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Typhoid.

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WHAT IS IT?

Abstract

VOL: 100, ISSUE: 14, PAGE NO: 33

 

WHAT IS IT?
- Typhoid fever is an infectious disease caused by the typhoid bacillus Salmonella enterica serovar typhi (S. typhi).

 

 

- It only affects humans.

 

 

INCIDENCE
- Typhoid is common in the developing world. Globally there are 13-17 million cases a year with 600,000 deaths (Macnair, 2004).

 

 

- About 150 cases of typhoid are reported each year in England and Wales.

 

 

TRANSMISSION
- People with typhoid carry the bacteria in their bloodstream and intestinal tract.

 

 

- The organisms are passed in human faeces and urine and acquired through heavily contaminated food and water (Health Protection Agency, 2004).

 

 

- The disease can be transmitted as long as the bacteria remain in a person’s system.

 

 

- A minority of people (about two to five per cent) although symptom free, still carry the bacteria, continuing to shed it in their waste.

 

 

SYMPTOMS
- Sudden fever.

 

 

- Severe headache.

 

 

- Nausea.

 

 

- Abdominal pain.

 

 

- Loss of appetite.

 

 

- Constipation followed by diarrhoea.

 

 

- A rash called ‘rose spots’ is present in some cases.

 

 

- General discomfort.

 

 

- Bloody stools.

 

 

- Lethargy.

 

 

- Nosebleed.

 

 

- Chills.

 

 

- Delirium.

 

 

- Hallucinations.

 

 

- Symptoms can be very severe - there is a mortality rate of one in ten unless treatment is given (Macnair, 2004).

 

 

DIAGNOSIS
- Typhoid is diagnosed by finding bacilli in blood, urine and/or faeces.

 

 

- Blood tests can show an elevated white blood cell count.

 

 

- A blood culture during the first week of fever can show S. typhi.

 

 

- A stool culture can isolate S. typhi in the faeces.

 

 

- An enzyme-linked immunosorbent assay (ELISA) test on urine can show Vi (virulence) antigen, which is specific for typhoid.

 

 

- A platelet count can show decreased platelets.

 

 

- A fluorescent antibody study can also demonstrate the presence of Vi antigen.

 

 

TREATMENT
- Antibiotics are used in the treatment of typhoid and they considerably reduce mortality.

 

 

- Stool cultures are used to monitor the progress of treatment.

 

 

- It is important for patients to be advised to do the following:

 

 

- Take the entire course of prescribed antibiotics;

 

 

- Wash hands carefully after using the toilet;

 

 

- Do not prepare food for others.

 

 

RESISTANCE
- Recently S. typhi has acquired resistance to antibiotics, including chloramphenicol, trimethoprim, ampicillin, and tetracycline.

 

 

- In Vietnam up to 93 per cent of S. typhi strains are reported to be multidrug-resistant.

 

 

- In Tadjikistan antimicrobial resistance is extending to new drugs such as cephalosporins and quinolones (World Health Organization, 2004).

 

 

PREVENTION
- Both injectable and oral vaccines are available.

 

 

- Precautions for food and water hygiene include the following:

 

 

- Drink bottled water. Carbonated water is safer than uncarbonated water;

 

 

- Take drinks without ice and avoid ice lollies;

 

 

- Ensure food is thoroughly cooked;

 

 

- Avoid raw vegetables and fruits that cannot be peeled;

 

 

- Avoid food from street vendors.

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