
in developing countries, where sanitation is poor and access to
vaccines is limited. However, the incidence of the disease has
declined in developed countries.
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Symptoms
 The symptoms of typhoid fever usually develop 1 or 2 weeks
after a person becomes infected with the Salmonella typhi
bacteria.
 With treatment, the symptoms of typhoid fever should quickly
improve within 3 to 5 days.
 If typhoid fever isn’t treated, it’ll usually get worse over the
course of a few weeks, and there’s a significant risk of lifethreatening complications developing.
 Without treatment, it can take weeks – or even months – to fully
recover, and symptoms can return.
 The main symptoms of typhoid fever are:
 a persistent high temperature that gradually increases each day
 a headache
 general aches and pains
 extreme tiredness (fatigue)
 a cough
 constipation
 Later, as the infection progresses you may lose your appetite,
feel sick and have a tummy ache and diarrhoea. Some people
may develop a rash.
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Diagnosis
 Medical history and physical examination: The doctor will ask
about your symptoms, travel history, and risk factors for typhoid
fever. They will also perform a physical examination, looking for
signs of the disease such as fever, rash, and abdominal pain.
 Laboratory tests:The doctor may order a number of laboratory
tests to help diagnose typhoid fever. These tests may include:
 Blood culture: This test is the most accurate way to diagnose
typhoid fever. A sample of your blood is taken and placed in a
special culture medium where the bacteria can grow. If the
bacteria grow, it confirms that you have typhoid fever.
 Stool culture: This test is used to look for the bacteria in your
stool. It is not as accurate as a blood culture, but it can be helpful
if the blood culture is negative.
 Urine culture: This test is less commonly used to diagnose
typhoid fever.
 Bone marrow culture: This test is only used if the other tests are
negative. It is more invasive than the other tests, but it is also
more accurate.
 Serological tests: These tests look for antibodies to the typhoid
bacteria in your blood. Antibodies are proteins that your body
produces in response to an infection. A positive serological test
means that you have been exposed to the typhoid bacteria, but
it does not necessarily mean that you have typhoid fever.
 If you are diagnosed with typhoid fever, your doctor will
prescribe antibiotics to treat the infection. You will need to stay
in the hospital until the antibiotics have cleared the infection.
 Here are some additional things to keep in mind about the
diagnosis of typhoid fever:
 The symptoms of typhoid fever can be similar to other diseases,
such as malaria, dengue fever, and salmonellosis. This is why it
is important to see a doctor if you have any of the symptoms of
typhoid fever.
 The diagnosis of typhoid fever can be difficult, especially in the
early stages of the disease. This is because the bacteria may not
be present in the blood or stool cultures.
 There are a number of new diagnostic tests for typhoid fever
that are being developed. These tests are more accurate and
faster than the traditional tests.
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Treatment
 Activity rest is helpful
 Medical care
 Antibiotic
 Corticosterois (for severe typhoid fever) Antipyretics
 Diet fluid and electrolytes should be monitored. Soft digestible
diet is preferable in absence of abdominal distension and ileus
 Surgical care in cases of intestinal perforation.
 Medicines
 Antibiotic
 Chloramphenicol
 Ampicillin
 Typhoid is treated with antibiotics. Some newer types of the
bacteria are able to survive antibiotic treatments, so you’ll be
treated with different antibiotics depending on what type of
typhoid you have and where you got sick. Paratyphoid fever is
also treated with antibiotics.
 How are typhoid fever and paratyphoid fever treated?
 Antibiotics treat typhoid fever and paratyphoid fever.
 The danger from typhoid fever or paratyphoid fever doesn’t end
when symptoms disappear.
Even if your symptoms seem to go away, you may still be
carrying Salmonella Typhi or Salmonella Paratyphi. If so, the
illness could return, or you could pass the bacteria to other
people. Some people may not be able to return to work until a
doctor says they no longer carry the bacteria. These people
include healthcare workers, food handlers, and childcare
workers.
 If you are being treated for typhoid fever or paratyphoid fever,
these steps can lower the chance of passing the bacteria to
someone else.
 Keep taking antibiotics for as long as the doctor has
recommended.
 Wash your hands carefully with soap and water after using the
bathroom.
 Do not prepare or serve food for other people.
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Prevention
 Typhoid fever is common in places with poor sanitation and a
lack of safe drinking water. Access to safe water and adequate
sanitation, hygiene among food handlers and typhoid
vaccination are all effective in preventing typhoid fever.
 Typhoid conjugate vaccine, consisting of the purified Vi antigen
linked to a carrier protein, is given as a single injectable dose in
children from 6 months of age and in adults up to 45 years or 65
years (depending on the vaccine).
 Two additional vaccines have been used for many years in older
children and adults at risk of typhoid, including travellers. These
vaccines do not provide long-lasting immunity (requiring repeat
or booster doses) and are not approved for children younger
than 2 years old:
 An injectable vaccine based on the purified antigen for people
aged 2 years and above; and a live attenuated oral vaccine in
capsule formulation for people aged over 6 years.
 Two typhoid conjugate vaccines have been prequalified by WHO
since December 2017 and are being introduced into childhood
immunization programmes in typhoid endemic countries.
 All travellers to endemic areas are at potential risk of typhoid
fever, although the risk is generally low in tourist and business
centres where standards of accommodation, sanitation and food
hygiene are high. Typhoid fever vaccination should be offered to
travellers to destinations where the risk of typhoid fever is high.
 The following recommendations will help ensure safety while
travelling:
 Ensure food is properly cooked and still hot when served.
 Avoid raw milk and products made from raw milk. Drink only
pasteurized or boiled milk.
 Avoid ice unless it is made from safe water.
 When the safety of drinking water is questionable, boil it, or if
this is not possible, disinfect it with a reliable, slow-release
disinfectant agent (usually available at pharmacies).
 Wash hands thoroughly and frequently using soap, in particular
after contact with pets or farm animals, or after having been to
the toilet.
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Wash fruits and vegetables carefully, particularly if they are
eaten raw. If possible, vegetables and fruits should be peeled.
THANKS