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TYPHOID FEVER
2
ROAD MAP
• What is Typhoid Fever?
• Sources of infection
• Clinical signs & symptoms
• Problem statement
• Case study of typhoid fever
• MNT for typhoid fever
• Diet plan
• Conclusion
• References 3
TYPHOID FEVER
• An acute illness associated with fever caused by Salmonella
typhi or Salmonella enterica
• Salmonella paratyphi causes less severe illness – Paratyphoid
• Enteric Fever, Food & water- born illness
• Bacterium grows in the intestines and blood
4CDC, 2016
CAUSATIVE AGENT
• Bacterium Salmonella typhi, also
known as Salmonella enterica
• Grows in the intestines and blood
• Grows best at 37ºC
5
The Bacterium Salmonella
tyhpi
SOURCES OF INFECTION
Primary Sources
• Feces and urine of cases
and carriers
• Fecal carriers are more
frequent than urinary
carriers
Secondary Sources
• Contaminated
̵ Water
̵ Food
̵ Fingers
̵ Flies
6
CLINICAL SIGNS
• Headache, malaise, sore throat & anorexia
• Sustained fever as high as 103° to 104° F persisting for 4-5 days
• Bronchitis - cough is common
• Relative bradycardia
• Involvement of intestinal lymphoid tissues, macrophage system &
gall bladder
Danish, 2011 7
8
PROBLEM STATEMENT
Approx. 21 million cases &
0.2 million deaths worldwide
WHO, 2015
9
10
Common in developing world,
affecting 21.5 million people each
year
CDC, 2016
451.7 cases per 100,000
persons /year in Pakistan
WHO, 2008
11
CASE STUDY
Patient’s name: Shamim
Age: 42 years
Weight: 55 kg
Height: 5.3”
BMI: 21.5 kg/m2
Medical History: DM⁻ , HTN⁻ , IHD⁻
Presenting Complaint: Cough with sputum and fever from 7 days
12
LABORATORY FINDINGS
Tests Results Normal ranges Remarks
Total WBCs 13.2 * 10³/ µL 4-11 * 10³/ µL Leukocytosis
Neutrophils 86 % 40-70 % Neutrophilia
Lymphocytes 10% 20-40% Lymphocytopenia
Total RBCs 3.8 * 10⁶/µL 4-5.5 * 10⁶/µL Low
ESR 10 mm/1st h. Up-to 10 mm/1st hr. Borderline normal
ALT 27 U/I 0-41 U/I Normal
AST 22 U/I 8-40 U/I Normal
BP 90/60 mmHg 120/80 mmHg Hypotension 13
MEDICAL REPORTS
• Typhoid Report
IgG – Positive
IgM – Positive
Interpretation: Acute Typhoid fever (in middle state of infection)
• USG Report
Liver is minimally enlarged.
Echo pattern changes in liver could be fatty.
14
DIAGNOSIS
• Acute Bacterial Infection
• Acute Typhoid Fever (in middle stage of infection)
• Mild Hepatomegaly (in USG)
15
24 Hrs. DIETARY RECALL
Meals Foods
Breakfast 1 cup Tea + Biscuit (2-3)
Lunch 1 plate Mutton stock/Yakhni
Snack 1 Orange
Dinner ---
16
MEDICAL NUTRITION THERAPY
• Should be consisting of small and frequent meals
• High calorie, High Protein, Low residue diet
• Maintenance of water and electrolytes
• Oral Nutrition with a soft, easily digestible diet
• Immune boosting, Anti-inflammatory foods
17
WHY AVOID HIGH FIBER FOOD?
High fiber foods are restricted in typhoid fever because they
 Have increased stay time in stomach/intestine
 Can cause irritation/stress to damaged digestive system
 Provide favorable conditions for the bacterium to grow
18
PROGRESSIVE DIET
• During first few (2-3) days
Liquid diet - fresh fruit/vegetables juices, broths, electrolyte
solutions
• After few days, when appetite gets better
Soft/Bland diet - blended soups, boiled white rice, lentil
soups
• Gradual shifting to normal diet
19
Khosla , 2008
DIETARY REQUIREMENTS
• Total Energy Requirement = 1850 kcal/day
• Total Protein Requirement = 85 g
• Fluid requirement = 1925 mL or 7-8 glass/day
20
Strengthening
the immune
system
Reducing the
complications
Rapid
Recovery
Improved
quality of life
DIET PLAN
Meals Timings Foods
Before Breakfast 6:30 – 7:00 am ½ cup carrot juice (fresh & strained)
Breakfast 7:00 – 8:00 am
1 cup cooked/Blended porridge with 1 cup
skimmed milk
1 small banana
9:00 – 9:30 am
1 cup (250 mL) fresh seasonal fruit juice
(orange)
Mid morning
Snack
10:30 – 11:30 am
1 cup Tomato soup (garlic & ginger
added)/Black chickpea soup 21
Meals Timings Foods
Lunch 1:00 – 2:00 pm
Khichri ( 1 cup soft, boiled rice + ½ cup
split yellow gram/moong lentil), low spices
Afternoon At 3:30 pm
1 small cup of cinnamon ( ½ inch stick) +
ginger ( ½ inch) tea
Evening snack 4:30 – 5:00 pm Grapes/Jujube (1 cup whole)
Dinner 6:30 – 7:30 pm
1 bowl Chicken (4 oz., organic) & vegetable
soup (blended)
Post 8:00 – 9:00 pm
1 cup lukewarm, low fat milk + 1/2 tsp
flaxseed powder (OR) turmeric powder 22
FOOD CHOICES
ALLOWED RESTRICTED
Refined cereals, de-husked pulses Whole grains, whole pulses, pulses with husk
Soft fruits & well cooked fruits, vegetables in
soft and puree form
Raw fruits and vegetables, strongly flavored
vegetables cabbage, capsicum, turnip, radish
Skim milk, shakes, custard, buttermilk, yogurt Whole milk & whole milk products
Eggs, lean meats, fish, poultry (organic) Fatty meat, red meat, processed meat
Simple carbohydrates like jam, honey Fried fatty foods, chemical irritants
23
CONCLUSION
• Proper diet helps to reduce LSH by rapid recovery
• Dietary modifications help to minimize the weakness left by
typhoid fever
• Proper hygienic practices, drinking boiled water
• Proper washing of fruits and vegetables, proper cooking
practices
24
REFERENCES
• CDC (2016) Typhoid Fever, Accessed from https://www.cdc.gov/typhoid-
fever/index.html
• Danish I (2011) Short Text Book of Medical Diagnosis & Management, 11th
ed., Pakistan: Paramount Books (Pvt.) Ltd
• WHO (2015) Typhoid, Immunization, Vaccines and Biologicals, Accessed
from http://www.who.int/immunization/diseases/typhoid/en/
• Khosla SN (2008) Typhoid Fever Its Cause, Transmission And Prevention,
New Delhi, India: Atlantic Publishers & Distributers
• Ochiai RL, Acosta CJ, Danovaro-Holliday MC, Baiqing D, Bhattacharya SK,
(2008) A study of typhoid fever in five Asian countries: disease burden and
implications for controls, pp 260-268. 25
Typhoid fever

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Typhoid fever

  • 1. 1
  • 3. ROAD MAP • What is Typhoid Fever? • Sources of infection • Clinical signs & symptoms • Problem statement • Case study of typhoid fever • MNT for typhoid fever • Diet plan • Conclusion • References 3
  • 4. TYPHOID FEVER • An acute illness associated with fever caused by Salmonella typhi or Salmonella enterica • Salmonella paratyphi causes less severe illness – Paratyphoid • Enteric Fever, Food & water- born illness • Bacterium grows in the intestines and blood 4CDC, 2016
  • 5. CAUSATIVE AGENT • Bacterium Salmonella typhi, also known as Salmonella enterica • Grows in the intestines and blood • Grows best at 37ºC 5 The Bacterium Salmonella tyhpi
  • 6. SOURCES OF INFECTION Primary Sources • Feces and urine of cases and carriers • Fecal carriers are more frequent than urinary carriers Secondary Sources • Contaminated ̵ Water ̵ Food ̵ Fingers ̵ Flies 6
  • 7. CLINICAL SIGNS • Headache, malaise, sore throat & anorexia • Sustained fever as high as 103° to 104° F persisting for 4-5 days • Bronchitis - cough is common • Relative bradycardia • Involvement of intestinal lymphoid tissues, macrophage system & gall bladder Danish, 2011 7
  • 8. 8
  • 9. PROBLEM STATEMENT Approx. 21 million cases & 0.2 million deaths worldwide WHO, 2015 9
  • 10. 10 Common in developing world, affecting 21.5 million people each year CDC, 2016
  • 11. 451.7 cases per 100,000 persons /year in Pakistan WHO, 2008 11
  • 12. CASE STUDY Patient’s name: Shamim Age: 42 years Weight: 55 kg Height: 5.3” BMI: 21.5 kg/m2 Medical History: DM⁻ , HTN⁻ , IHD⁻ Presenting Complaint: Cough with sputum and fever from 7 days 12
  • 13. LABORATORY FINDINGS Tests Results Normal ranges Remarks Total WBCs 13.2 * 10³/ µL 4-11 * 10³/ µL Leukocytosis Neutrophils 86 % 40-70 % Neutrophilia Lymphocytes 10% 20-40% Lymphocytopenia Total RBCs 3.8 * 10⁶/µL 4-5.5 * 10⁶/µL Low ESR 10 mm/1st h. Up-to 10 mm/1st hr. Borderline normal ALT 27 U/I 0-41 U/I Normal AST 22 U/I 8-40 U/I Normal BP 90/60 mmHg 120/80 mmHg Hypotension 13
  • 14. MEDICAL REPORTS • Typhoid Report IgG – Positive IgM – Positive Interpretation: Acute Typhoid fever (in middle state of infection) • USG Report Liver is minimally enlarged. Echo pattern changes in liver could be fatty. 14
  • 15. DIAGNOSIS • Acute Bacterial Infection • Acute Typhoid Fever (in middle stage of infection) • Mild Hepatomegaly (in USG) 15
  • 16. 24 Hrs. DIETARY RECALL Meals Foods Breakfast 1 cup Tea + Biscuit (2-3) Lunch 1 plate Mutton stock/Yakhni Snack 1 Orange Dinner --- 16
  • 17. MEDICAL NUTRITION THERAPY • Should be consisting of small and frequent meals • High calorie, High Protein, Low residue diet • Maintenance of water and electrolytes • Oral Nutrition with a soft, easily digestible diet • Immune boosting, Anti-inflammatory foods 17
  • 18. WHY AVOID HIGH FIBER FOOD? High fiber foods are restricted in typhoid fever because they  Have increased stay time in stomach/intestine  Can cause irritation/stress to damaged digestive system  Provide favorable conditions for the bacterium to grow 18
  • 19. PROGRESSIVE DIET • During first few (2-3) days Liquid diet - fresh fruit/vegetables juices, broths, electrolyte solutions • After few days, when appetite gets better Soft/Bland diet - blended soups, boiled white rice, lentil soups • Gradual shifting to normal diet 19 Khosla , 2008
  • 20. DIETARY REQUIREMENTS • Total Energy Requirement = 1850 kcal/day • Total Protein Requirement = 85 g • Fluid requirement = 1925 mL or 7-8 glass/day 20 Strengthening the immune system Reducing the complications Rapid Recovery Improved quality of life
  • 21. DIET PLAN Meals Timings Foods Before Breakfast 6:30 – 7:00 am ½ cup carrot juice (fresh & strained) Breakfast 7:00 – 8:00 am 1 cup cooked/Blended porridge with 1 cup skimmed milk 1 small banana 9:00 – 9:30 am 1 cup (250 mL) fresh seasonal fruit juice (orange) Mid morning Snack 10:30 – 11:30 am 1 cup Tomato soup (garlic & ginger added)/Black chickpea soup 21
  • 22. Meals Timings Foods Lunch 1:00 – 2:00 pm Khichri ( 1 cup soft, boiled rice + ½ cup split yellow gram/moong lentil), low spices Afternoon At 3:30 pm 1 small cup of cinnamon ( ½ inch stick) + ginger ( ½ inch) tea Evening snack 4:30 – 5:00 pm Grapes/Jujube (1 cup whole) Dinner 6:30 – 7:30 pm 1 bowl Chicken (4 oz., organic) & vegetable soup (blended) Post 8:00 – 9:00 pm 1 cup lukewarm, low fat milk + 1/2 tsp flaxseed powder (OR) turmeric powder 22
  • 23. FOOD CHOICES ALLOWED RESTRICTED Refined cereals, de-husked pulses Whole grains, whole pulses, pulses with husk Soft fruits & well cooked fruits, vegetables in soft and puree form Raw fruits and vegetables, strongly flavored vegetables cabbage, capsicum, turnip, radish Skim milk, shakes, custard, buttermilk, yogurt Whole milk & whole milk products Eggs, lean meats, fish, poultry (organic) Fatty meat, red meat, processed meat Simple carbohydrates like jam, honey Fried fatty foods, chemical irritants 23
  • 24. CONCLUSION • Proper diet helps to reduce LSH by rapid recovery • Dietary modifications help to minimize the weakness left by typhoid fever • Proper hygienic practices, drinking boiled water • Proper washing of fruits and vegetables, proper cooking practices 24
  • 25. REFERENCES • CDC (2016) Typhoid Fever, Accessed from https://www.cdc.gov/typhoid- fever/index.html • Danish I (2011) Short Text Book of Medical Diagnosis & Management, 11th ed., Pakistan: Paramount Books (Pvt.) Ltd • WHO (2015) Typhoid, Immunization, Vaccines and Biologicals, Accessed from http://www.who.int/immunization/diseases/typhoid/en/ • Khosla SN (2008) Typhoid Fever Its Cause, Transmission And Prevention, New Delhi, India: Atlantic Publishers & Distributers • Ochiai RL, Acosta CJ, Danovaro-Holliday MC, Baiqing D, Bhattacharya SK, (2008) A study of typhoid fever in five Asian countries: disease burden and implications for controls, pp 260-268. 25

Notas do Editor

  1. A group of organisms, microorganisms, or cells distinguished by their shared specific antigens as determined by serologic testing Enteric fever is the generic term for infection caused by Salmonella typhi or paratyphi which cause typhoid and paratyphoid respectively. Salmonella typhi and paratyphi species belongs to the group Enterobacteriaceae. The organism live in the intestine(enteron) and cause the fever hence is called as enteric fever The etymology of this name is derived from enteros which means the intestine. The bacteria usually enter through contaminated food or drink and invade the intestine as a first event from which they enter the bloodstream causing fever…. hence the name Enteric fever.
  2. A small number of persons, called carriers, recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed Salmonella Typhi in their feces (stool). Ingestion of raw or undercooked meat, poultry, fish, eggs, unpasteurized dairy products; unwashed fruits and raw vegetables
  3. Chest congestion resulting in Shortness of breath Meningitis in severe cases , complication of typhoid fever, pt. becomes unable to move
  4. 93% in south Asian countries like Pakistan, India, Bangladesh
  5. Leukocytosis occurs in first 10 days,,, high neutrophils and low lymphocytes shows acute bacterial infection. As the disease progresses leukopenia occurs, showing weakness of immune system with lymphocytosis and neutropenia.
  6. High sweating, High temperature -> chances of dehydration, mineral loss -> increase fluid/electrolyte monitoring -> ORS/Glu. Soln. Increased muscle degeneration -> protein loss/breakdown -> high proteins given + high fluids because ammonia is formed, requires water for excretion Fat and fiber causes irritation to GIT
  7. S. typhi resides in intestines, causes lesions, and high fiber causes disturbance to already damaged GIT, also bacterial stay time increases bcz fiber forms gel,
  8. Liquid diet: strained, coconut water, barley water and ORS/glucose soln. Soft diet : baked potato, banana, poached egg, yogurt, etc. Semi-solid diet: plenty of fruits and vegetables, high in fluid/electrolytes