Understanding Typhoid Fever: Symptoms, Causes, and Treatment

What is Typhoid Fever

It is an intestinal infectious disease characterized by fever, diarrhoea, and rash. It is caused by the bacterium, Salmonella typhi. Salmonella is a gram-negative bacillus. It is a potentially fatal multi-systemic illness when left untreated. It is an acute systemic bacterial disease caused by Salmonella typhi.

Incubation Period

It has an incubation period of 8 to 14 days.

Pathophysiology of Typhoid Fever

Following ingestion of contaminated food or water, the bacteria invade the wall of the gastrointestinal tract. The bacteria then localize and multiply in the mesenteric lymph nodes and the masses of lymph tissues in the mucous membrane of the intestinal wall (intestinal lymph nodes) called peyer’s patches. Macrophages in the intestines try to stop the spread of the bacteria by phagocytosis. The bacteria resist destruction and continue to multiply within the phagocytes. The bacilli cause inflammation of the aggregated lymph nodes known as peyer’s patches. The lymphatic tissues or peyer’s patches undergo necrosis and then sloughing. When the lymphatic tissues slough and become separated, it causes bleeding, ulceration and perforation of the intestinal wall. Eventually, the bacilli escape from the infected lymphoid tissues and spread via the bloodstream causing bacteremia and establishment in other organs of the body.

Signs & Symptoms of Typhoid Fever

The course of untreated typhoid fever is divided into four stages, with each stage lasting for a week.

1. The first week is the prodromal stage.
2. The second week is when rash manifests.
3. The third week is when diarrhea sets in.
4. The fourth week is when complications set in.

1st Week (Prodromal Stage)

• Fever which rises gradually to 400C in a step-ladder fashion at an incremental rate of 0.50C
• Profuse sweating
• Loss of appetite
• Non-productive cough
• Severe headache
• Malaise
• Nausea and vomiting
• Restlessness
• Joint pain (arthralgia)
• Muscle pain (myalgia)
• Bradycardia

2nd Week

• Fever remains consistently high
• Abdominal distention, pain and tenderness
• Constipation
• Delirium, confusion
• Weakness
• Lethargy and drowsiness
• Rose spots (flat rashes) all over the body, especially on the chest and abdomen. Each spot disappears within a period of 3 to 4 days.
• Splenomegaly
• Hepatomegaly

3rd Week

• Fever subsides
• Diarrhoea with pea soup stools. Stools may contain blood
• Weak, rapid pulse
• Weight loss
• Sunken eyes
• Fatigue, weakness

4th Week (Complications)

• Intestinal bleeding
• Intestinal perforation
• Septicaemia
• Peritonitis
• Endocarditis
• Kidney failure

Diagnostic Investigations & Test

• Blood for culture and sensitivity
• Stool for culture and sensitivity
• Urine for culture and sensitivity
• Erythrocyte sedimentation rate (ESR) for inflammation
• Abdominal X-ray for edematous and gaseous distension of the small and large intestines.
• Widal test – measures agglutinating antibodies (rise in titers) to the antigen (Salmonella). This is not reliable since it may give false results due to the varied subspecies of Salmonella.

Typhoid Fever Treatment

• Antibiotics such as Amoxicillin, Ciprofloxacin, Co-trimoxazole, Ceftriaxone, Chloramphenicol
• Intravenous fluids
• Antipyretics
• Analgesics

Nursing Management of Typhoid Fever

The following are the measures to put in place in the care of patient's with Typhoid Fever

Observations

• Monitor fluid intake and output to know fluid and electrolyte status.
• Observe and record the colour, consistency, and odour of patient’s stools.
• Observe and record vomitus.
• Observe and record urine.
• Monitor and record vital signs.
• Administer and record prescribed drugs.

Nutrition

• Serve copious nourishing fluids or semi-fluid diet when vomiting subsides and client can tolerate oral fluids
• Serve food high in calories and protein
• Serve easily digestible foods
• Avoid spicy foods due to GIT irritation
• Serve high residue diet due to constipation
• Encourage intake of fluids or water

Protection

• Isolation and barrier nursing should be ensured
• Raise the bedside rails of clients who are delirious and confused to prevent falls.
• Nurse clients on low beds to prevent falls and injuries
• Clear away sharp objects from patient’s environment due to the delirium
• Clear away slippery objects from patient’s environment and wipe all water on the floor
• Disinfect faeces, urine, and vomitus before disposal
• Nurses should practice infection prevention measures such as proper hand washing and wearing of gloves

Personal hygiene

• Ensure adequate personal hygiene by encouraging and assisting client to bath twice daily.
• Clean client’s skin with soap and antiseptic solution after each defaecation and vomiting.
• Clean skin folds and the perineum thoroughly

Education

• If patient has positive stool cultures on discharge, tell him/her to use a different bathroom and avoid eating uncooked foods such as salad prepared for the family.
• Advise prompt refrigeration of meat and cooked foods.
• Teach patient the importance of proper hand washing.
• Advise those at high risk of contracting typhoid (travellers, laboratory technicians) to seek vaccination.

Preventions of Typhoid Fever

• Control and inspection of people who handle food.
• Prevention of fly contamination.
• Purification of water.
• Proper sanitation and food hygiene.
• Health inspectors must be placed where food preparation for the public consumption takes place.
• Immunization against typhoid fever.