New Telegraph

Typhoid fever

Scene one

Mr 123; Good day Doctor Doctor; Good day, Mr 123, why are you here today? Mr 123; I have typhoid, the feelings are all over Doctor; You have typhoid? What are these things you feel? Mr 123; Internal heat, something walking all over my body, burning sensation all over, heaviness of the head…I just know it’s Typhoid, these are what I usually feel and they correspond to what the drug vendor in a bus listed! Doctor; Mr 123, do you mind if we have some tests done, I’m afraid you may have something else Mr 123; Doctor, I’m not teaching you your job but I know I have typhoid! (Much later) Mr 123 with mouth agape after result of one of the tests (fasting blood glucose) is out. Doctor; My word Mr 123, you’re diabetic, so all the while you’re bring wrongly managed for Typhoid fever, over and over, again and again! The above typifies the story of an average client presenting to a hospital in this environment; most of what they diagnose as ‘’Typhoid’’ is not it!

What it is

Typhoid fever (aka Enteric fever) is an infection caused by the bacteria Salmonella typhimurium. It gains access into the body through contaminated food, water/beverages, thriving in conditions of poor sanitation, crowding, and social chaos.

The genesis

S. typhi (a bacteria) enters through the mouth (through contaminated food, water and other drinks) and spend 1-3 weeks in the intestine. Thereafter, it makes its way through the intestinal wall and into the bloodstream. From the bloodstream, it travels to the lymph nodes (a component of the body’s immune system), gallbladder, liver, spleen, and other parts of the body. The immune system of the host can do little to fight back because S. typhi can live within the host’s cells, safe from the immune system. Long term carriers are responsible for much of the transmission of the organism. While asymptomatic, they may continue to shed bacteria in their stool for decades.

Modes of transmission

  1. Oral transmission via food or water or beverages handled by an often asymptomatic individual—a carrier—who in the long term, sheds the bacteria through stool or less commonly, urine 2. Hand-to-mouth transmission after using a contaminated toilet and neglecting hand hygiene 3. Oral transmission via sewage-contaminated water (especially in environments with poor hygiene).

What may give it away

Symptoms are often non-specific and clinically non-distinguishable from other illnesses that cause fever. Symptoms occur 6-30 days after exposure to the bacteria. They may include; prolonged fever, (the major feature of this fever is that it usually rises in the afternoon up to the first and second week) headache, abdominal pain, nausea, body weakness, loss of appetite, and constipation or sometimes diarrhoea. Some develop a rash (rose spot) in their abdomen and chest. Some individuals are asymptomatic carriers of typhoid, meaning that they harbor the bacteria but suffer no ill effects. As many as 1 in 6 people have the capacity to be a silent carrier. These individuals are particularly dangerous within high-risk populations. Mary Mallon, better known as “Typhoid Mary” (1869-1938), was the first documented asymptomatic typhoid carrier in the U.S. During her career as a cook, Mary was thought to have infected at least 51 people, three of whom died. Mary, an Irish immigrant, worked as a cook for a string of families, infecting numerous members of each household before moving on to work elsewhere.

The Catch

After a comprehensive history is taken and examination done,the following may be requested for; Full blood count (FBC); will show a high number of white blood cells. Platelet count (blood unit that prevents bleeding) may be reduced. Blood culture during the first week of the fever can show S. typhi bacteria. A type of urine test can also pick the bacteria that cause Typhoid fever Stool culture is a reliable method of diagnosis. A bone marrow culture is the most sensitive for S.typhi (but it’s only done in very extreme cases in this environment). Urine, Stool or Blood culture would usually suffice. Note; Widal; a major limitation of Widal test is that it is reactive only after 7-10 days of Typhoid fever and it has false positives and false negatives. The Widal test causes misdiagnosis and wrong treatment and in essence not reliable!

Negative Outcomes

Intestinal perforation (leading to peritonitis), Intestinal bleeding, inflammation of the brain, Neuropsychiatric symptoms (delirium), Pneumonia, infection of lung tubes, reduced level of blood unit that prevents bleeding and severe dehydration.

How is it treated?

This is determined by your doctor. The earlier you visit the hospital, the better the outcome.

Preventive measures

Sanitation and hygiene are important to prevent typhoid. Typhoid can only spread in environments where human feces are able to come into contact with food or drinking water. Careful food preparation and Hand hygiene are crucial to prevent typhoid. To help decrease rates of typhoid fever in developing nations, the World Health Organization (WHO) endorsed the use of a vaccination program that commenced in 1999. Vaccinations have proven to be a great way at controlling outbreaks in high incidence areas

Take Home

Widal is not a reliable test for Typhoid fever but rather it may be a tool for exploitation by quacks! If any ‘’doctor’’ requests for it, run… please run!

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