Typhoid fever

Introduction of typhoid fever, its causative agent and sources of spread. Case study of typhoid fever. What kind of diet is given in typhoid fever.

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2. TYPHOID FEVER 2

3. ROAD MAP What is Typhoid Fever? Sources of infection Clinical signs & symptoms Problem statement Case study of typhoid fever MNT for t yphoid 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 4 CDC , 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 R elative bradycardia I nvolvement of intestinal lymphoid tissues, macrophage system & gall bladder Danish, 2011 7

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9. PROBLEM STATEMENT Approx. 21 million cases & 0.2 million deaths worldwide WHO, 2015 9

10. 10 Common in developing world, affecting 21.5 million people each year CDC, 2016

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/1 st h. Up-to 10 mm/1 st 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

16. 24 Hrs. DIETARY RECALL Meals Foods Breakfast 1 cup Tea + Biscuit (2-3) Lunch 1 plate Mutton stock/ Yakhni Snack 1 Orange Dinner --- 16

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

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 P roper 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