TYPHOID FEVER
DEFINITION: - Typhoid fever is a systemic infectious disease caused by the bacterium Salmonella enterica serotype Typhi also known as s. typhi. Salmonella enterica serotype paratyphi( s. paratyphi) A, B, C cause the clinically similar condition known as paratyphoid. Typhoid and paratyphoid fever collectively referred to as enteric fever.
The contagious nature of the disease and incriminated faecally contaminated water sources in transmission was described by William Budd in 1873.
EPIDEMIOLOGY
India the typhoid fever is a major public health problem because of poor sanitation, lack of safe drinking water supply and low socioeconomic condition. That’s why in India there is lots of case of typhoid fever. The typhoid fever is usually observed throughout the year.
Age group: - mainly affect children and young adults
Gender: - more common in a male. As female are chronic carriers.
Socioeconomic factor: - Typhoid fever is a disease of poverty and associated with inadequate sanitation facilities and unsafe water supplies.
MODE OF TRANSMISSION
Typhoid fever is transmitted by the fecal-oral route, via contaminated food and water. Occasionally health care workers can acquire the disease from infected patients.
AETIOPATHOLOGY
I have lots of information regarding this section but as our motto is to explain in easy understand so I will briefly explain how bacteria enter in our bloodstream and produce typhoid fever as below,
S. Typhi is ingested with food and water (both contaminated).
Passes through the stomach and invade gut epithelium
In the small intestine invade and translocate to an intestinal lymphoid follicle
Some pass on to reticuloendothelial cells of liver and spleen
In the liver and spleen, they multiply
After 7 to 14 days of incubation clinical conditions such as fever appear
CLINICAL FEATURES
Prolonged fever: - initially low grade, rises progressively, and by the second week is often high and sustained. Continues fever rising in step-ladder fashion is observed
Fever including chills, headache, anorexia, cough, weakness, sore throat, dizziness, muscle pain and abdominal pain.
There are some physical sing present in typhoid fever such as coated tongue, tender abdomen, hepatomegaly and/or splenomegaly may be found.
In some patient at the end of 1st week small maculopapular, blanching and erythematous rush typically on trunk and chest may be seen.
Constipation may present in some patient
DIAGNOSIS
Typhoid should be considered in any patient with prolonged unexplained fever with an appearance of a rose spot.
Complete blood count
Widal test is the best serological test to diagnose typhoid fever
COMPLICATION
The commonest complication is as follow
Intestinal perforation
Gastrointestinal hemorrhage
Typhoid encephalopathy
PROGNOSIS
When untreated the fever persists for 2 weeks or more and defervescence occurs slowly over the following 2 to 3 weeks. Death occurs in between 10% to 30% of an untreated patient following complication.
PREVENTION
We can prevent typhoid fever by improving sanitation, ensuring the safety of food and water supplies, identification and treatment of chronic carries of s.typhi, and use of typhoid vaccines to reduce the susceptibility of the host to infection.
Vaccination is recommended for use in travelers to endemic areas, for household contact of typhoid carries, and laboratory workers.
There are two type of vaccine available for typhoid fever
1 Parenteral Vi polysaccharide vaccine.
2 Oral Vaccine ( S. Typhi strain Ty21a is live attenuated oral vaccine)
TREAMENT
General Management
Supportive measures such as adequate rest, tepid bath and sponging, appropriate nutrition and diet, all are important in the management of typhoid fever.
Anti-microbial therapy
There are many medicines to treat typhoid fever but without consultation with your family physician, you cannot use any antibiotics. If you have high-grade fever since 7 to 10 days without any relief in symptoms please consult your family physician for proper treatment
Dr. Amin I Bayad
(BHMS)
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