A young lad met me on my way back from
work. “Good day sir,” he said; “I have been sick for up to two weeks
now. My mouth was bitter and I had a fever. I was treated for malaria
initially, after which I was placed on several antibiotics but I still
feel sick and my mouth is still bitter. They said I have typhoid.”
“Who said so?”I queried? “Ah! Doctor, I went to the laboratory and they did Widal test for me and it was high.”
I laughed and replied jokingly, “Why must it always be typhoid fever?”
Everyone with a fever is labelled as
typhoid fever. It is even worse when the diagnosis is being made
straight from the laboratory without consulting a doctor. But, doctors
are also guilty of sustaining the ugly trend of the so-called
typhoid/malaria/typhoid syndrome.
Fact: Widal test is not
meant to be diagnostic for typhoid fever. Where Widal test is used, the
test has to be done serially. It is a rising level in the antibody
levels that is suggestive of an acute infection and not just a single
antibody titre.
Fact: Salmonella, which
is the cause of typhoid fever, is endemic here and most people will
have a raised typhoid antibody levels in their blood, thereby giving a
false impression.
Here are more facts.
What is typhoid fever?
Typhoid fever can be a life-threatening
illness that is rare in industrialised countries. However, it remains a
serious public health threat in the developing world like ours. When
treated with antibiotics, most people with typhoid fever feel better
within a few days; although a small percentage of them may die of
complications.
Continue reading after the cut....
Vaccines against typhoid fever are
available, but only partially effective. Vaccines usually are reserved
for those who may be exposed to the disease or are travelling to areas
where typhoid fever is common.
How typhoid fever is spread Faecal-oral route:
The bacteria that cause typhoid fever spread through contaminated food
or water and occasionally through direct contact with someone who is
infected.
Salmonella is passed in the faeces and
sometimes in the urine of infected people. Infection can be contracted
when food is handled by someone with typhoid fever who hasn’t washed
after toilet use. You can also become infected by drinking water
contaminated with the bacteria.
Therefore, typhoid fever is more common
in areas of the world where hand washing is less frequent and water is
likely to be contaminated with sewage.
Chronic typhoid carriers: A
small number of people who recover from typhoid fever continue to
harbour the bacteria in their body, often for years. They shed the
bacteria in their faeces and are capable of infecting others, although
they look well.
Signs and symptoms: Persons
with typhoid fever usually have high fever (39° to 40° C), headache,
abdominal pain, and constipation or diarrhoea. Also, they have weakness,
loss of appetite and a rash. The only way to know for sure if an
illness is typhoid fever is to have samples of stool, blood or urine
tested for the germ.
Complications
Typhoid complications include intestinal
bleeding or perforation, inflammation of the heart muscle
(myocarditis), inflammation of the lining of the heart and valves
(endocarditis), pneumonia, inflammation of the pancreas (pancreatitis),
inflammation of the gallbladder (cholecystitis) Kidney or bladder
infections, infection and inflammation of the membranes and fluid
surrounding the brain and spinal cord (meningitis), psychiatric problems
such as delirium, hallucinations and paranoid psychosis.
Treatment
See your doctor immediately you notice
these symptoms or suspect you have typhoid fever. Suitable antibiotic is
the mainstay of treatment. Surgery may be indicated in complicated
cases as in intestinal perforation. Persons given antibiotics usually
begin to feel better within 2 to 3 days, and deaths rarely occur.
However, persons who do not get treatment may continue to have fever for
weeks or months, and as many as 20% may die from complications of the
infection.
Prevention
Vaccination
Vaccines are not 100 per cent effective
and would require repeat immunisations as vaccine effectiveness
diminishes over time. This is especially important if you are travelling
to a country where typhoid is common.
Because the vaccine won’t provide
complete protection, follow these guidelines: Wash your hands.
Frequent hand-washing is the best way to control infection. Wash your
hands thoroughly with hot, soapy water, especially before eating or
preparing food and after using the toilet. Carry an alcohol-based hand
sanitiser for times when water isn’t available.
- Avoid drinking untreated water. Buy it bottled or boil it. Ask for drinks without ice unless the ice is made from bottled or boiled water
- Avoid raw fruits and vegetables: Avoid raw vegetables and fruits that cannot be peeled. Vegetables like lettuce are easily contaminated 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.
- Choose hot foods: Eat foods that have been thoroughly cooked and that are still hot and steaming.
- Don’t patronise street vendors: It is difficult for food to be kept clean on the street, and many travellers get sick from food bought from street vendors.
-Punch
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