MUST IT ALWAYS BE TYPHOID FEVER?

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 and after which I was placed on several antibiotics but I still feel sick and my mouth is 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. Then I laughed and replied jokingly; MUST IT ALWAYS BE TYPHOID FEVER?

It has become a trend in our society to label everyone with a fever as having typhoid fever. It is even worse when the diagnosis is being made straight from the laboratory without consulting a doctor. It has become obvious that some doctors are involved in this menace of diagnosing every fever as typhoid fever, hence sustaining the ugly trend of the so called typhoid/malaria/typhoid syndrome.

It is important to note that 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 titre in the antibody levels that is suggestive of an acute infection and not just a single antibody titre.Salmonella, which is the cause of typhoid fever infection is endemic in our setting and most people will have a raised typhoid antibody levels in their blood and thereby giving a false impression. Here are some of the facts concerning typhoid fever.

WHAT IS TYPHOID FEVER?

Typhoid fever is a life-threatening illness caused by the bacterium Salmonella typhi. Typhoid fever is rare in industrialized 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.

Vaccines against typhoid fever are available, but they're only partially effective. Vaccines usually are reserved for those who may be exposed to the disease or are traveling to areas where typhoid fever is common.

HOW IS TYPHOID FEVER SPREAD?

Fecal-oral transmission route

The bacteria that cause typhoid fever spread through contaminated food or water and occasionally through direct contact with someone who is infected.

 Salmonella typhi is passed in the feces and sometimes in the urine of infected people. Infection can be contracted when food handled by someone with typhoid fever who hasn't washed carefully after using the toilet is eaten. 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.

Typhoid carriers

A small number of people who recover from typhoid fever continue to harbor the bacteria in their intestinal tracts or gallbladders, often for years. They shed the bacteria in their feces and are capable of infecting others, although they no longer have signs or symptoms of the disease themselves. They are referred to as chronic carriers.

WHAT ARE THE SIGNS AND SYMPTOMS OF TYPHOID FEVER?
Persons with typhoid fever usually have a sustained fever as high as 39° to 40° C, headache, abdominal pain, and either constipation or diarrhea. Other features may include weakness, loss of appetite, and rash of flat, rose-colored spots. 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 presence of S. Typhi.

WHAT IS THE TEST THAT CAN BE DONE TO DIAGNOSE TYPHOID FEVER?

Samples of blood, stool, urine or bone marrow can be tested. (CULTURE).A bone marrow culture is often the most sensitive test for salmonella typhi

WHAT ARE THE COMPLICATIONS OF TYPHOID FEVER?

Ø  Intestinal bleeding or perforation

Ø  Inflammation of the heart muscle (myocarditis)

Ø  Inflammation of the lining of the heart and valves (endocarditis)

Ø  Pneumonia

Ø  Inflammation of the pancreas (pancreatitis)

Ø  Inflammation of the gallbladder (cholecystitis)

Ø  Kidney or bladder infections

Ø  Infection and inflammation of the membranes and fluid surrounding your brain and spinal cord (meningitis)

Ø  Psychiatric problems such as delirium, hallucinations and paranoid psychosis

 HOW CAN TYPHOID FEVER BE TREATED?

See your doctor immediately you notice symptoms or suspect you have typhoid fever. Suitable antibiotic may be prescribed, which is the main stay 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.

HOW CAN TYPHOID FEVER BE PREVENTED?

Vaccination

Vaccines are not 100 percent effective, and would require repeat immunizations as vaccine effectiveness diminishes over time. This is especially important if you are traveling to a country where typhoid is common.

Because the vaccine won't provide complete protection, follow these guidelines should be ensured,

"Boil it, cook it, peel it, or forget it"

·         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 sanitizer 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.

·         Avoid foods and beverages from street vendors - It is difficult for food to be kept clean on the street, and many travelers get sick from food bought from street vendors.

DR EMORINKEN KELVIN