As of 2019 estimates, there are 9 million cases of typhoid fever annually, resulting in about 110 000 deaths per year according to WHO.
What is Typhoid Fever?
Typhoid fever (also known as enteric fever) is a severe systemic infection caused by the Gram-negative bacterium Salmonella typhi.
Epidemiology
Improved living conditions and the introduction of antibiotics resulted in a drastic reduction of typhoid fever morbidity and mortality in industrialized countries.
However, the disease continues to be a public health problem in many developing areas of the WHO African, Eastern Mediterranean, South-East Asia and Western Pacific Regions.
As of 2019 estimates, there are 9 million cases of typhoid fever annually, resulting in about 110 000 deaths per year.
Typhoid risk is higher in populations that lack access to safe water and adequate sanitation, and children are at highest risk.
{Source: WHO}
Causes of Typhoid fever
- Taking contaminated water or food
- Poor hygiene
- Oral or anal intercourse with an individual with Salmonella typhi bacterium
- Decreased stomach pH due to excess usage of antacids, proton pump inhibitors, histamine-2 receptor antagonists (H2 blockers); gastrectomy, and achlorhydria
Pathophysiology
Typhoid fever is transmitted by the fecal-oral route, typically through contaminated food and water.
Organisms exclusively infect people; thus, transmission occurs by infected excreta from a human with typhoid or through a carrier. Typhoid is most commonly transmitted by polluted water, although shellfish picked from sewage-contaminated beds and fresh vegetables fertilized with night soil are high-risk diets. The incubation period ranges from 10 to 21 days.
Unless there is achlorhydria, the disease is usually caused by the ingestion of a high number of organisms. Organisms are absorbed in the gut and transferred to the liver and spleen via the bloodstream. They are released into the bloodstream after 10 to 14 days causing symptoms.
The organisms are found in the small intestine’s lymphoid tissue, which is prone to bleeding and perforation. This is the leading cause of death from typhoid disease.
Most people with typhoid will expel organisms at some point during their disease. Approximately 10% of typhoid fever patients excrete the organisms for three months after the acute stage, whereas 2–5% become long-term carriers if not treated. The likelihood of being a carrier increases with age, particularly in females.
Clinical Manifestations
- Rising fever
- Severe headache
- Constipation
- Dry coughs
- Abdominal tenderness with or without hepatomegaly and splenomegaly
- Decreased pulse rate
- Diarrhea may develop later, together with bronchitis; the patient may also show signs of confusion.
- Weakness, dehydration, and most commonly intestinal bleeding and perforation.
- Septicemia
Assessment and Diagnostic Findings
Blood culture is the most essential way of diagnosis. The organism is more likely to be isolated from the feces during the second and third weeks of illness. In rare circumstances, isolating bacteria from urine can be utilized as a diagnostic procedure.
Medical Management
Medical management of typhoid fever typically involves a combination of antibiotics, supportive care, and prevention measures.
1. Antibiotics: Antibiotics are the primary treatment for typhoid fever. Fluoroquinolones (like ciprofloxacin), cephalosporins (like ceftriaxone), and azithromycin are some of the most often used antibiotics. The choice of antibiotic may be influenced by factors such as sickness severity, area antibiotic resistance patterns, and individual patient characteristics.
2. Supportive Care: Supportive care aims to relieve symptoms and prevent complications. This may include:
- Adequate hydration: Drinking plenty of fluids to prevent dehydration, especially if there’s vomiting or diarrhea.
- Nutritional support: Eating a balanced diet to maintain strength and aid recovery.
- Fever management: Using antipyretic medications (such as acetaminophen) to reduce fever and discomfort.
- Rest: Getting plenty of rest to aid recovery and conserve energy.
3. Monitoring: Patients with typhoid fever should be closely monitored for complications and treatment outcomes. This could include regular check-ups with healthcare providers, monitoring of vital signs (such as temperature, heart rate, and blood pressure), and laboratory tests (such as blood tests to monitor for problems or assess response to therapy).
4. Prevention Measures: Prevention of typhoid fever involves both individual and community-level interventions, including:
- Vaccination: Vaccines are available to prevent typhoid fever. These include oral live attenuated vaccines and injectable Vi polysaccharide vaccines. Vaccination is recommended for travelers to high-risk areas and individuals at increased risk of exposure.
- Hygiene and sanitation: Practicing good hygiene, such as washing hands regularly with soap and water, and ensuring access to clean water and proper sanitation facilities can help prevent the spread of typhoid fever.
- Food safety: Avoiding consumption of contaminated food or water, particularly in areas with poor sanitation or hygiene practices.
5. Isolation and Infection Control: Patients with typhoid fever should be isolated to prevent the spread of the infection to others. Healthcare providers and close contacts should follow appropriate infection control measures, including hand hygiene and wearing personal protective equipment.
Nursing Management
The nursing management of typhoid fever involves implementing the nursing process, which consists of assessment, diagnosis, planning, implementation, and evaluation. Here’s how each step of the nursing process can be applied to the management of typhoid fever:
1. Assessment:
- Perform a thorough assessment of the patient’s medical history, including recent travel to endemic areas, exposure to contaminated food or water, and symptoms such as fever, abdominal pain, and diarrhea.
- Conduct a physical examination to assess vital signs, hydration status, abdominal tenderness, and other signs of systemic illness.
- Obtain relevant laboratory tests, including blood cultures, complete blood count (CBC), and electrolyte levels to confirm the diagnosis and assess for complications.
2. Diagnosis:
Nursing diagnoses for a patient with typhoid fever may include:
- Risk for fluid volume deficit related to vomiting, diarrhea, and fever.
- Impaired Nutrition less than body requirements related to anorexia and decreased oral intake.
- Hyperthermia related to the pyrogenic effect of the infection.
- Risk for Infection related to exposure to contaminated food or water.
3. Planning:
- Develop a comprehensive care plan in collaboration with the healthcare team and the patient.
- Set realistic and measurable goals, such as maintaining adequate hydration, promoting nutritional intake, reducing fever, and preventing complications.
- Prioritize nursing interventions based on the identified nursing diagnoses and patient needs.
4. Nursing Intervention
- Provide supportive care to address the patient’s needs, including:
- Administering prescribed antibiotics as per schedule and monitoring for any adverse reactions.
- Encouraging oral or intravenous fluid intake to maintain hydration status.
- Offering small, frequent meals that are easy to digest and rich in nutrients.
- Administering antipyretic medications as prescribed to reduce fever.
- Implementing infection control measures to prevent the spread of the infection.
- Educating the patient and family members about the importance of hand hygiene, food safety, and adherence to treatment.
- Providing emotional support and reassurance to alleviate anxiety and promote coping.
5. Evaluation:
- Regularly reassess the patient’s condition and response to treatment, including vital signs, hydration status, and resolution of symptoms.
- Evaluate progress towards achieving the established goals and modify the care plan as needed.
- Collaborate with other members of the healthcare team to ensure continuity of care and appropriate follow-up after discharge.