Typhoid Fever — Causes, Symptoms, Diagnosis, Treatment, Nursing Management & Prevention
Typhoid fever (enteric fever) is a systemic bacterial infection caused primarily by Salmonella enterica serovar Typhi (commonly called Salmonella typhi). It remains an important public health problem in many low- and middle-income countries where safe water, sanitation and hygiene are limited. For nurses and nursing students, understanding the clinical features, diagnosis, treatment and nursing management of typhoid is essential — both for hospital care and community-level prevention. This article is written in simple, exam- and practical-friendly format with clear nursing priorities, file-ready checklists and patient teaching points.
Overview & Epidemiology
Typhoid is transmitted via the fecal–oral route: ingestion of water or food contaminated with feces from an infected person. Carriage can be transient or chronic (gallbladder carriers). Outbreaks occur where sanitation is poor and water supplies contaminated. While children and young adults are commonly affected, all age groups can become ill. The incubation period is typically 7–14 days but can range from 3–60 days based on dose and host factors.
Causative Agent & Mode of Transmission
Organism
The principal agent is Salmonella Typhi — a gram-negative bacillus. Closely related organisms (Salmonella Paratyphi A, B, C) can cause similar clinical syndromes (paratyphoid).
Transmission
- Fecal contamination of drinking water or food
- Poor hand hygiene after defecation
- Flies and food-handlers as mechanical vectors
- Chronic carriers (often asymptomatic) shedding bacteria in stool
Pathophysiology (Concise)
After ingestion, Salmonella Typhi survives gastric acidity, invades the intestinal mucosa (Peyer's patches), and enters the bloodstream via the reticuloendothelial system. Bacteremia disseminates the organism to liver, spleen and bone marrow. The immune response and bacterial toxins contribute to systemic symptoms such as prolonged fever, malaise and abdominal pain. In severe or prolonged disease, intestinal ulceration and perforation may occur.
Clinical Features — Signs & Symptoms
Typhoid often begins insidiously with:
- Gradually increasing high fever (step-ladder pattern)
- Headache, generalized body ache and malaise
- Loss of appetite, nausea; abdominal discomfort
- Constipation early; diarrhea may develop later (especially children)
- Coated (dirty) tongue, relative bradycardia (in some patients)
- Rose spots (faint salmon-pink maculopapular rash) on chest/abdomen — present in a minority
- Severe complications: intestinal bleeding, perforation, encephalopathy
Diagnosis — Lab & Bedside
Clinical suspicion is important in endemic areas. Confirmatory tests include:
- Blood culture: gold standard early in disease (first week) — yields organism in many cases.
- Stool/urine culture: useful later in illness and for carrier detection.
- Widal test: detects agglutinins; useful as supportive evidence but limited by false positives/negatives and prior vaccination.
- CBC: may show leukopenia; anemia can develop in prolonged illness.
- Other tests: LFTs, CRP, electrolytes for monitoring complications and response to therapy.
Differential Diagnosis
Consider malaria, dengue, viral hepatitis, leptospirosis, shigellosis, amoebic dysentery and other febrile illnesses; local epidemiology guides priorities.
Treatment — Medical & Nursing Roles
Medical treatment (antibiotics)
Choice of antibiotic depends on local sensitivity patterns (antimicrobial resistance is rising). Commonly used agents include:
- Azithromycin (oral)
- Ceftriaxone (IV) for severe disease or where resistance to fluoroquinolones is suspected
- Ciprofloxacin or other fluoroquinolones — use guided by sensitivity (resistance common in many areas)
Treatment duration is usually 7–14 days depending on severity and response. For chronic carriers, prolonged antibiotic courses or cholecystectomy in selected cases may be required.
Nursing responsibilities during treatment
- Administer antibiotics on time and monitor for adverse effects
- Ensure blood cultures obtained before antibiotic start
- Monitor fluid balance, vitals, and signs of complications (peritonitis, GI bleeding)
- Provide symptomatic care: antipyretics (paracetamol), sponge baths for high fever
- Encourage adequate oral intake; IV fluids if oral intake inadequate
Complications to watch for
- Intestinal hemorrhage (ulceration of Peyer's patches)
- Intestinal perforation — surgical emergency
- Severe sepsis / septic shock
- Encephalopathy, delirium
- Relapse and chronic carriage
Detailed Nursing Management (File-ready)
Nursing management focuses on infection control, supportive care, monitoring for complications and patient education. Below are practical, exam-friendly points you can put in your file.
Assessment
- Record onset and progression of fever, abdominal pain, bowel habits
- Check vitals regularly (temp, pulse, RR, BP) and note trends
- Monitor intake & output, stool frequency and characteristics
- Observe for signs of dehydration, bleeding, or peritonitis
Immediate nursing interventions
- Ensure isolation precautions as required — strict hand hygiene
- Obtain cultures as ordered before antibiotics
- Administer antibiotics and supportive meds per prescription
- Control fever: antipyretics and tepid sponging; avoid aspirin (bleeding risk)
- Encourage light, nutritious, easy-to-digest foods (khichdi, curd rice, soups) when appetite returns
Ongoing monitoring
- Daily CBC, LFTs and electrolyte monitoring as ordered
- Watch for abdominal tenderness progression, guarding, rebound (signs of perforation)
- Monitor for medication adverse effects (GI upset, allergic reactions)
3 File-ready Nursing Care Plans (NCPs) — copy-paste format
NCP 1 — Hyperthermia related to infection
ASSESSMENT:
- Temperature: __°C; patient reports feeling hot and shivering.
- Associated: headache, malaise.
NURSING DIAGNOSIS:
Hyperthermia related to infectious process (Salmonella Typhi) as evidenced by elevated temperature and chills.
GOALS:
- Temp will be maintained between 36.5–37.5°C within 48 hours.
- Patient will report increased comfort.
INTERVENTIONS:
1. Monitor temperature Q4H (or as ordered).
2. Administer prescribed antipyretics (paracetamol) as scheduled.
3. Tepid sponge baths and light clothing; keep room ventilated.
4. Encourage oral fluids to prevent dehydration.
5. Monitor for signs of complications (delirium, dehydration).
EVALUATION:
- Temperature stabilized and patient reports improved comfort.
NCP 2 — Risk for fluid volume deficit related to fever and decreased intake
ASSESSMENT:
- Reduced oral intake, high fever, possible vomiting/diarrhea.
NURSING DIAGNOSIS:
Risk for fluid volume deficit related to fever and decreased intake.
GOALS:
- Maintain adequate hydration (urine output >0.5 mL/kg/hr).
- Prevent signs of hypovolemia.
INTERVENTIONS:
1. Record intake & output chart accurately.
2. Encourage oral fluids (ORS, soups) frequently.
3. Start IV fluids as ordered; monitor infusion rate and IV site.
4. Monitor BP, pulse and capillary refill; report hypotension/tachycardia.
5. Provide mouth care for comfort.
EVALUATION:
- Urine output adequate; vitals stable; signs of dehydration resolved.
NCP 3 — Knowledge deficit regarding disease transmission and prevention
ASSESSMENT:
- Patient and family unaware of hygiene measures; poor handwashing practices.
NURSING DIAGNOSIS:
Knowledge deficit regarding typhoid transmission and prevention.
GOALS:
- Family will demonstrate correct handwashing and safe food handling within hospital stay.
- Patient will understand importance of completing antibiotics.
INTERVENTIONS:
1. Teach handwashing technique (soap + 20 sec rubbing) to patient/family.
2. Explain how typhoid spreads (fecal–oral) and show preventive steps.
3. Advise on safe water, boiling, and food handling.
4. Emphasize completion of full antibiotic course even after feeling better.
5. Provide written pamphlets in local language if available.
EVALUATION:
- Family demonstrates correct handwashing; patient verbalizes importance of completing medication.
Prevention & Public Health Measures
Prevention is the most powerful tool against typhoid: ensuring safe water, improved sanitation, hand hygiene and food safety are key. Vaccination (Ty21a oral vaccine or Vi polysaccharide/Vi-conjugate vaccines) is recommended for travelers to endemic areas and in certain public health campaigns. For community control:
- Ensure safe piped or treated water supply
- Promote handwashing with soap at critical times
- Safe disposal of human waste and proper sewage
- Food safety regulations and training for food handlers
- Identify and manage chronic carriers (public health screening)
Role of Nurses in Community & Outbreaks
Nurses are frontline in outbreak detection and response: early case finding, educating households, guiding safe water use, supporting vaccination drives and reporting to public health authorities. They also support surveillance and contact tracing in coordination with local health systems.
Frequently Asked Questions (FAQs)
Q1: Is typhoid contagious from person to person?
A: Direct transmission requires fecal contamination of food/water. Good hygiene and handwashing break the chain.
Q2: How long does fever last in typhoid?
A: Without treatment, fever can be prolonged for weeks. With appropriate antibiotics fever usually begins to fall within 48–72 hours.
Q3: Can someone become a chronic carrier?
A: Yes — a small proportion become chronic carriers (often in gallbladder) and can shed bacteria without symptoms.
Q4: Should the patient be isolated?
A: Standard precautions and good hand hygiene are essential; strict isolation is not always required but use contact precautions if diarrhea is profuse or if the setting demands.
Documentation — Quick Template
DATE/TIME:
ASSESSMENT: (Temp, pulse, BP, stool frequency, intake/output)
INTERVENTIONS: (Meds given, fluids, cultures sent)
RESPONSE/EVALUATION:
PATIENT EDUCATION PROVIDED:
PLAN:
SIGNATURE:
Conclusion
Typhoid fever remains preventable and treatable. Early diagnosis, appropriate antibiotics guided by sensitivity, vigilant nursing care and prevention through water/sanitation and hygiene are the pillars of control. For nursing students and practicing nurses, mastering clinical assessment, timely interventions and patient education is crucial. Use these file-ready NCPs, monitoring checklists and patient teaching points to improve outcomes and to prepare for practical exams and real-world clinical duties.
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