WHAT IS IT?
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.
- 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.
- Abdominal pain.
- Loss of appetite.
- Constipation followed by diarrhoea.
- A rash called ‘rose spots’ is present in some cases.
- General discomfort.
- Bloody stools.
- 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.