TYPHOID FEVER

1. TYPHOID FEVER Abad, Mary Raina Angeli Z. Iewida, Samira Yaser P. Lameda, Randall M. HUB 42

2. What are Water-Borne Diseases? • Diseases that are supported, carried or transmitted by water. • Examples are: Cholera, Hepatitis A, Amoebic Dysentery, Brainerd Diarrhea & Typhoid Fever

3. What is Typhoid Fever? • Typhoid Fever is an acute systemic illness characterized by fever, headache and abdominal discomfort. • Also known as Enteric Fever or commonly just typhoid.

4. What causes Typhoid Fever? • Typhoid Fever is caused by the bacterium Salmonella typhi from the family Enterobacteriacea. • Salmonella typhi is a gram-negative bacteria that is motile due to its peritrichous flagella. • The bacteria grows best at 37°C.

6. Color pink therefore Gram-negative With peritrichous flagella

7. It can also be caused bySalmonella paratyphi, a related bacterium that usually causes a less severe illness known as Paratyphoid Fever.

8. Epidemiology • Typhoid Fever is common worldwide but is more prevalent in areas of developing countries lacking adequate waste disposal and clean drinking water facilities. • Humans are the only host for S. typhi.

9. Estimated 16-33 million cases annually resulting in 500,000 to 600,000 deaths in endemic areas • WHO identifies typhoid as a serious health problem • Incidence is highest in children and young adults between 5 to 19 years old.

11. Cases of Typhoid Fever in the Philippines Data taken from an official report done by the DOH the Republic of the Philippines: http://www2.doh.gov.ph/data_stat/html/fhsis/nd_byear.pdf

12. Cases of Typhoid Fever in Philippines & Japan • Statistics obtained from: www.WHO.int/en/

13. Mode of Transmission • S. typhi is most commonly transmitted through the fecal-oral route. • It can also be transmitted by ingestion of contaminated food or water.

14. Patients with typhoid can contaminate the water supply with their stool, where the bacteria flourish. • The food supply can become contaminated by infected stool or poor sanitation.

15. Some people, known as chronic carriers, still harbor typhoid bacteria, and can still contaminate food and water supplies even after receiving antibiotic treatment and proving to be free of symptoms.

16. How does the bacteria cause disease? Come in contact with infected individual or ingestion of contaminated food or water Salmonella bacteria penetrate the epithelial wall of the small intestine Phagocytosed by macrophages

17. S. typhi then alters its structure to resist destruction and allow them to exist within the macrophage Travels to the reticulo endothelial system and then to the different organs throughout the body Spread via the lymphatics while inside the macrophages

18. Goes back to thebloodstream accompanied with development of symptoms Salmonella bacteria may be passed out through the stool Cycle continues

19. Signs and Symptoms • Incubation period: around 10 to 14 days • High fever – around 39°C to 40°C • Profuse sweating and headache • Gastroenteritis • Nonbloody diarrhea

20. Poor appetite • Lethargy, weakness and fatigue • Generalized aches and pains • Abdominal pain and discomfort • Rash – rose-colored spots on the lower chest and upper abdomen

21. Rose Spots

22. Terminal Stage • Disturbance in consciousness • Muttering delirium • Coma vigil • Typhoid Psychosis • Intestinal bleeding • Death – 10% to 30% of untreated cases

23. Typhoid Terminal State

24. How is Typhoid Fever diagnosed? • Blood, bone marrow or stool cultures • Widal Test • ELISA – Enzyme-Linked Immunoabsorbent Assay • Fluorescent Antibody Test

25. How is Typhoid Fever treated? • Antibiotics – ampicillin, trimethoprim-sulfamethoxazole, amoxicillin and ciprofloxacin • Ceftriaxone, Azithromycin – antibiotics used for MDR typhoid (multidrug-resistant typhoid)

26. Chloramphenicol – original drug used to treat typhoid fever but was replaced because of many rare side effects

27. Vaccine against Typhoid • Vivotif Berna – oral Ty21a vaccine • Typhim Vi or Typherix – injectable Typhoid polysaccharide vaccine

28. How can Typhoid Fever be prevented? • Proper sanitation and hygiene • Careful food preparation and washing of hands • Avoid drinking untreated water • Avoid raw fruits and vegetables • Adequately clean household items

29. Public education campaigns encouraging people to wash their hands after defecating and before handling food are important components in controlling the spread of the disease.

30. According to CDC, chlorination of drinking water had led to dramatic decrease in the transmission of typhoid fever.

31. References • http://www.cdc.gov/ncidod/dbmd/diseaseinfo/typhoidfever_g.htm • http://www.cureresearch.com/t/typhoid_fever/stats-country.htm • http://deploymenthealthlibrary.fhp.osd.mil/products/Staying%20Healthy%20Guide-%20Soldiers%20Guide%20in%20the%20Philippines%20(Tri-fold)%20(133).pdf • http://www2.doh.gov.ph/data_stat/html/fhsis/typhoidfever.pdf • http://www.gmanews.tv/story/83222/Typhoid-cases-in-Laguna-decline-but-danger-not-yet-over---DOH • http://www.medicinenet.com/typhoid_fever/article.htm • http://www.medicalnewstoday/articles/156859.htm • http:// www.merriam-webster.com/dictionary/waterborne • http://pediatrics.uchicago.edu/chiefs/documents/typhoid.pdf • http://www.psmid.org/ph/vol21/vol21num2tpoic2.pdf • http://www.who.int/vaccines-documents/DocsPDF03/www740.pdf • http://www.who.int/vaccine_research/documents/en/typhoid_diagnosis.pdf • http://www.wpro.who.int/NR/rdonlyres/92EC0A38-6EA7-4BDA-B19E-C2E398D4724D/0/PHL.pdf

32. FIRST DAY

35. SECOND DAY

37. THANK YOU!!!