Pharmacotherapy of Typhoid Fever
PST 06106
Basic Pharmacotherapy
Session 10: Pharmacotherapy of Typhoid Fever
Learning Objectives
By the end of this session students are expected to be able to:
Define typhoid fever
Explain pathophysiology of typhoid fever
Explain the clinical presentation of typhoid fever
Outline diagnosis of typhoid fever
Describe pharmacological treatment of typhoid fever
Describe monitoring of typhoid fever therapy
Activity: Buzzing
is typhoid fever?
Definition of Typhoid Fever
Typhoid Fever
Typhoid fever, also called enteric fever, is caused by a bacterial infection with
Salmonella enterica
subspecies enterica serotype
Typhi
or serotypes
Paratyphi A, B or C
.
Infection is acquired through ingestion of contaminated food and water.
Humans are the only known hosts of
Salmonella Typhi
.
Bacteria are shed in the faeces of an infected person and transmitted from person to person via ingestion of food or water contaminated by these faeces (faecaloral route).
Definition of Typhoid Fever
Cont.….
Large outbreaks of typhoid fever are often associated with contamination of a drinking water.
Furthermore, the organism can survive for prolonged periods (up to several months) in contaminated foods
Pathophysiology Of Typhoid Fever
Once ingested and successfully beyond host defense mechanisms such as low gastric pH and bile salts, organisms can attach and invade the distal ileum and proximal colon.
Gastroenteritis often is characterized by massive neutrophil infiltration followed by lymphocytes and macrophages.
The serotypes that are responsible for human illness cause intestinal epithelial
cellsto
secrete interleukin 8, a potent neutrophil chemo-tactic factor.
Degranulation and release of toxic substances by neutrophils may contribute to inflammation and result in tissue damage, fluid secretion, or leakage across the intestinal mucosa
Clinical Presentation Of Typhoid Fever
Few clinical features reliably distinguish typhoid fever from other causes of febrile illnesses(temporary increase in average body temperature). Infection in the absence of treatment manifests after an average incubation period of 10-14 days (range 5-21 days) as a multistage febrile illness
.
Acute typhoid fever:
Systemic illness characterised by:
Fever: remittent during the first week, rising in a stepwise fashion and becomes sustained (lasting > 48 hours) after the first week.
Headache
Clinical Presentation Of Typhoid
Fever
Cont
….
Gastrointestinal symptoms including:
Abdominal pain/cramps
Nausea and vomiting (usually not severe), and/or
Constipation or diarrhoea (diarrhoea is more frequent in children and HIV infected adults).
Clinical presentation
cont.
…
Relative bradycardia
(slower heart rate)
Hepatosplenomegaly (23-65
%).——liver and spleen swell beyond normal size
Leukopenia (16-46
%).—— Low white blood count
Nonspecific symptoms, such as chills, diaphoresis, anorexia, cough, weakness, sore throat,
Dizziness, and muscle pains, are frequent before the onset of fever.
Severe illness and extra-intestinal complications may include;
gastrointestinal bleeding ,
intestinal perforation,
Septic shock or acidosis.
Blood culture is the diagnostic test of choice
Activity
: Small Group Discussion
is the first line treatment of Typhoid Fever??
Pharmacological Treatment Of Typhoid Fever
Monitoring of Typhoid fever Therapy
After therapy has been instituted, appropriate clinical parameters such as signs and symptoms and other laboratory markers should be monitored to ensure the efficacy and safety of the therapeutic regimen
Key
Points
It
is an acute systemic disease resulting from infection by Salmonella
typhi
and
S.paratyphi
,
serovar
group A and B respectively.
Infection is acquired through ingestion of contaminated food and water.
Patients may complain of nausea and vomiting followed by abdominal cramps, headache, fever, and diarrhea
Ciprofloxacin (PO) 500mg 12 hourly for 10 days
OR
Azithromycin (PO) Adult 500mg for 7 days can be used for treatment
Evaluation
What
is typhoid fever?
What is the pathophysiology of typhoid fever?
What are the signs and symptoms of acute typhoid fever?
How is the treatment of typhoid fever?
References
Wells
BG,
DiPiro
J,
Schwinghammer
T (2013),
Pharmacotherapy Handbook
(6
th
Ed). New York, NY: McGraw-Hill.
DiPiro
JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008):
Pharmacotherapy: A Pathophysiologic Approach
(7
th
ed
): New York, NY: McGraw-Hill.
Katz M D.,
Matthias KR.,
Chisholm-Burns M A.,
Pharmacotherapy(2011)
Principles & Practice Study Guide: A Case-Based Care Plan Approach
:
New York, NY: McGraw-Hill.
Schwinghammer
TL, Koehler JM (2009)
Pharmacotherapy Casebook: A Patient-Focused Approach
(7
th
ed
): New York, NY: McGraw-Hill.
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