What is Typhoid?

WHAT IS IT?

Typhoid fever is an infectious disease characterized by severe systemic illness with fever and abdominal pain. It is also known as enteric fever. The term "enteric fever" is a collective term that refers to both typhoid and paratyphoid fever as they clinically indistinguishable diseases. The organism classically responsible for the enteric syndrome is Salmonella enterica serotype Typhi (formerly known as S. typhi). The illness is characterized by a very high fever, sweating, gastroenteritis, and diarrhea and it is easily spreads through contaminated food and water supplies and close contact with others who are infected.

HOW TYPHOID FEVER SPREADS?

Salmonella Typhi lives only in humans and it is commonly transmitted through the fecal-oral route. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract, then spreads them to other persons. Typhoid fever can be spread through various ways:

• Eat food and drink beverages that have been handled by a person who is shedding the bacteria.
• Consume/use tainted food or water that has been contaminated with the bacteria. Including use the water to wash the food.
• Poor sanitation/ fails to wash hands after using the bathroom.

WHAT ARE THE SYMPTOMS OF TYPHOID FEVER?

First week:

• Rising ‘stepwise’ fever and bacteremia
• Chills and rigors
• Relative bradycardia
• Pulse temperature

Second week:

• Abdominal pain develops
• ‘Rose spots’ (faint salmon coloured macules on the trunk and abdomen) may be seen

Third week:

• Hepatosplenomegaly
• Intestinal bleeding
• Perforation due to ileocecal lymphatic hyperplasia of the Peyer’s patches
• Secondary bacteremia
• Peritonitis
• Septic shock/ altered level of consciousness

WHY IS IT DANGEROUS?

Typhoid Fever if untreated properly, could leads to many serious complications and fatal. For example, in the United States, an estimated 5,700 cases of typhoid fever occur annually, mostly among travelers. An estimated 21 million cases of typhoid fever and 200,000 deaths occur worldwide.Without therapy, the illness may last for 3 to 4 weeks and death rates range between 12% and 30%. This situation could be worsened in the endemic countries where the burden of the disease is higher such in second and third world countries.

HOW CAN WE AVOID TYPHOID FEVER?

Two basic actions can protect you from typhoid fever:

1. Avoid risky foods and drinks:

• If you drink water, buy it bottled or bring it to a rolling boil for 1 minute before you drinkit.
• Bottled carbonated water is safer than uncarbonated water.
• Ask for drinks without ice unless the ice is made from bottled or boiled water.
• Avoid popsicles and flavored ices that may have been made with contaminated water.
• Eat foods that have been thoroughly cooked and that are still hot and steaming.
• Avoid raw vegetables and fruits that cannot be peeled. Vegetables like lettuce are easilycontaminated and are very hard to wash well.
• When you eat raw fruit or vegetables that can be peeled, peel them yourself. (Wash your hands with soap first.) Do not eat the peelings.
• Avoid foods and beverages from street vendors. It is difficult for food to be kept clean Onthe street, and many travelers get sick from food bought from street vendors.

2. Get vaccinated against typhoid fever:

• If you are traveling to a country where typhoid is common, you should consider being vaccinated against typhoid.
• Remember that you will need to complete your vaccination at least 12 weeks (dependent upon vaccine type) before you travel so that the vaccine has time to take effect.
• Typhoid vaccines lose effectiveness after several years; If you were vaccinated in the past, check with your doctor tosee if it is time for a booster vaccination.

DOES THE DANGER ENDS WHEN THE SYMPTOMS DISAPPEAR?

Even if your symptoms seem to go away, you may still be carrying Salmonella Typhi. If so, the illness could return, or you could pass the disease to other people. In fact, if you work at a job where you handle food or care for small children, you may be barred legally from going back to work until a doctor has determined that you no longer carry any typhoid bacteria. If you are being treated for typhoid fever, it is important to do the following:

• Keep taking the prescribed antibiotics for as long as the doctor has asked you to take them.
• Wash your hands carefully with soap and water after using the bathroom, and do not prepare
• Or serve food for other people. This will lower the chance that you will pass the infection on to someone else.
• Have your doctor to perform a series of stool cultures to ensure that no Salmonella Typhi bacteria remain in your body.

References:

1. <www.uptodate.com>

2. Centers for Disease And Prevention Control

3. <http://www.medicalnewstoday.com/articles/156859>

4. Bulletin of World Health Oragnization 2004; 82; 346-352