SCOPE HOMOEOPATHIC MEDICINES TREATMENT OF FEVER IN TYPHOID

SUBMITTED BY
MITESH HARESHBHAI PATEL

PROVISIONAL REGISTRATION NO:

ENROLLMENT NO: 180408101057

INTERNSHIP BATCH

JAWAHARLAL NEHRU HOMEOPATHIC MEDICINE COLLEGE

YEAR 2023-2024

PROJECT GUIDE

Dr.Falguni Patel (H.O.D FMT)

JAWAHAR NEHRU HOMOEOPATHIC MEDICAL COLLEGE PARUL UNIVERSITY.

LIMDA,WAGHODIA VADODARA-391760,GUJRAT-INDIA

Signature of Intern Student Internship In charge

Project Guide Head of the Institute

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 INDEX

SR NO TOPIC
1 CERTIFICATE
2 ACKNOLEDGMENT
3 ABSTRACT
4 AIMS AND OBJECTIVES
5 FEVER IN TYPHOID
6 HOMOEOPATHIC MANAGEMENT OF
FEVER IN TYPHOID
7
8
9
10
11
12

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 ACKNOWLEDGEMENT:-
I would like to express my sincere& heartfelt gratitude to my respected teachers
& my guide Dr Falguni Patel .I would like to thank Dr Devanshu Patel (president of
Paul University), Dr Poorav Desai (principal of JNHMC), and other professors for
their valuable guidance & constructive criticism with constant encouragement
through my graduation course. I considerate as privilege to be under their
guidance and to receive their expert advice which is very helpful in improvement
of every aspect of student. I express my sincerest gratitude to principal of
J.N.H.M.C. for his encouragement, valuable guidance and great support right from
initial stage.

I deeply extend my entire gratitude to all my teacher and colleagues for their
keen help and their invaluable support

ABSTRACT
Background and objectives:
Typhoid fever is a major human bacterial infection. Typhoid fever occurs in all
parts of the world where water supplies and sanitation are sub-standard. The
disease is now uncommon in developed countries where most of the cases that
occur are either acquired abroad or imported by immigrants. The socio-economic
impact of the disease is huge, because typhoid survives may take several months
to recover and resume work. The prevalence rate of typhoid fever in India is 88
cases/lac population and the death rate due to typhoid is 0.029 /lac population.

Method:
A hospital-based cross-sectional study was conduct from 2021- to 23 all
clinical data were collected from the JNHMC hospital. A total of
TYPHOID FEVER was taken for study

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Results:
A total of patient with TYPHOID FEVER were sees in the hospital over a
period of 12 months. Out of these 10 cases, the more vulnerable age
group is the adult group. the efficacy of in TYPHOID FEVER has given the
marvelous result.

Introduction
There are very few typhoid fevers condition, which cannot be,
mimicked this the most lethal of all enteric disease.

A case of typhoid fever may be present as a disease clinically

indistinguishable from malaria, progress to bacillary dysentery mimic a
case of acute bronchitis, cause an acute with perforation & then finally
in convalescence, with its evil spent, linger on as orchitic, myocarditis or
peripheral neuritis.

Shellfish such as oysters, cockles & mussels, which feed on raw

sewage at the estuaries of livers are a potent source of infection with
typhoid & other salmonella infection. this is both because they are
usually swallowed raw.

It refers to the fact that typhoid bacillus can live for many years
after the death of a carrier. Typhoid fever is due to infection with
SALMONELLA TYPHI.it is still an epidemic in many the developing
countries of the world.

These usual reasons are where a carrier has infected a static

water supply, ice cream, or some other food.

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 Infection with other salmonella organisms is more common. These
include both paratyphoid fever, as well as infection with one of nearly
1000 different stains of salmonellae. Infection is more likely to follow
rather than infected water, as is the case in typhoid fever. The carrier
problem is a serious one, especially in the gall bladder of patient
convalescent from an attack of typhoid

The term “ENTERIC FEVER “includes both typhoid & paratyphoid

fevers. The disease may occur sporadically, epidemically, or
endemically.

AIM & OBJECTS: -

- Aim:
 To study the efficacy of baptisia in the management of the
management of typhoid fever.

- OBJECTS:
 To study the clinical profile of typhoid.
 To study the efficacy of the in the management of typhoid fever.
 To avoid further complication.
 To treat effectively, safely, economically, palatably & by the
available way
 To manage the patient & provide early recovery & cure

PREVALENCE: -
Enteric fever also known as typhoid isn’t common bacterial
disease caused by the ingestion of contaminated food or water
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 which contain TH bacterium salmonella enterica serovar typhi. It
is very common in India.

Typhoid fever is endemic in India. The prevalence rate of typhoid

fever in India is 88 cases /lac population and the death rate due to
typhoid is 0.029/lac population assuming 0.2% cases -fatality rate.

- RISK FACTOR IN THE DEVELOPMENT OF TYPHOID FEVER ARE:

 Travel to endemic areas.
 Poor hygiene habits.
 Recent use of antibiotics.
 Poor sanitation condition.
 Proximity to flying insects feeding on feces.
 Contact someone who recently suffered from typhoid fever.

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 REVIEW OF LITERATURE: -
• Typhoid fever is also known as enteric fever.
• Typhoid fever is an acute illness associated with fever caused by
the salmonella typhi bacteria. It can also be caused by salmonella
para typhi, a related bacterium that usually causes a less severe
illness.
• Major cause morbidity & mortality.
• Food waterborne disease.
• The bacteria are deposited in water or food by a human by a
human carrier & then spread to other people.

CAUSES: -
• Bacteria: -
- Salmonella typhi A.
- Salmonella typhi B.

They are Gram-negative bacilli

TRANSMISSION: -
1. Fecal – oral route.
2. Close contact with patients or carriers.
3. Contaminated water & food.
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 4. Files &cockroaches.

TYPES OD ENTERIC FEVER: -

I. Typhoid fever
II. Paratyphoid fever
III. Other salmonella infection (salmonellosis)

I. PARATYPHOID FEVER
• The paratyphoid fevers A, B & C resemble
typhoid fever & usually, but not always run
a milder course. The salmonellae para typhi,
however, require a medium in which to
multiple, & meat pies and synthetic cream
& milk are the usual vehicle for this.
Paratyphoid fever resemble other non-
specific salmonella infections in this
respect.
• Paratyphoid B may occasionally have an
onset similar to a non-specific salmonella
gastroenteritis. Despite this, paratyphoid
fever is primarily an invasive type of disease
like typhoid fever
• Paratyphoid A, however more is likely to
cause than typhoid fever but is more likely

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 to result in carriers and to cause jaundice,
thromboses and suppurative lesions.
• Paratyphoid C differs clinically from typhoid
fever & other paratyphoid by causing more
septicemic manifestation. This includes
complications such as arthritis, cholecystitis,
& abscesses with little in the way of
gastrointestinal lesion.

II. SALMONELLOSIS:
• Other salmonella infections are related to
the paratyphoid bacilli rather than to
typhoid fever .as a result, they usually cause
gastroenteritis rather than an invasive
illness
• This is not always so, they may occasionally
cause an illness very
• Similar to typhoid fever with bacteremia &
septicemia.
• This incidence in the tropics & subtropics is
much higher & the vast majority of these
cases are never notified.

 SALMONELLOSIS:
- It is one of the most common foodborne diseases.
- Salmonella and other bacteria responsible for salmonellosis.
- Salmonella has several distinct symptoms.

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 - Diarrhea
- Fever
- Abdominal cramps
- Headache

INCUBATION PERIOD: -
- Usually, 10-14 days but it may be as short as 3 days.
- As long as 3 weeks depending upon the dose of the bacilli
ingested.

SOURCE OF INFECTION: -
- Primary source: faces & urine of cases or carriers.
- Secondary source: contaminated water, food, objects etc.

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 PATHOPHYSIOLOGY
Ingest contaminated food

Ingested bacilli invade small intestinal mucosa

Taken by macrophages & amp: transported to regional lymph node

Typhi multiply in the intestinal tissue

Intact with enterocyte & sump: M cells [ileal Peyer’s patches] during the 1-3 week of
incubation period

End of the incubation period, bacilli enter bloodstream [bacteremia phase]

Bacteria invade the gallbladder, biliary system & amp; lymphatic tissue of the bowel &
amp multiply in high number

Then pass into the intestinal tract (stool)

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 CLINICAL FEATURES: -
1.STAGE 1 (1ST WEEK)

- Slowly rising (stepladder fashion) of temperature for 4-5 days.

- Abdominal pain.
- Malaise.
- Headache.
- Constipation.
- Relative bradycardia.

2.STAGE 2 (2ND WEEK)

- Sign & symptoms of 1st week progress.

End of 2nd week

Delirium, complication, then coma & death (if untreated)

3.STAGE 3 (3RD WEEK)

- Febrile become toxic & anorexia with significant weight loss

- Typhoid state (Apathy, confusion, psychosis)
- High risk (5-10%) of hemorrhage & perforation may cause death.
4.STAGE 4 (4TH WEEK)

- Recovery period.
- If the individual survives to the 4th week the fever, mental state &
abdominal distension slowly Improves over a new few days.
- Intestinal & neurological complication may still occur in surviving
untreated individual.

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 - Weight loss & debilitant weakness last months.
- Some survivors become asymptomatic typhi carriers & have the
potential to transmit the bacterial indefinitely.

COMPLICATION: -
• Many complications have been described, of which
gastrointestinal bleeding, intestinal perforation & typhoid
encephalopathy are the most imps.
• GI bleeding is the most common symptoms.
• It results is the most common symptoms.
• Intestinal bleeding in typhoid fever usually occurs from the ulcers
in the ileum or proximal colon & most common
colonoscopicmanifestation are multiple variable-sized punched
ulceration.
• The shape of the ulcer is usually ovoid with the longest diameter
parallel to the long to the axis of the gut, so that stricture
formation does not occurs after healing
• The edges are soft, swollen & irregular but not undermined. The
floor is usually smooth & is formed by the muscular coat.
• Near the ileocecal valve, where perforation occurs more
commonly, ulcers become deeper than elsewhere,
• Hemorrhage & intestinal perforation are the 2 major
complications of small intestinal typhoid fever.

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 INVESTIGATION: -
1. Blood culture
2. Specific serological test
- Identify salmonella antibodies / antigens /fluorescent
antibody
- Study to look for a substance that is specific to typhoid
3. Wadalites & ELISA test
4. Urine & stool culture (2nd & 3rd week)
5. Bonemarrowculture
- 90% sensitive unless until after 5 days commencement of
antibiotics.
6. Punch biopsy samples of nose spots culture.
- 63% sensitive
7. Clot culture
- Culture may be obtained from CSF, peritoneal fluid,
mesenteric NS, resected intestinal, gallbladder, pharynx,
tonsils, abscess, bone.

SEROLOGY
 WIDAL TEST: tube agglutination test (2nd & 3rd week)
- Detects O &H antibodies
- Diagnosis of typhoid & paratyphoid
- Testing for H agglutination in dryness tube, narrow tube
floccules at the bottom

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 - Testing for O agglutination in Felix tube, chalky incubation
at 37c overnight
 OTHER NON-SPECIFIC LAB STUDIES:
- Moderate anemic, increased ESR, thrombocytopenia,
lymphopenia – slightly elevated platelets & APTT, decreased
fibrinogen level.
- Mild hyponatremia & hypokalemia.
- Serum ALT: LDH > 9:1 - viral hepatitis
>9:1 – typhoid hepatitis

SPECIMENTS COLLECTION based on different phase of enteric fever:

INVESTIGATION TABLE:
DURATION OF SPECIMEN % POSITIVITY
DISEASE EXAMINATION

 1st week • Blood culture • 90%

 2nd week • Blood culture • 75%

• Fleetest • 50%
• Wadalites • Loctite

• 3rd week • Wadalites • 80-100%

• Blood culture • 60%
• Fleetest • 80%

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 TREATMENT:
MEDICAL CARE:

1. Antibiotics
2. Corticosteroids
3. Antipyretics
4. Antiemetics
5. Typhoid vaccine

SUEGICAL CARE:
- Advice in case of intestinal perforation.
DIET:

- Fluid & electrolytes should be monitored.

- Soft digestible diet is advised.
- Avoid to take plenty of water.

MIASMATIC DIAGNOSIS:
TYPHOID IN ACUTE DISEASE.

ACUTE MIASM:

- According to the master Kent – an acute miasm is one that comes

upon they economy passes through its regular prodromal period

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 longer or shorter, has its period of progress of decline & which
there is tendency to recovery. The acute miasm has 2 types:
1. RECURRING TYPE: those type of acute miasm that occur in
same manner more than once in life time of a particular
person.
E.g. typhoid fever, dengue fever, swine flu, plague, etc.

2. NON RECCURING TYPE: This is called fixed miasm these ties of

acute miasm are those which attack a person only once in life
time and called non recurrent or fixed miasm
E.g. whooping cough.

HOMOEOPATHIC APPROACH IN TYPHOID

FEVER
• Homoeopathy treats the person as a whole.
• Homoeopathy t/t focuses on the patient as a person & his
pathological condition.
• The homoeopathic medicine is selected after a full
individualizing examination and & case analysis, which
includes the medical history of the patient, and physical &
constitution, family history, printing symptoms,
underlying pathology, possible causative factors ECT.
• Homoeopathy effort proven medicine for typhoid.
• Homoeopathic remedies for typhoid are safe & effective

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 • They act at the root to stop the recurrence of the disease
process & they stimulate the disease fighting mechanism
of the body.
• As the immune system of the body is strengthened, its
resistance to salmonella typhi bacteria increases.
• Homoeopathic medicine for typhoid fever has the added
advantages of using the body’s owned restorative
processes to make it disease – free additional treatment

TYPHOID PREVENTION MANAGEMENT:

• Do not eat or drink contaminated food or water.
• Wash your hands as often as possible, especially before
meal.
• Avoid food from street vendors as it is more likely to be
contaminated.
• Practice good sanitation habits.

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