TYPHOID FEVER

• Typhoid fever


  A systemic infection characterized by continued fever, anorexia, involvement of lymphoid tissue, especially ulceration of Peyer's patches
• Etiologic agents


  Salmonella typhi or Typhoid bacillus
• Sources of infection


  • Feces and urine of infected persons
  • Contaminated urine
  • Direct/indirect contact with infected person
  • Ingestion of contaminated food, water and milk
• Incubation period


  1 to 3 weeks; average (2 weeks)
• Period of communicability


  As long as typhoid bacilli appears in excreta
• Clinical manifestations


  • Headache
  • Nausea/Vomiting
  • Ladder-like fever
  • Rose spots on the abdomen
  • Typhoid state (coma vigil, subsultus tendinum, carphologia, delirium)
• Complications


  • Hemorrhage/Perforation
  • Peritonitis
  • Bronchitis and pneumonia
  • Typhoid spine
  • Septicemia
  • Reiter's syndrome (joint pain, eye irritation)
• Diagnostic tests


  • Typhidot confirmatory
  • ELISA
  • Widal
  • Rectal swab
  • Bone marrow aspiration (identifies S. typhi)
• Treatment modalities


  • Chloramphenicol (drug of choice)
  • Ampicillin
  • Co-trimoxazole
  • Ciprofloxacin
  • Cefixime/Azithromycin
  • Ceftriaxone (for complicated cases)
• Nursing management


  • Isolation
  • Maintain standard precautions
  • Give nourishing fluids in small quantities
  • Monitor vital signs
  • Prevent further injury
  • Provide good skin and mouth care
  • Turn patient frequently and perform mild passive exercises
• Prevention and control


  • Sanitary and proper disposal of excreta
  • Proper supervision of food handlers
  • Enteric isolation
  • Provision of safe drinking water supply
  • Detection and supervision of typhoid carriers