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
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
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
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.
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
Chest congestion resulting in Shortness of breath
Meningitis in severe cases , complication of typhoid fever, pt. becomes unable to move
93% in south Asian countries like Pakistan, India, Bangladesh
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.
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
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,
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