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cAUSES OF FEVER
CAUSES OF
FEVER
ENDOGENOUS
FACTORS
ANTIGENANTIBODY
REACTION
MALIGNANCY &
GRAFT
REJECTIONS
EXOGENOUS
FACTORS
BACTERIA OR
FUNGI
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EXOGENOUS FACTOR
INFECTION DUE TO BACTERIA OR
FUNGI
ACTIVATION OF PHAGOYTES IN THE
BONE MARROW
RELEASE OF PYROGEN
SYNTHESIS OF PROSTAGLANDIS
THERMOREGULATORY CENTRE IN THE
ANTERIOR HYPOTHALAMUS
INCREASE IN THE TEMPERATURE
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TYPES OF FEVER
TYPES OF
FEVER
ACUTE
SHORT
DURATION
ACCOMPANY
INFECTIONS
LIKE- TONSILITIS,
TYPHOID,
INFLUENZA
TEMPERATURE
MAY RISE TO 104
F
INTERMITTENT
ALSO CALLED
RECURRENT
FEVER
REPEATED
EPISODES OF
HIGH FEVER
MALARIA
CHRONIC
LONG DURATION
TEMPERTURE MAY
REMAIN LOW BUT
LONGER TIME
PERIOD.
HAS SLOW,
GRADUAL ONSET
& LOW IN SEVERITY
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METABOLISM IN FEVER
7% increase in BMR with every 1F increase
in body temperature or 13% increase with
every 1C rise in body temperature.
 Glycogen & adipose tissue stores decrease
significantly.
 Rate of protein catabolism increases.
 Loss of body fluid in the form of excessive
sweat & urine formation.
 Increased loss of minerals.
 Absorption of nutrients decreases.

CURRENT SLIDE
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SYMPTOMS OF FEVER
Loss of appetite
 Loss of weight
 Severely emaciated
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GENERAL DIETARY
CONSIDERATIONS
 ENERGY-:
 Increases
about 50%.
 Restlessness also increases the calorie
requirement.
 PROTEIN-:
 About 100g protein or more is prescribed.
 High protein beverages may be used as
supplements to the regular meals.
 CARBOHYDRATES-:
 Glycogen stores are replenished by a liberal
intake of carbohydrates.
BACK
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Glucose is preferred.
 FATS-:
Energy intake can be increased through the
use of fats.
Fried foods & rich pastries may retard
digestion.
 MINERALS-:
 A sufficient intake of salt is necessary.
Fruit juices & milk are good sources.
 VITAMINS-:
Requirement of vitamin A & ascorbic acid
with B-complex vitamins are increased.

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Oral therapy interfere with the synthesis of Bcomplex vitamins.
 FLUID-:
 Liberal fluid intake is preferred.
 Daily, 2500-3000 ml of fluid is necessary.
 EASE OF DIGESTION-:
 Blend, readily digested food should be used.
 The food may be soft & of regular consistency.
 Fluid diet can be used initially
 INTEVALS OF FEEDING-:
 Small quantities of food at interval will permit
adequate nutrition.
 Soft or liquid foods as desired should be offered.
 Sufficient intake of fruits & salt is essential.

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ACYTE FEVER- TYPHOID
Infectious disease caused by a bacteriaSalmonella typhosa.
 Salmonella schottmulleri causes parathyroid B.
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CAUSATIVE ORGANISM-:
 Do not multiply in water.
 May survive for over a month
in ice & ice cream.
 Grow rapidly in milk.
 Gram- negative
 Motile
 Grows best at human temperature.
• INCUBATION PERIOD-: 10-14 days.
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
DEVELOMENT OF DISEASE-:
SMALL
INTESTINE
LYSIS OF
BACTERIA BY
ANTIBODIES
LIBERATION OF
ENDOTOXIN
BACTERIA
ATTACH TO
INTESTINAL
WALL
REACH BLOOD
STREAM
GENERALISED
SYMPTOMS
PENETRATION
MULTIPLY IN
LYMPHNODES
FEVER
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BACTERIA
MOVES TO
ESTABLISH A
SECONDARY
INFECTION
DIARRHOEA
LIVER
SECRETED INTO
INTESTINE
CHRONIC
CARRIERS
GALL- BLADDER
BILE DUCTS
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TRANSMISSION OF DISEASE
FLYING INSECTS
FEEDING ON FECES

ASYMPTOMATIC
CARRIER OF
TYPHOID FEVER
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DIAGNOSIS OF TYPHOID FEVER
Diagnosis is made by any blood, bone
marrow or stool cultures and with the Vidal
test.
 The Vidal test is time consuming and
oftentimes when diagnosis is reached it is
too late to start an antibiotic regimen.
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Continued , high inflammation of the intestine.
Formation of intestinal ulcers
Loss of tissue proteins
Disturbance in water electrolyte balance
Haemarrhage
Enlargement of spleen
Payer’s patches or flat patches of lymphatic
tissue.
Diarrhoea or constipation
Severe stomach ache
Abdominal absorption of nutrients decrease
Feeling of headache & anorexia.
CURRENTSLIDE 1
CURRENT SLIDE 2
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PREVENTION & TREATMENT
Sanitation and hygiene are the critical measures
that can be taken to prevent typhoid.
 Careful food preparation and washing of hands
are crucial to preventing typhoid.
 There are two vaccines currently recommended
by the World Health Organization for the
prevention of typhoid:these are the live, oral
Ty21a vaccine and the inject able Typhoid
polysaccharide vaccine.
 Typhoid fever in most cases is not fatal.
Antibiotics, such as ampicillin, chloramphenicol,
Amoxicillin and ciprofloxacin, have been
commonly used to treat typhoid fever.
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Treatment of typhoid includes-:
Rest in bed
Keeping the patient warm
Antibiotic therapy
A modified diet
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To maintain adequate nutrition
 To restore positive nitrogen balance
 To provide relief from symptoms
 To correct & maintain water & electrolyte
balance
 To avoid irritation of intestinal tract
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ENERGY-:
BMR increases by about 50%
Restlessness also increases the energy
expenditure
Increase energy by 10-20%
 PROTEIN-:
Increased to 1.5- 2 times than normal i.e. 1.52g protein /kg body wt/day
Protein foods of high biological value should
be included
 CARBOHYDRATES-:
 A liberal intake of carbohydrate is suggested
For protein sparing action

BACK
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 Well
cooked, easily digestible carbohydrates should be
included.
 More of glucose can be used
 DIETARY FIBRE-:
 All harsh, irritating fibre should be avoided
 FATS-:
 Emulsified fat should be given
 Fried food should be restricted
 MINERALS-:
 Salty soups, broths, fruit juices, milk etc should be
included
 Fe supplementation is also important
 VITAMINS-:
 Increase the amount of vitamin A & C
 Requirement of vitamin B also increases
BACK
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 FLUID-:
Liberal
intake of fluid is necessary
Fluid may be included in the form of
beverages, soups, juices, plain water etc.
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• HIGH
ENERGY,
HIGH
PROTEIN
& FULL
FLUID
DIET
• SMALL
MEALS AT
FREQUEN
T INTERVL
• A BLAND,
LOW
FIBRE,
SOFT DIET
• AVOID ALL
IRRITATIN
G FOODS
ADEQUATE NUTRITION
DIET & FEEDING PATTERN
EASILY DIGESTED & ABSORVABLE
ILL AND ANOREXIC

• WELL
COOKED,
MASHED &
SEMISOLID
FOODS
SHOULD
BE GIVEN
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FOODS TO BE USED IN
RESTRICTED AMOUNTS OR
AVOIDED
FOODS TO BE INCLUDED
HIGH FIBRE FOODS LIKE- WHOLE
GRAIN CEREALS, & THEIR PRODUCTS,
e.g. Whole wheat flour, & cracked wheat,
whole pulses & pulses with husk.
Plenty of fluids like- juices & soups
All raw vegetables & fruits
Milk & milk based beverages
Fried fatty foods
Low fibre foods such as- refined cereals,
& their products, dehusked pulses, well
cooked fruits, vegetable in soft & puree
form & potatoes
Chemical irritants such as- condiments, Foods providing protein of high biological
spices, pickles, relishes, chutneys, &
value e.g.- eggs, fish, poultry
strongly flavoured vegetables like cabbage, Plain gelatin based desserts, sugars, honey,
capsicum etc.
jam.
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INFLUENZA
Acute infection of short duration
 Spreads from person to person by contact
inhalation of virus
 INCUBATION PERIOD-: 2 days with a
range of 1-7 days.
 Sudden onset
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SYMPTOMS
Headache, lassitude, myalgia, shivering & fever
 Dry cough with sneezing or sore threat
 Depression
 Bronchitis and pneumonia are the most
common & frequent complications of
influenza.
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DIETARY CONSIDERATIONS

General principles of dietary treatment are
followed for influenza patient
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MALARIA

CAUSATIVE ORGANISM
PLASMODIUM
P.VIVAX
P. MALARIAE
P. OVALE
P. FALCIPARUM
Is transmitted from human to human by the
bite of female anopheles mosquitoes.
 Induced malaria occurs due to congenital
transmission or transmission by blood
transfusion.
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SIGNS & SYMPTOMS
Typical malarial attacks show sequentially
over 4-6 hrs.
 Shaking chills, fever to 41C or higher & the
sweating stage.
 Fatigue, headache, diziness, GI symptoms,
myalgia, arthalgia, backache & dry cough.
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DIETARY MANAGEMENT

Same as for fever.
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CHRONIC FEVER- TUBERCULOSIS
Is a chronic infectious disease
 Major cause of illness & death in the
underdeveloped countries
 Caused by a bacteria Mycobacterium
tuberculosis.
MALNUTRITION
 CAUSE-:

POVERTY &
POOR
SANITATION
IGNORANCE
INFECTION
UNHYGENIC
LIVING
CONDITIONS
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CAUSATIVE ORGANISM-:
 The bacteria most affects the lungs, leading to
pulmonary tuberculosis.
 Infection may be localized in other organs
like- lymphnodes or kidneys or may be
generalised.
 Small, non-motile, aerobic organism
 Gram positive
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DEVELOPNENT OF DISEASE
LYMPH NODES
SPREAD
THROUGH
BLOOD STREAM
PULMONARY
ALVEOLI
TRANSPORT
SECONDARY
LESIONS
DEVELOP
INVADE &
REPLICATE
PRIMARY SITEGHON FOCUS
IN LUNGS
EFFECTS ALL
PARTS
MYCOBCTERIUM
TUBERCULOSIS
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TRANSMISSION
TRANSMISSION
AIR
MTB INFECTION
COUGH, SNEEZE
ASYMPTOMATIC
SALIVA OF
INFECTED
PERSON
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RISK FACTORS

People with silicosis have an approximately
30-fold greater risk for developing TB.
SILICON
RISK OF TB

IRRITATE
RESPIRATORY
SYSTEM
IMMUNE
RESPONSES
BLOCKAGE
LYMPHATIC
VESSEL
DEPOSITS
Persons with chronic renal failure and also
on hemodialysis have an increased risk.
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Persons with diabetes mellitus have a risk
for developing active TB that is two to four
times greater than persons without diabetes
mellitus, and this risk is likely to be greater
in persons with insulin-dependent or poorly
controlled diabetes.
 Low body weight is associated with risk of
tuberculosis as well.
 Twin studies in the 1940s showed that
susceptibility to TB was heritable.
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Wasting of tissues, exhaustion, cough,
expectoration, & fever
 Acute phase- high fever, increased circulation &
respiration
 Chronic phase- low grade fever, high metabolic
rate
 Loss of appetite, pain in chest, fatigue, weight
loss, night sweats, & a persistent, worsening
cough
 Lymphnodes & kidneys can also be affected
 Increased catabolism of tissue proteins
 Increased loss of body fluids
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DAIGNOSIS
Diagnosis relies on
 radiology (commonly chest X-rays), a
tuberculin skin test,
 blood tests, as well as microscopic
examination and
 microbiological culture of bodily fluids.
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Refampicin, isoniazid, pyrazinamide, &
ethambutol are the drugs used
These drugs are supplied free to the patients
Treatment lasts for a minimum period of nine
months
Rest, antibiotic therapy & fresh air along with
nourishing food.
Social contacts are also screened and treated if
necessary.
Antibiotic resistance is a growing problem in
(extensively) multi-drug-resistant tuberculosis.
Prevention relies on screening programs and
vaccination, usually with Bacillus CalmetteGuérin vaccine.
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DIETARY MANAGEMENT
Objectives of dietary management are-:
 To reduce mortality by providing nutrients
required by the body’s immune mechanism
 To control weakness & loss of weight
 To accelerate convalescence
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 ENERGY-:
Energy
needs are increased to minimize
weight loss
Energy intakes are increased by 300500kcal/day
 PROTEIN-:
Increase the protein intake
Protein foods of high biological value should
be included
About 1.2-1.5 of protein/kg body weight/day
must be included
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 CARBOHYDRATES & FAT-:
 Enough carbohydrate is required
to meet the
energy
 Abundant carbohydrate help in protein sparing
action
 Too much fat should be avoided
 MINERALS-:
 Liberal amount of Ca should be included in the
diet.
 Fe supplements should be given.
 VITAMINS-:
 Liberal amount of vitamins should be provided.
 Diet should provide as much as retinol as
possible.
 Additional amount of ascorbic acid is
recommended
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 Good
amount of vitamin D is included.
 B- complex vitamins need also increase.
 Provide supplements of vitamin B-6 & folate.
 DIET & FEEDING PATTERN-:
 A high protein, high energy, full fluid diet is given.
 Meals should be simple, easily digestible, well
prepared & tempting
 Force feeding is harmful
 Too much fat should be avoided.
 All pulses should have a cereal-pulse
combination
 Cheap sources of vitamin C must be given
 Seasonal vegetables must be given.
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
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Acute illnesses are those that will eventually resolve
without any medical supervision (such as colds and
teething).
Chronic illnesses are more serious illnesses that require
medical supervision (like Tuberculosis or Cancer).
An Acute illness typically will "run its course”
A Chronic illness is one that requires medical
supervision.
Usually, medicines for acute illnesses are regulated as
OTC (over-the-counter) drugs.
. Usually, medicines for chronic illnesses are regulated as
Prescription Only.
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TYPHOID
TUBERCULOSIS
METABOLIC RATE INCREASES TO A
GREAT EXTENT.
BMR INCREASES BUT IS NOT AS
HIGH AS IN TYPHOID.
HIGH GRADE FEVER.
LOW GRADE FEVER.
CAUSATIVE ORGANISMSALMONELLA TYPHOSA
CAUSATIVE ORGANISMMYCOBACTERIUM TUBERCULOSIS
INTESTINAL DISEASE
IT IS A DISEASE OF LUNGS.
ENERGY INCREASES TO 10-20%.
INCREASES ABOUT- 300500KCAL/DAY.
PROTEIN- 1.5- 2g/ kg body wt
PROTEIN- 1.3- 1.5g/ kg body wt
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