Typhoid

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Overview

Typhoid fever is also called enteric fever. It is a prospectively, multisystemic illness that has been a public health problem, especially in the developing world. It is caused by Salmonella typhi and Salmonella paratyphi.[1] Enteric fever is a cumulative term that illustrates both typhoid and paratyphoid fever. Paratyphoid is clinically indistinct from typhoid fever; thus, enteric and typhoid fever are used mutually. Typhoid fever is one of the major causes of mortality and morbidity in overcrowded and unhygienic areas though comprehensive research and public health interventions have decreased the occurrence. The disease course ranges from early gastrointestinal distress to nonspecific systemic illness but ultimately may lead to multiple complications. Salmonella is said to spread by the 'four Fs" (flies, fingers, feces, fomites). Fever characteristically comes in a step-wise pattern (i.e., rises and falls alternatively) followed by headache and abdominal pain.

Symptoms

Fever that starts low and increases daily, possibly reaching as high as 104.9 F (40.5 C)

Headache.

Weakness and fatigue.

Muscle aches.

Sweating.

Dry cough.

Loss of appetite and weight loss.

Stomach pain.

Causes

People who drink contaminated water or eat food washed in contaminated water can develop typhoid fever. Other ways typhoid fever can be contracted include: using a toilet contaminated with bacteria and touching your mouth before washing your hands. eating seafood from a water source contaminated by infected poo or pee.

Risk factors

Work in or travel to areas where typhoid fever is established.

Work as a clinical microbiologist handling Salmonella typhi bacteria.

Have close contact with someone who is infected or has recently been infected with typhoid fever.

Drink water polluted by sewage that contains Salmonella typhi.

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Complications

Complications caused by typhoid fever usually only happen in people who haven't been treated with appropriate antibiotics or who weren't treated straight away.

In these circumstances, about 1 in 10 people experience complications, which usually develop during the 3rd week of infection.

The 2 most common complications in untreated typhoid fever are:

internal bleeding in the digestive system

splitting (perforation) of a section of the digestive system or bowel, which spreads the infection to nearby tissue

Internal bleeding

Most internal bleeding that happens in typhoid fever isn't life threatening, but it can make you feel very unwell.

Symptoms include:

feeling tired all the time

breathlessness

pale skin

an irregular heartbeat

vomiting blood

poo that's very dark or tar-like

A blood transfusion may be required to replace lost blood, and surgery can be used to repair the site of the bleeding.

Perforation

Perforation is potentially a very serious complication. This is because bacteria that live in your digestive system can move into your stomach and infect the lining of your abdomen (the peritoneum). This is known as peritonitis.

Peritonitis is a medical emergency as the tissue of the peritoneum is usually sterile (germ-free).

Unlike other parts of the body, such as the skin, the peritoneum doesn't have an inbuilt defence mechanism for fighting infection.

In peritonitis, the infection can rapidly spread into the blood (sepsis) before spreading to other organs.

This carries the risk of multiple organ failure. If it isn't treated properly, it may result in death.

The most common symptom of peritonitis is sudden abdominal pain that gets progressively worse.

If you have peritonitis, you'll be admitted to hospital, where you'll be treated with antibiotic injections.

Prevention

When traveling to countries that have higher incidences of typhoid, it helps to follow these prevention tips:

Be careful about what you drink

Don’t drink from the tap or a well.

Avoid ice cubes, popsicles, or fountain drinks unless you’re certain they’re made from bottled or boiled water.

Buy bottled drinks whenever possible (carbonated water is safer than noncarbonated water, be sure bottles are tightly sealed).

Nonbottled water should be boiled for 1 minute before drinking.

It’s safe to drink pasteurized milk, hot tea, and hot coffee.

Watch what you eat

Don’t eat raw produce unless you can peel it yourself after washing your hands.

Avoid food from street vendors.

Don’t eat raw or rare meat or fish. Foods should be thoroughly cooked and still hot when served.

Eat only pasteurized dairy products and hard-cooked eggs.

Avoid salads and condiments made from fresh ingredients.

Don’t eat wild game.

Practice good hygiene

Wash your hands often, especially after using the bathroom and before touching food (use lots of soap and water if available — if not, use hand sanitizer containing at least 60 percent alcohol).

Don’t touch your face unless you’ve just washed your hands.

Avoid direct contact with people who are sick.

If you’re sick, avoid other people, wash your hands often, and don’t prepare or serve food.