Patients Care

TYPHOID

Typhoid fever, also known as Enteric Fever or commonly just typhoid, is a common worldwide illness, transmitted by the ingestion of food or water contaminated with the feces of an infected person.

Typhoid fever is an acute illness associated with fever caused by bacteria. It can also be caused by Salmonella paratyphi, a related bacterium that usually causes a less severe illness. The bacteria are deposited in water or food by a human carrier and are then spread to other people in the area.

Causes

  • Typhoid fever is contracted by the ingestion of the bacteria in contaminated food or water.
  • Patients with acute illness can contaminate the surrounding water supply through stool, which contains a high concentration of the bacteria.
  • Contamination of the water supply can, in turn, spoil the food supply. About 3%-5% of patients become carriers of the bacteria after the acute illness.
  • Some patients suffer a very mild illness that goes unrecognized. These patients can become long-term carriers of the bacteria.
  • The bacteria multiply in the gallbladder, bile ducts, or liver and passes into the bowel. The bacteria can survive for weeks in water or dried sewage.
  • These chronic carriers may have no symptoms and can be the source of new outbreaks of typhoid fever.

Signs and symptoms

  • Typhoid fever is characterized by a slowly progressive fever as high as 40 °C (104 °F).
  • Profuse sweating, gastroenteritis and nonbloody diarrhea. Less commonly a rash of flat, rose-colored spots may appear.
  • Classically, the course of untreated typhoid fever is divided into four individual stages, each lasting approximately one week.
  • In the first week, there is a slowly rising temperature with relative bradycardia, malaise, headache and cough. A bloody nose is seen in a quarter of cases and abdominal pain is also possible.
  • There is leucopenia, a decrease in the number of circulating white blood cells, with eosinopenia and relative lymphocytosis, blood cultures are positive for Salmonella typhi or paratyphi.
  • The classic Widal test is negative in the first week.
  • In the second week of the infection, the patient lies prostrated with high fever in plateau around 40 °C (104 °F) and bradycardia and palpitation.
  • Delirium is frequent, frequently calm, but sometimes agitated.
  • Rose spots appear on the lower chest and abdomen in around 1/3 patients.
  • The abdomen is distended and painful in the right lower quadrant.
  • Diarrhea can occur in this stage: six to eight stools in a day, green with a characteristic smell. However, constipation is also frequent.
  • The spleen and liver are enlarged and tender.
  • The Widal reaction is strongly positive.
  • Blood cultures are sometimes still positive at this stage. In the third week of typhoid fever a number of complications can occur.

    The incubation period is usually one to two weeks and the duration of the illness is about four to six weeks. The patient experiences:

    • Poor appetite
    • Headaches
    • Generalized aches and pains
    • Fever
    • Lethargy and
    • Diarrhea.

Management

  • Diagnosis is made by any blood, bone marrow or stool cultures and with the Widal test.
  • In epidemics and less wealthy countries, after excluding malaria, dysentery or pneumonia, a therapeutic trial time with chloramphenicol is generally undertaken while awaiting the results of Widal test and cultures of the blood and stool.
  • Typhoid fever is treated with antibiotics which kill the Salmonella bacteria.
  • With antibiotics and supportive care, mortality has been reduced to 1%-2%. With appropriate antibiotic therapy, there is usually improvement within one to two days and recovery within seven to 10 days.
  • The choice of antibiotics needs to be guided by identifying the geographic region where the organism was acquired and the results of cultures once available.
  • The carrier state, which occurs in 3%-5% of those infected, can be treated with prolonged antibiotics. Often, removal of the gallbladder, the site of chronic infection, will cure the carrier state.
  • For those traveling to high-risk areas, vaccines are now available.
  • Typhoid fever in most cases is not fatal.