Typhoid Fever

TYPHOID FEVER

An acute illness caused by and Salmonella enterica serotype Typhi bacteria which is really associated with high fever (>100⁰F) for long period of time, especially 3-5 days is termed to be typhoid fever.  It can sometimes be caused by Salmonella paratyphi, which usually causes a less severe illness.  Typhoid is spread by contact and ingestion of infected human feces

The typhoid bacteria are basically found in contaminated water and food.  The bacterium lives in the intestines and bloodstream of humans, no animal can carry typhoid bacteria.  Environmental sanitation can limit the occurrence of typhoid to its limit.  Worldwide, typhoid fever affects more than 21 million people annually, with about 200,000 people dying from the disease.  An unknown carrier of typhoid can also pass to another person, as the carrier will be lack of symptoms, even the carrier is unknown about being a carrier.

Early treatment of typhoid with antibiotics results in better outcome and if untreated can be fatal.  20% of untreated typhoid cases can be fatal while if treated there is chances of only 4% to be fata.

SOME FACTS ON TYPHOID

• Typhoid is a common bacterial infection in countries with low incomes.
• Untreated, it is fatal in around 25 percent of cases.
• Symptoms include a high fever and gastrointestinal problems.
• Some people carry the bacteria without developing symptoms
• The only treatment for typhoid is antibiotics

PATHOPHYSIOLOGY OF TYPHOID BACTERIA

S. typhi is transmitted through contaminated food or water from the unknown carrier.  S. typhi enters through the mouth and spends 1 to 3 weeks in the intestine then it proceeds through the intestinal wall into the bloodstream.  Then it spreads into other tissues and organs. The immune system of the host can do little to fight back because S. typhi can live within the host's cells undetected by the immune system.  Following 1-3 weeks of incubation period following symptoms are seen in the patient.

SYMPTOMS

The two major symptoms of typhoid are fever and rash. Typhoid fever is particularly high, gradually increasing over several days up to 104^oFahrenheit (39-40^o Celsius).

The rash is not seen in all patient but t some it consists of rose-colored spots, particularly on the neck and abdomen.  Other associated symptoms would be weakness, abdominal pain, constipation and in some rare cases confusion, diarrhea, and vomiting.

In serious, untreated cases, the bowel can become perforated. This can lead to peritonitis, an infection of the tissue that lines the inside of the abdomen, which has been reported as fatal in between 5 and 62 percent of cases.

Treatment

The only effective treatment for typhoid is antibiotics. The most commonly used are ciprofloxacin (for non-pregnant adults) and ceftriaxone and/or azithromycin and cefixime. Other than antibiotics, it is important to re-hydrate by drinking adequate water.  In more severe cases, where the bowel has become perforated, surgery may be required.

Typhoid antibiotic resistance

It has been reported that S. typhi is getting resistant to trimethoprim-sulfamethoxazole and ampicillin. Ciprofloxacin, a key medication for typhoid, is also experiencing similar difficulties. Some studies have found Salmonella typhimurium resistance rates to be around 35 percent.

Typhoid vaccination

If traveling to an area where typhoid is prevalent, vaccination is recommended. This can be achieved by oral medication, a live, attenuated vaccine consisting of 4 tablets, one to be taken every second day and travel can be done after 1 weeks of that, another would be a shot, administered 2 weeks before travel.  Vaccination are prohibited if the individual is currently ill or under the age of 6. Anyone with HIV should not take the live, oral dose.

PRIMORDIAL PREVENTION

• Drink bottled water, preferably carbonated or drink a water after heating till it boils for at least one minute before consuming.
• Avoid eating at street food stands, and only eat food that is still hot.
• Do not have ice in drinks.
• Avoid raw fruit and vegetables, peel fruit yourself, and do not eat the peel.

Managing patients

The local health protection unit (HPU) should be informed immediately if a patient is suspected of having typhoid fever - reporting should not wait for laboratory confirmation.  Nurse should take care of patient with the initiative of antibiotic therapy.  They should give plenty of water to drink for re-hydration.  Hand sanitation should be maintained.  Children under the age of five to be avoided to be contact with the patient.