🔘 Typhoid Fever (Antarika Jwara)

TYPHOID FEVER (ANTRIKA JWARA):-

💫 ACCORDING TO MODERN:- TYPHOID

👉🏻 Introduction:-

- Typhoid fever is due to systemic infection mainly by Salmonella typhii.

- The disease is clinically characterised by a typical continuous fever for 2-3 weeks.

- In Ayurveda it is correlated with  'Enteric fever, आन्त्रिक ज्वर or मन्थर ज्वर.

👉🏻 Causitive organism:-

- Salmonella typhii (Gram -ve, anaerobic bacilli)

👉🏻 Incubation period:-

- 10-14 days

👉🏻 Source of infection:-

√ The primary source of infection are:-

- Contaminated food, milk and water

- Pollution of drinking water supplies

- Open air defecation and urination

- Low standards of food

- Low personal hygiene and health ignorance

√ Transmission :- Feco-oral route

√ Carrier :- House flies

👉🏻 Risk factors:- 

- Typhoid fever is a serious worldwide threat and affects about 27 million or more people each year.

- The disease is established in India, Southeast Asia, Africa, South America and many other areas.

- Worldwide, children are at greatest risk of getting the disease, although they generally have milder symptoms than adults do.

√ If you live in a country where typhoid fever is rare, you're at increased risk if you:-

- Work in or travel to areas where typhoid fever is established

- Work as a clinical microbiologist handling Salmonella typhi bacteria

- Have close contact with someone who is infected or has recently been infected with typhoid fever

- Drink water polluted by sewage that contains Salmonella typhi.

👉🏻 Pathogenesis:-

- Due to contaminated food, milk and water, salmonella typhi bacilli enters and reaches to the intestine.

- In intestine, it penetrate the mucosa of intestine and reaches to the intestinal lymphatic through peyer's patches.

- From peyer's patches it enters in blood stream.

- In blood stream, the bacteria is disseminated throughout body via blood and intracellular multiplication occurs.

- The organism enters intro the blood stream and producing bacteremia when all organs are repeatedly exposed.

- It affect different body organs.

• Brain:- Encephalitis

• Heart:- Cardiac failure

• Lungs:- Pneumonia, Bronchitis

• Liver:- Hepatomegaly

- 3rd week is most critical phase.

👉🏻 Clinical features:-

✓ 1st week (Prodromal stage):-

- Mild fever (99-100° F)

- Malaise

- Headache

- Generalised bodyache

- Cough

- Sore throat

- Often with abdominal pain

- Constipation

- Stepladder fashion (pattern) fever

- Relative lynohocytosis with leucopenia.

✓ 2nd week:-

- High grade fever (Temperature gradually rise upto 107° F)

- Fever reaches at peak and patient looks toxic appearing exhausted.

- Marked abdominal tenderness

- Mild hepatospleenomegaly

- Relative bradycardia

- Diarrhoea:- Pea soup like stool

- Red rose spots or red spots may seen on chest and abdomen, disappeared within 2-3 days

- Constipation:- Caused by swelling on lymphoid tissue around ileocaecal junction.

✓ 3rd week (Stage of complication):-

- Intestinal perforation and haemorrhage

- Meningitis

- Pneumonia, bronchitis

- Cardiac failure

- Encephalitis

👉🏻 Diagnosis:-

- CBC:- Leucopenia - 1st week

- Antigen:- WIDAL test - 2nd week

- WIDAL test detects O and H Antigen of Salmonella typhii.

- Culture:- Stool, Urine - 3rd and 4th week

- Typhi DOT:- More accurate than WIDAL, shows early result on 2nd or 3rd day

👉🏻 Diffrential diagnosis:-

- Pneumonia

- Dengue fever

- Malaria

- Cerebrospinal fever

- Tuberculosis

- Relapsing fever

👉🏻 Management:-

1) For prevention:-

- Providing clean water to public

- Proper excreta disposal

- Protection of water from contamination

2) For treatment:-

- Bed rest

- Fluid management:- Oral / IV

- Antibiotics

- Steroid therapy

- Surgical intervention:- 3-5%

✓ Antibiotics:-

1. Chloramphenicol:- 3-4 gm/day 

(Continues with 2gm/day for 18 days)

2. Amoxicillin:- 4-6 gm/day (In 4 divided doses)

3. Ciprofloxacin:-:500-750mg BD

4. Ampicillin

5. Ceftriaxone:- 75 mg/kg/day

6. Cefexine:- 400mg BD

7. Azythromycin:- 1gm, once in a day for 5-7 days

✓ Steroid:-

1. Dexamethasone:- 1mg/kg every 6hrs

💫 ACCORDING TO AYURVEDA:- ANTRIKA JWARA Or MANTHARA JWARA

👉🏻 Introduction:-

- There are presence of Pidakas or manthari in this type of jwara, hence named as Manthara jwara.

- It is also known as Antrika Jwara, because this fever widely affect intestine.

- In this type of Jwara, all tridosha lakshana are present. 

- In modern it is correlated with Typhoid fever.

👉🏻 Samanya Nidana:-

• "बह्वध्व क्लान्ततनवस्तथाऽनश्नकर्षिताः। 

दुर्गन्धिपूर्णभूमौ वा नित्यमेव निवासिनः॥

आंत्रिककेत्यभिधानं चापरमस्यैव कथ्यते। 

सामस्य कारणं प्रोक्तं विशिष्टं तु निगद्यते॥"

(मा.नि. परि. मंथर ज्वर 1-4)

- Ati margagamana

- Ati upavasa

- Durgandha purna, dushita sthana nivasa

- Intake of food and drinks contaminated with dushita mala etc.

👉🏻 Vishista Nidana:-

- Agantuja karana:- Bacterial infection

👉🏻 Samprapti:-

• कीटाणवो बेसिलस टाइफोसस नामकाः । 

दण्डाकाराः कृतावासा रक्ते मूत्राशये मले।

स्वेदे पित्ताशये प्लीह्नि पिडिकास्वान्त्रिकव्रणे। 

जनयन्ति नृणां देहे ज्वरं प्रोक्तं विशेषतः॥"

(मा.नि.परि.)

• मलमूत्रस्वेदजात दोष संसर्ग दूषिते। 

भक्ष्यपेयादिभिद्रव्यैर्नाना संक्रमणकारणैः ॥

लक्ष्येत यदि रक्तस्थस्रावो भिन्नान्त्रता तदा॥" 

(मा.नि.परि.मन्थर ज्वर 7/11)

- Due to nidana sevana and Bacterial infection (Jivanu sankramana) jivanu (bacteria) enters into antra (intestine).

- After entering, it produces swelling in sntra granthis.

- Due to swelling doshas, rasa and rakta dhatu exists in intestine are aggravated and producing kshata (injury) to the intestine.

- After some time kshata (injury) increases and produces chhidra in antra (perforation of intestine) and causes continuous blood flow in intestine.

- It creates Manthara (antrika) jwara, and this condition is Asadhya when antra is perforated.

👉🏻 Samprapti ghataka:-

- Dosha:- Tridosha

- Dushya:- Rasa, Rakta

- Srotasa:- Annavaha, Rasavaha

- Srotodushti:- Sanga

- Adhisthana:- Antra

- Swabhava:- Chirakari

- Sadhyasadhyatva:- Kruchrasadhya

👉🏻 Purvaroopa:-

• शिरोव्यथा स्यादरुचिस्ततोऽरतितमोऽवसादौऽपि च बिड्बद्धता।

सप्ताहपर्यन्तमिति स्फुटास्फुटं ज्वरेऽग्ररुपं नियंत सदाऽऽत्रिके॥

 (मा.नि.परि.)

- Shirovyatha (headache)

- Aruchi (anorexia)

- Restlessness

- Darkness in front of eyes

- Depression

- Malabaddhata (constipation)

👉🏻 Lakshana (Clinical features):-

• तदग्ररुपं च ततोऽष्मेऽहनि भवेदभिव्यक्तिमवाप्यलक्षणम्।

ज्वरोऽथ नित्यं क्रमश: प्रवर्द्धते सहापरैमर्थरेकऽत्र लक्षणैः ।।

भवेत्तदा तु ज्वरजाप सीमा चतुर्भुतं पञ्चमुतं शतं वा॥

उपद्रवसमाधिक्यं सप्ताहितं सेविन:।

(मा.नि. परिशिष्ट)

- It is similar to Pittolbana Sannipataja jwara.

- It is explained by Acharya Gananath sena in Siddhanta nidana, which are similar to Typhoid fever in modern.

✓ 1st week:-

- Jwaradhikya (Hyperpyrexia)

- Pleehavriddhi (Spleenomegaly)

- Jihva malina evum rakta varna (Tongue coated and reddish)

- Adhmana (Flatulence)

- Vibandha (Constipation)

- Red spots on neck, abdomen and chest area

✓ 2nd week:-

- Jwaradhikya (Hyperpyrexia)

- Pralapa (Delirium)

- Tandra (Drowsiness)

- Kasa (Cough)

- Furrowed tongue, dry with reddish coloration

- Durbalata (weakness)

- Mukhashosha (Dryness of mouth)

- Arati (Restlessness)

- Adhmana (Flatulence)

- Dicrotic pulse

- Blood mixed stool

👉🏻 Asadhya Lakshana:-

- Ati raktasrava (Excessive bleeding)

- Increased pulse rate

- Acute pain in abdomen

- Tendency of raised body temperature during morning hours and night

- Generalized peritonitis

- Excessive weakness

- Tremora in hands and feet

- Intestinal bleeding

👉🏻 Upadrava:-

- Antra kshaya (Intestinal tuberculosis)

- Vishaktata (Toxaemia)

- Raktasrava (Haemorrhage)

- Peritonitis

- Antra vidarana (Intestinal perforation)

- Vrukka Shopha (Nephritis)

👉🏻 Chikitsa sutra:-

- Firstly Langhana should be done for dosha pachana.

- In Sannipataja jwara, when there is ugra vega of jwara; first treat pitta then treat kapha and vata dosha respectively.

• कफस्थानानुपूा तु सन्निपात ज्वरं जयेत्।" (च.चि. 3)

- In lakshana Manthara jwara is similar to Sannipataja jwara so its treatment should be done according to Kapha sthana

- Firstly done Kapha and Amadosha pachanaz then treat aggravated vata and pitta.

- In case of constipation sramsana aushadha should be used for koshtha shodhana according to Bala of rogi.

- In antra pradhaha sheeta, tikta and madhura rasatmaka dravya should be used.

- If Trishna present, then use Shadangapaniya.

- Pathya Palana

- Pushtikaraka, balaprada and supachya drava ahara should be taken.

👉🏻 Chikitsa:-

1. Samshodhana Chikitsa:-

√ Same as Sannipataja jwara treatment:- 

 a) Langhana

 b) Swedana :- Baluka, Sandhava sweda, Snigdha sweda

 c) Shirovirechana:-

- Trikatu churna pradhamana nasya

- Kataphala twak churna pradhamana nasya

- Shwara kuthara rasa nasya

 d) Anjana prayoga

2. Samshamana Chikitsa:-

a) Rasa / Bhasma / Pishti:-

• Matra:- 125-250 mg

• Anupana:- Ushnodaka / Madhu

- Sutashekhara rasa

- Pravala pamchamrita

- Karpura rasa

- Ramabana rasa

- Yogendra rasa

- Bola parpati

- Navayasa lauha

 b) Vati:-

• Matra:- 250-500 mg

• Anupana:- Ushna jala

- Madhurantaka vati

- Saubhagya vati

- Samshamani vati

c) Churna:-

• Matra:- 3-6 gm

• Anupana:- Koshna jala

- Sitopaladi churna

- Yavani shadava churna

d) Kwatha / Asava / Arishta:-

• Matra:- 10-20 ml

• Anupana:- Jala

- Chandanadi kwatha

- Mustadi kwatha

- Kiratadi kwatha

- Chandana kiratadi kwatha

- Lohasava

- Draksharishta

e) Anya yogas:-

- Lavanga:- 7 

- Jatiphala:- 2gm

- Sunthi:- 2gm

- Ela:- 2

- Tulasi:- 5 patra

• These all should be added with 400 ml water and boiled until 50 ml is remained and given with madhu.

👉🏻 Pathya-Apathya :-

1) Pathya:-

- Ahara:- 

Kurchika, dadima, draksha, munnaka, godugdha, mudga, yava manda, laja manda, Purana shali, peya, vilepi, patola, lavangodaka, Shadangapaniya etc.

- Vihara :- 

Langhana, Vishrama, avoid vega dharana

2) Apathya:- 

- Ahara :- 

Guru, Abhishyandi, tikshna bhojana, pizza, burger, samosa, kachori, halva, malpuva etc.

- Vihara :- 

Adhyashana, Vyayama, Vyavaya, Shrama, Chinta, Jagarana etc.