What is #Typhoid
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TYPHOID

Typhoid is a bacterial infection that can lead to a high fever, diarrhea, and vomiting. It can be fatal. It is caused by the bacteria Salmonella typhi.

Often times, the infection is passed on through contaminated food and drinking water, and it is more prevalent in places where hand washing is less frequent. It can also be passed on by carriers who do not know they carry the bacteria.

If typhoid is diagnosed early, it can be successfully treated with antibiotics, however if not treated, typhoid can be fatal.

Fast facts on typhoid

  • Typhoid is a common bacterial infection in countries with low incomes.
  • Untreated, it is fatal in over 20 percent of cases.
  • Symptoms include a high fever and gastrointestinal problems.
  • Some people carry the bacteria without developing symptoms
  • Most cases reported in the United States are contracted overseas
  • The only treatment for typhoid is antibiotics

WHAT IS TYPHOID?

Typhoid is an infection caused by the Salmonella typhimurium bacteria that is spread from human to human.

The bacterium lives in the intestines and bloodstream of humans. It spreads between individuals by direct contact with the feces of an infected person.

Animals do not carry this disease, so transmission is always human to human.

If not treated, approximately 1 in every 5 cases of typhoid can be fatal. S. typhi enters through the mouth and spends 1 to 3 weeks in the intestine. After this, it makes its way through the intestinal wall into the bloodstream.

From the bloodstream, it spreads into other tissues and organs. The immune system of the host can do almost nothing to fight back because S. typhi normally lives within the host’s cells, where it is safe from the immune system.

Typhoid is diagnosed by detecting the presence of S. typhi through blood, stool, urine, or bone marrow samples.

CAUSES

Although related, Salmonella typhi and the bacteria responsible for salmonellosis, another serious intestinal infection, are different and therefore are not the same.

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. In developing nations, where typhoid fever is endemic, most cases result from contaminated drinking water and poor sanitation. The majority of people in industrialized and developed countries pick up typhoid bacteria during travels and spread it to others through the fecal-oral route.

This means that Salmonella typhi is passed in the feces and sometimes in the urine of infected people. One can contract the infection from food that has been handled by someone with typhoid fever who has not washed the hands carefully after using the toilet. A person can also become infected by drinking water contaminated with the bacteria.

Carriers of Typhoid

Even after treatment with antibiotics, a small number of people who recover from typhoid fever will continue to harbor the bacteria in their intestinal tracts or gallbladders, often for years. These people are called chronic carriers, they shed the bacteria in their feces and are capable of infecting others, although they do not exhibit signs or symptoms of the disease themselves.

RISK FACTORS

Typhoid fever remains a serious worldwide threat especially in the developing world. The disease is endemic in India, Southeast Asia, Africa, South America and other areas.

Children are at greatest risk of getting infected with the disease, although they generally have milder symptoms than adults.

If you live in a country where typhoid fever is rare, you're at increased risk if you:

  • Work as a clinical microbiologist who handles Salmonella typhi bacteria
  • Work in or travel to areas where typhoid fever is endemic.
  • Drink water contaminated by sewage that contains Salmonella typhi
  • Come into close contact with someone who is infected or has recently been infected with typhoid fever.

COMPLICATIONS

Intestinal bleeding or holes -The most serious complications of typhoid fever is intestinal bleeding or perforations in the intestine. This may develop in about the third week of illness. A perforated intestine occurs when the small intestine or large bowel develops a hole, causing intestinal contents to leak into the abdominal cavity. This will trigger signs and symptoms such as severe abdominal pain, nausea, vomiting and bloodstream infection (sepsis). This is a life-threatening complication that will require immediate medical care.

Other possible complications include:

  • Inflammation of the pancreas (pancreatitis) - Pancreatitis is inflammation that occurs in the pancreas. It can be very serious, even life-threatening. But it usually goes away within a few days of treatment.
  • Pneumonia - Pneumonia is an infection in one or both lungs caused by bacteria, viruses, and fungi. The infection causes inflammation in the air sacs in the lungs Inflammation of the heart muscle (myocarditis) - Myocarditis is inflammation of the myocardium (the heart muscle). Most people with myocarditis recover without any complications but in rare cases there can be damage to the heart when inflammation is severe.
  • Infection and inflammation of the membranes and fluid surrounding the brain and spinal cord (meningitis) - Meningitis is a disease caused by an inflammation of the meninges (the membranes that surround the brain). There are three meninges.
  • Inflammation of the lining of the heart and valves (endocarditis) - Endocarditis is inflammation of the inner lining of the heart chambers and valves, or endocardium. Endocarditis is a rare but life-threatening disease.
  • Kidney or bladder infections - A bladder infection is most often caused by a bacterial infection within the bladder. For people with weakened immune systems, yeast can cause bladder infections as well. While a kidney infection (also called pyelonephritis), is when bacteria or viruses cause problems in one or both kidneys. It is a type of urinary tract infection (UTI)
  • Psychiatric problems, such as delirium, hallucinations and paranoid psychosis - Psychotic disorders due to medical or neurologic conditions present symptoms that may include delusions and/or hallucinations, these often meet criteria for delirium. Vivid visual hallucinations and confusion are particularly common when the psychosis is related to an underlying metabolic disturbance.

With prompt treatment, most people in industrialized nations recover from typhoid fever.

SYMPTOMS

It can take a week or two after infection for symptoms to appear. Some of these symptoms are:

  • Stomach pain - Abdominal pain is pain that one feels anywhere between the chest and groin. This is often referred to as the stomach region or belly.
  • Poor appetite - A decreased appetite occurs when one has a reduced desire to eat. It may also be known as a poor appetite or loss of appetite
  • High fever - Anything from 39-42 is high fever and above 42.4°C the fever is considered very dangerous and can cause serious, long-lasting damage.
  • Weakness - Weakness is a decrease in the strength in one or more muscles. In the strictest sense, the medical definition of weakness refers to loss of muscle strength.
  • Headache - Headache is defined as a pain arising from the head or upper neck of the body. The pain originates from the tissues and structures that surround the skull or the brain because the brain itself has no nerves that give rise to the sensation of pain.
  • Constipation, diarrhea - Constipation occurs when bowel movements become less frequent and stools become difficult to pass. Diarrhea is loose and watery stool during a bowel movement. It is said that one “has diarrhea” when it happens more than three times in a day.
  • Confusion - Confusion is a symptom that makes one feel as if they cannot think clearly. With a feeling of disorientation, an individual can have a hard time focusing on anything or making decisions.
  • Fatigue - Fatigue is a term used to describe an overall feeling of tiredness or lack of energy. It isn't the same as simply feeling drowsy or sleepy. When one is fatigued, they have simply no motivation and no energy.
  • Rash - A rash is an area of irritated or swollen skin. Many rashes are itchy, red, painful, and irritated. Some rashes can also lead to blisters or patches of raw skin.

Serious complications can include intestinal bleeding or perforations in the intestine but are rare. This can lead to a life-threatening bloodstream infection (sepsis), which has nausea, vomiting, and severe abdominal pain as symptoms.

WHEN TO SEE A DOCTOR

One will need to see a doctor immediately if they suspect they have typhoid fever. If you are from a foreign country and become ill while traveling in another country, call the related consulate for a list of doctors you could see. Better still, people must find out in advance about medical care in the areas they visit, and perhaps carry a list of the names, addresses and phone numbers of recommended doctors.

If signs and symptoms develop after returning home, patients must consider consulting a doctor who focuses on international travel medicine or infectious diseases. A specialist may be able to recognize and treat your illness more quickly than a doctor who may not be versed with these areas.

RISK FACTORS

Common risk factors in the development of typhoid fever are:

  • Poor sanitation conditions
  • Crowded housing
  • Travel to endemic areas
  • Recent use of antibiotics
  • Poor hygiene habits
  • Proximity to flying insects feeding on feces
  • Contact with someone who recently suffered from typhoid fever
  • Immunosuppressive illnesses such as AIDS
  • Consumption of raw fruits and vegetables contaminated with sewage
  • Prolonged illness
  • Being a health care worker
  • Being a clinical microbiologists who handles salmonella typhi
  • Childhood

DIAGNOSIS

Medical and travel history:-

The doctor is likely to suspect typhoid fever based on the symptoms presented plus medical and travel history. But the diagnosis is usually confirmed by identifying Salmonella typhi in a culture of blood or other body fluid or tissue.

Body fluid or tissue culture

For the culture, a small sample of the patient’s blood, stool, urine or bone marrow is placed on a special medium that encourages the growth of bacteria. The culture is checked under a microscope for the presence of typhoid bacteria. A bone marrow culture often is the most sensitive test for Salmonella typhi.

Although performing a culture test is the mainstay for diagnosis, in some instances other testing may be used to confirm a suspected typhoid fever infection, such as a test to detect antibodies to typhoid bacteria in the blood or a test that checks for typhoid DNA in blood.

TREATMENT

Treatment at home

If typhoid fever is diagnosed in its early stages, a course of antibiotic tablets may be prescribed. Averagely, people need to take the prescription for up to 2 weeks.

Some strains of the Salmonella typhi bacteria that cause typhoid fever have developed a resistance to one or more types of antibiotics.

Any blood, stool or urine samples taken during the diagnosis will usually be tested in a laboratory to determine which strain of infection you have, this will enable the doctor decide on the appropriate antibiotic.

Generally, symptoms should begin to improve within 2 to 3 days of taking antibiotics. Despite this, it is very important to finish the course to ensure the bacteria are completely removed from the body.

Ensure adequate rest, drink plenty of fluids and eat regular meals. You may find it easier to eat smaller meals more frequently, rather than 3 larger meals a day.

Good standards of personal hygiene must be maintained, such as regular washing of hands with soap and warm water, to reduce the risk of spreading the infection to others.

Contact a doctor as soon as possible if the symptoms get worse or new symptoms develop while being treated at home.

In a small number of cases, relapses occur. This means the symptoms or infection may recur.

Staying off work or school

Except those people who work with food and vulnerable people (children under 5, the elderly and those in poor health), most people being treated for typhoid fever can return to work or school as soon as they start to feel better.

In these cases, people must return only after samples taken at 48-hour intervals have shown that the bacteria are no longer present.

Hospital treatment

Hospital admission is usually recommended for those with severe symptoms of typhoid fever, such as persistent vomiting, severe diarrhea or a swollen stomach.

As a precautionary measure, young children who develop typhoid fever may be admitted to hospital.

In hospital, antibiotic injections will be dispensed, fluids and nutrients may be given directly into a vein through an intravenous drip.

Surgery may be needed should life-threatening complications of typhoid fever develop (e.g. internal bleeding or a section of your digestive system splitting). Though this is very rare in people being treated with antibiotics.

Most people respond well to hospital treatment and improve within 3 to 5 days, but it may be several weeks until one is well enough to leave hospital.

Relapses

Some people who are treated for typhoid fever experience relapses, which is when symptoms return. In these cases, the symptoms usually return around a week after antibiotic treatment has ended.

The second bout of symptoms are usually milder and last for a shorter time than the original illness, but it may require further treatment with antibiotics.

Long-term carriers

After your symptoms have passed, you should have another stool test to check whether there are still Salmonella typhi bacteria in the faeces. If there are, the person may have become a carrier of the typhoid infection. You may thus need to have a further course of antibiotics to 'flush out' the bacteria.

Until test results show that one is free of bacteria, handling or preparing food must be avoided.

It is also very important to wash the hands thoroughly after going to the toilet.

PREVENTION

Countries with less access to clean water and washing facilities typically will have a higher number of typhoid cases.

Vaccination

Vaccination is recommended if one is traveling to an area where typhoid is prevalent,.

Before traveling to a high-risk area, getting vaccinated against typhoid fever is the best option. This can be obtained as an oral medication or a one-off injection:

Oral: Consists of 4 tablets, one to be taken every second day, the last of which is taken 1 week before travel. This is a live attenuated vaccine for oral administration only.

Shot: An inactivated vaccine, administered 2 weeks before travel.

Caution should still be exercised when eating and drinking because vaccines are not 100 percent effective.

Vaccination should not be employed if the individual is currently ill or if the individual is under 6 years of age. The vaccine may have adverse effects. Some people will experience a fever. There may be gastrointestinal problems after the oral vaccine (e.g. Nausea, and headache). Severe side effects are however rare with either vaccine.

There are two types of typhoid vaccine already available, but a more powerful vaccine is still needed. The live, oral version of the vaccine is the stronger of the existing two. After 3 years, it still protects individuals from infection most of the time. However, this vaccine has more side effects.

The current vaccines are not always effective, and because typhoid is so prevalent in poorer countries, more research needs to be done to find better ways of preventing its spread.

Eliminating typhoid

Even when the symptoms of typhoid have passed, it is still possible for one to be carrying the bacteria.

This makes it difficult to stamp out the disease entirely, because carriers whose symptoms have finished may be less careful when washing food or interacting with others.

Avoiding infection

Typhoid is only spread by contact and ingestion of infected human feces. This can happen through an infected water source or when handling food.

The following are some general rules to follow to help minimize the chance of typhoid infection:

  • Be wary of eating anything that has been handled by someone else.
  • Drink bottled water, preferably carbonated.
  • Avoid raw fruit and vegetables, peel fruit yourself, and do not eat the peel.
  • If bottled water cannot be sourced, ensure water is heated on a rolling boil for at least one minute before consuming.
  • Avoid eating at street food stands, and only eat food that is still hot.
  • Do not have ice in drinks.

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