TYPHOID FEVER:

Typhoid fever is also called enteric fever. It is an acute infectious illness associated with fever that is most often caused by salmonella typhi bacteria(typhoid fever) or paratyphi (paratyphoid fever), a related bacterium that usually leads to a less severe illness. Typhoid fever is rare in industrial countries but continues to be a significant public health issue in developing countries.

TYPHOID FEVER IS CAUSED BY?

Typhoid fever is caused by various strains of salmonella, belonging to a family,
Enterobacteriaceae which is a gram-negative facultative anaerobe consists of flagella.
The etiologic agents include
• Salmonella typhi
• Salmonella paratyphi
• Salmonella Typhimurium

TYPHOID FEVER SYMPTOMS:

Fever intense varies between 39-40C (103F-104F)
First week
• Stepwise fever
• Headache
• General aches
• Cough
• White coating on the tongue
• Weight loss
• Constipation
• Malaise(general feeling of discomfort)

Between 1st and second week
• Intense fever
• Rose spots
• Splenomegaly
• Abdominal pain
• Ulcers in the intestine
• Diarrhoea

Beyond 3rd week
• Intestinal bleeding
• Confusion
• Melena(dark sticky faeces with blood due to internal bleeding)
• Coma
• Delirium
• Death

STAGES OF TYPHOID FEVER:

There are mainly 4 stages of typhoid fever or enteric fever includes,
1. First stage: The patient may experience some preliminary typhoid symptoms like dry cough, and headache. This stage may or may not be accompanied by fever.
2. Second stage: This stage causes an increase in fever and may stomach becomes bloated. The patient may feel lethargic and agitated in alternation
3. Third stage: The symptoms may become serious. Severe Intestinal perforation may cause abdominal haemorrhage. The person becomes more hydrated with an increase in the intensity of the delirium
4. Fourth stage: This stage is characterized by extremely high fever. This stage leads to severe complications including pneumonia, acute kidney failure, and meningitis.

MODE OF TRANSMISSION:

1. Fecal oral transmission: Ingestion of contaminated food and water. The person
infected by the bacteria may eliminate them in their faces and sometimes in their urine.
If they didn’t wash their hands
• Contamination of raw vegetables
• Shellfish are taken from sewage-contaminated water
• Food contaminated by flies
• Contaminated milk and milk products

2. Typhoid carriers: some people who recover from typhoid fever continue to harbour the bacteria without showing signs and symptoms. They are known as chronic carriers and they shed the bacteria in stool, which is capable of infecting others

What is the incubation period?

The incubation period is 8-14 days
May be as short as 3 days, or as long as 21 days depending upon the dose of bacilli ingested.

RISK FACTORS OF TYPHOID FEVER:

• Work or travel in areas where typhoid fever is established. Typhoid fever is endemic
in Asia, Africa, and Latin America but 80% of cases come from Bangladesh, China, India,
Indonesia, Nepal Or Vietnam
• Working clinical microbiologist handling salmonella typhi
• Drinking water polluted by sewage

COMPLICATIONS OF TYPHOID FEVER:

• Haemorrhage (including disseminated intravascular coagulation)
• Perforation of the bowel
• Jaundice may be due to hepatitis, cholangitis Or haemolysis
• Pancreatitis with acute kidney injury
• Hepatitis with hepatomegaly
• Toxic myocarditis
• Neurological and psychiatric disturbances

PREVENTION OF TYPHOID FEVER:

• Vaccination
• Wash hands properly with soap and water after going to the toilet and before
eating.
• Boil or disinfect all water before drinking it – use disinfectant tablets or liquid
available in pharmacies or drink commercially bottled beverages.
• Peel all fruit and vegetable skins before eating.
• Keep flies away from food.
• Watch out for ice cubes, ice cream, and er unpasteurized milk, which can easily be or contaminated.
• Cook all food properly and eat it while it is hot.
• Be aware of the “danger foods” Which are responsible for causing diseases such as shellfish, salads, and raw fruit and vegetables.
• Don’t eat food or drink beverages from street vendors.

HOME REMEDIES FOR TYPHOID FEVER:

• Increase fluid intake/drink plenty of water
• Use cold compresses to combat high fever
• Garlic: It has antimicrobial properties and helps to fight against the salmonella typhi and speed recovery from fever due to its antioxidant property
• Basil: Shows antibiotic and antimicrobial property
• Banana: Helps to treat the symptoms of typhoid fever. It will reduce the fever and treat diarrhoea
• Cloves: shows antibacterial property and helps to fight against typhoid bacteria
• Consume curd, yoghurt and buttermilk to balance the intestinal flora
• Apple cider vinegar: It has acidic properties and helps to reduce the body
temperature and also helps to balance the pH of the body by replacing the minerals which loosed by diarrhoea
• Triphala: It will inhibit the growth of the bacteria causing typhoid fever

DIAGNOSIS OF TYPHOID FEVER:

Infection with typhoid or paratyphoid fever may lead to low-grade septicaemia. It is diagnosed as follows
1. Differential diagnosis
Increasing fever with evening exacerbation and morning remission
• Malaise with headache
• Furred tongue with red edges
• Epistaxis
• Slow pulse
• Splenomegaly
• Bronchial catarrh
The differential diagnosis in this group of symptoms will depend on travel history

2. Stool culture: Diagnosis is made by culturing the organism, this may be obtained from the stool. This test method will detect the presence of salmonella typhi.

3. Blood test: Helps to detect the IgM and IgG antibodies and also to detect the
bacteria responsible for causing typhoid fever (salmonella typhi)

4. Widal test: It is the traditional serological test. It measures agglutinating antibodies against flagellar(H) and somatic (O) antigens of salmonella typhi . High or raising O antibody titres generally indicate acute infection, whereas the H antibody is used to identify the type of infection.

TREATMENT OF TYPHOID FEVER:

• Typhoid fever antibiotics
Typhoid fever can be treated by using antibiotics that will kill the salmonella bacteria which is responsible for causing typhoid. Several types of antibiotics are effective for the treatment of typhoid fever or enteric fever include
Sulfamethoxazole
Ceftriaxone
Ciprofloxacin
Azithromycin
• Surgery is needed in case of intestinal perforations

VACCINE FOR TYPHOID FEVER:

Vaccination will help to prevent typhoid fever. (CDC) Centres for Disease Control and Prevention recommend vaccination for people travelling to different places where typhoid fever is more common which includes India, Bangladesh, south Asia and China. There are mainly two types of typhoid fever vaccine are available
• Oral vaccine: Typhoid vaccine live oral Ty21a is administered only through the oral
route. It is given only to people at least 6 years old.
• Injectable vaccine: ViCPS(vi capsular polysaccharide vaccine) is given directly to the bloodstream. It is given to people at least 2 years old