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


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



- It only affects humans.



- 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.



- 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.



- 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).



- 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.



- 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.



- 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).



- 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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