A young lad met me on my way back from work. “Good day sir,” he said; “I have been sick for up to two weeks now. My mouth was bitter and I had a fever. I was treated for malaria initially, after which I was placed on several antibiotics but I still feel sick and my mouth is still bitter. They said I have typhoid.”
“Who said so?”I queried? “Ah! Doctor, I went to the laboratory and they did Widal test for me and it was high.”
I laughed and replied jokingly, “Why must it always be typhoid fever?”
Everyone with a fever is labelled as typhoid fever. It is even worse when the diagnosis is being made straight from the laboratory without consulting a doctor. But, doctors are also guilty of sustaining the ugly trend of the so-called typhoid/malaria/typhoid syndrome.
Fact: Widal test is not meant to be diagnostic for typhoid fever. Where Widal test is used, the test has to be done serially. It is a rising level in the antibody levels that is suggestive of an acute infection and not just a single antibody titre.
Fact: Salmonella, which is the cause of typhoid fever, is endemic here and most people will have a raised typhoid antibody levels in their blood, thereby giving a false impression.
Here are more facts.
What is typhoid fever?
Typhoid fever can be a life-threatening illness that is rare in industrialised countries. However, it remains a serious public health threat in the developing world like ours. When treated with antibiotics, most people with typhoid fever feel better within a few days; although a small percentage of them may die of complications.
Vaccines against typhoid fever are available, but only partially effective. Vaccines usually are reserved for those who may be exposed to the disease or are travelling to areas where typhoid fever is common.
How typhoid fever is spread Faecal-oral route: The bacteria that cause typhoid fever spread through contaminated food or water and occasionally through direct contact with someone who is infected.
Salmonella is passed in the faeces and sometimes in the urine of infected people. Infection can be contracted when food is handled by someone with typhoid fever who hasn’t washed after toilet use. You can also become infected by drinking water contaminated with the bacteria.
Therefore, typhoid fever is more common in areas of the world where hand washing is less frequent and water is likely to be contaminated with sewage.
Chronic typhoid carriers: A small number of people who recover from typhoid fever continue to harbour the bacteria in their body, often for years. They shed the bacteria in their faeces and are capable of infecting others, although they look well.
Signs and symptoms: Persons with typhoid fever usually have high fever (39° to 40° C), headache, abdominal pain, and constipation or diarrhoea. Also, they have weakness, loss of appetite and a rash. The only way to know for sure if an illness is typhoid fever is to have samples of stool, blood or urine tested for the germ.
Complications
Typhoid complications include intestinal bleeding or perforation, inflammation of the heart muscle (myocarditis), inflammation of the lining of the heart and valves (endocarditis), pneumonia, inflammation of the pancreas (pancreatitis), inflammation of the gallbladder (cholecystitis) Kidney or bladder infections, infection and inflammation of the membranes and fluid surrounding the brain and spinal cord (meningitis), psychiatric problems such as delirium, hallucinations and paranoid psychosis.
Treatment
See your doctor immediately you notice these symptoms or suspect you have typhoid fever. Suitable antibiotic is the mainstay of treatment. Surgery may be indicated in complicated cases as in intestinal perforation. Persons given antibiotics usually begin to feel better within 2 to 3 days, and deaths rarely occur. However, persons who do not get treatment may continue to have fever for weeks or months, and as many as 20% may die from complications of the infection.
Prevention
Vaccination
Vaccines are not 100 per cent effective and would require repeat immunisations as vaccine effectiveness diminishes over time. This is especially important if you are travelling to a country where typhoid is common.
Because the vaccine won’t provide complete protection, follow these guidelines: Wash your hands. Frequent hand-washing is the best way to control infection. Wash your hands thoroughly with hot, soapy water, especially before eating or preparing food and after using the toilet. Carry an alcohol-based hand sanitiser for times when water isn’t available.
Avoid drinking untreated water. Buy it bottled or boil it. Ask for drinks without ice unless the ice is made from bottled or boiled water
Avoid raw fruits and vegetables: Avoid raw vegetables and fruits that cannot be peeled. Vegetables like lettuce are easily contaminated and are very hard to wash well. When you eat raw fruit or vegetables that can be peeled, peel them yourself (wash your hands with soap first). Do not eat the peelings.
Choose hot foods: Eat foods that have been thoroughly cooked and that are still hot and steaming.
Don’t patronise street vendors: It is difficult for food to be kept clean on the street, and many travellers get sick from food bought from street vendors.
Source:Newstrack Biodun Ogungbo, Dr.Emorinken Kelvin
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