The Nursing Assessment of Thypoid Fever

TYPHOID FEVER
 Usually, Salmonellae typhi bacteria causes typhoid fever.

 People contract typhoid fever by ingesting contaminated
food or water.
 Diagnosis of typhoid fever is made when
the Salmonella bacteria is detected with a stool culture.
 Antibiotics treat typhoid fever.
 Typhoid fever symptoms are
o poor appetite,
o headaches,
o diarrhea,
o generalized aches and pains,
o fever, and
o lethargy.
 Approximately 3%-5% of patients become carriers of the
bacteria after the acute illness.
Typhoid Fever Prevention
Typhoid fever is an acute febrile illness caused by the bacterium Salmonella typhi. It is
spread by contaminated food and water. Although quite common at one time in the
U.S., it is very rare today. Most cases are in people who have traveled outside the U.S.
Worldwide, the disease affects 13 million people. People who are traveling to areas
with high rates of typhoid fever should receive the vaccine prior to leaving the U.S.
Travelers should consult the CDC web site for specific recommendations depending on
the countries they plan to visit (http://wwwn.cdc.gov/travel/).
What is typhoid fever?
What is the history of typhoid fever?

Typhoid fever is an acute infectious illness associated with fever
that is most often caused by the Salmonella
typhi bacteria. Salmonella paratyphi, a related bacterium that
usually leads to a less severe illness, can also cause typhoid fever.
The feces of human carriers of the bacteria may contaminate
water or food, and the illness then spreads to other people in the
area. Typhoid fever is rare in industrial countries but continues to
be a significant public health issue in developing countries.
The incidence of typhoid fever in the United States has decreased

since the early 1900s. In 2014, medical professionals reported
approximately 300 cases to the CDC, mostly in people who
recently traveled to endemic areas. This is in comparison to the
1920s, when there were over 35,000 reported cases in the U.S.,
with a 20% fatality rate.
In the early 1900s, a healthy carrier called Typhoid Mary (her

real name was Mary Mallon) caused several outbreaks in the New
York City area; she was infected, worked as a cook, and
consequently spread the disease to others.
A recent outbreak affected refugees in Manus Island, Papua New

Guinea.
The decrease in cases in the United States is the result of

improved environmental sanitation, vaccination, and treatment
with antibiotics. Mexico and South America are the most common
areas for U.S. citizens to contract typhoid fever. India, Pakistan,
and Egypt are also known high-risk areas for developing this
disease. Worldwide, typhoid fever affects more than 21 million
people annually, with over 200,000 patients dying of the disease.
If traveling to endemic areas, you should consult with your health

care professional and discuss if you should receive vaccination for
typhoid fever.
How do patients get typhoid fever?

People contract typhoid fever when they ingestion the bacteria in
contaminated food or water. Patients with acute illness can
contaminate the surrounding water supply through stool, which
contains a high concentration of the bacteria. Contamination of
the water supply can taint the food supply. About 3%-5% of
patients become carriers of the bacteria after the acute illness.
Some patients suffer a very mild illness that goes unrecognized.
These patients can become long-term carriers of the bacteria. The
bacteria multiply in the gallbladder, bile ducts, or liver and passes
into the bowel. The bacteria can survive for weeks in water or
dried sewage. These chronic carriers may have no symptoms and
can be the source of new outbreaks of typhoid fever for many
years.
What causes typhoid fever?
How do health care

professionals diagnose typhoid fever?
After the ingestion of contaminated food or water,
the Salmonella bacteria invade the small intestine and enter the
bloodstream temporarily. White blood cells carry the bacteria to
the liver, spleen, and bone marrow. The bacteria then multiply in
the cells of these organs and reenter the bloodstream. Patients
develop symptoms, including fever, when the organism reenters
the bloodstream. Bacteria invade the gallbladder, biliary system,
and the lymphatic tissue of the bowel. Here, they multiply in high
numbers. The bacteria pass into the intestinal tract and can be
identified for diagnosis in cultures from the stool tested in the
laboratory. Stool cultures are sensitive in the early and late stages
of the disease, but it may be necessary to perform blood cultures
to make a definitive diagnosis.
What are the signs and symptoms of typhoid

fever?
The incubation period is usually 1-2 weeks, and the duration of
the illness is about 4-6 weeks. The patient experiences
 poor appetite;
 abdominal pain and peritonitis;
 headaches;
 generalized aches and pains and weakness;
 high fever, often up to 104 F;
 lethargy (usually only if untreated);
 intestinal bleeding or perforation (after 2-3 weeks of the
disease);
 cough;
 diarrhea; or
 constipation.
People with typhoid fever usually have a sustained fever as high as

103 F-104 F (39 C-40 C).
Chest congestion develops in many patients, and abdominal

pain and discomfort are common. The fever becomes constant.
Improvement occurs in the third and fourth week in those
without complications. About 10% of patients have recurrent
symptoms (relapse) after feeling better for 1-2 weeks. Relapses
are actually more common in individuals treated with antibiotics.
Typhoid FeverSee pictures of Bacterial Skin ConditionsSee Images
What is the treatment for typhoid fever,

and what is the prognosis?
Antibiotics that kill the Salmonella bacteria treat typhoid fever.
Prior to the use of antibiotics and intravenous fluids, the fatality
rate was 20%. Death occurred from overwhelming
infection, pneumonia, intestinal bleeding, or intestinal perforation.
Antibiotics and supportive care have reduced the mortality rate
to 1%-2%. With appropriate antibiotic therapy, there is usually
improvement within one to two days and recovery within 7 to 10
days.
Several antibiotics are effective for the treatment of typhoid

fever. Chloramphenicol was the original drug of choice for many
years. Because of rare serious side effects, other effective
antibiotics have replaced chloramphenicol. The choice of
antibiotics needs to be guided by identifying the geographic region
where the organism was acquired and the results of cultures once
available. (Certain strains from South America show a significant
resistance to some antibiotics.) Ciprofloxacin (Cipro) is the most
frequently used drug in the U.S. for nonpregnant patients.
Ceftriaxone (Rocephin), an intramuscular injection medication, is
an alternative for pregnant patients. Ampicillin (Omnipen,
Polycillin, Principen) and trimethoprim (Bactrim, Septra) are
frequently prescribed antibiotics although resistance has been
reported in recent years.
Medical professionals have reported multi-drug resistance and use

cultures to guide treatment. If relapses occur, patients are
retreated with antibiotics.
Prolonged antibiotics can treat the carrier state, which occurs in
3%-5% of those infected. Often, removal of the gallbladder, the
site of chronic infection, will cure the carrier state.
What specialists treats typhoid fever?

Your primary care doctor can diagnose and treat typhoid fever.
Because the disease is very rare in the United States, an infectious
disease specialist often assists in the care of the patient with
typhoid fever, as well.
Is typhoid fever contagious?

Typhoid fever is very contagious and contracted by the ingestion
of the bacteria in contaminated food or water. Patients with
acute illness can contaminate the surrounding water supply
through infected stool, which contains a high concentration of the
bacteria. It does not spread through the air (by cough) or by
touching (assuming there is no fecal exchange or first bacterial
ingestion).
Is it possible to prevent typhoid fever?

For those traveling to high-risk areas, typhoid vaccines are now
available. The routine administration of the vaccine is usually not
recommended in the U.S. There are two forms of the vaccine
available, an oral and an injectable form. People need to complete
the vaccination at least 1-2 weeks (depending on the type of
vaccine) prior to travel and, depending on the type of vaccine. The
vaccine only protects from 2 to 5 years. The oral vaccine is
contraindicated in patients with depressed immune systems.
Details of the vaccination and the choice of vaccine should be
discussed with a health care professional.
THENURSING ASSESMENT OF TYPHOID FEVER
Four areas that should be assessed :

1. History of disease :
a. Past history
b. Current history
c. Family history
2. Physical assessment
3. Diagnostic evaluation
4. Laboratory study

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TYPHOID FEVER

 Usually, Salmonellae typhi bacteria causes typhoid fever.

Typhoid Fever Prevention

What is the history of typhoid fever?

The incidence of typhoid fever in the United States has decreased

In the early 1900s, a healthy carrier called Typhoid Mary (her

A recent outbreak affected refugees in Manus Island, Papua New

The decrease in cases in the United States is the result of

If traveling to endemic areas, you should consult with your health

How do patients get typhoid fever?

What causes typhoid fever?

How do health care

What are the signs and symptoms of typhoid

People with typhoid fever usually have a sustained fever as high as

Chest congestion develops in many patients, and abdominal

Typhoid FeverSee pictures of Bacterial Skin ConditionsSee Images

What is the treatment for typhoid fever,

Several antibiotics are effective for the treatment of typhoid

Medical professionals have reported multi-drug resistance and use

What specialists treats typhoid fever?

Is typhoid fever contagious?

Is it possible to prevent typhoid fever?

THENURSING ASSESMENT OF TYPHOID FEVER

Four areas that should be assessed :

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