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Typhoid fever

Typhoid fever is a common bacterial diseases which is transmitted by contaminated water or food of infected person by salmonella enterica bacteria.The disease has received various names, such as gastric fever, nervous fever, enteric fever, abdominal typhus, infantile remittant fever, slow fever, and pythogenic fever. The meaning of typhoid is resembling typhus and it comes from the neuropsychiatric sypmtoms common to typhoid and typhus.

 

Signs and Symptoms

Typhoid fever is divided to four stages and each stages are approximately one week.

 

  • In the first week, temperature rises slowly, fever fluctuations are seen with relative bradycardia, malaise, headache, and cough. In quarter of cases had epistaxsis, and abdominal pain is also possible.it seen decreasing in the number of circulation white blood cells with eosinopenia and lyphocytosis, also blood cultures are positive for salmonella typhi or parathypi. The widal test is negative in first week which is we use for discover salmonella bacteria in patient.

 

  • In the second week of infection, patient lies flat with high fever around 40 °C with bradycardia, classically with a dicrotic pulse wave. Delirium is frequent, often calm, but sometimes agitated. This delirium gives to typhoid the nickname of  “nerveous fever”. Rose spots appear on the lower chest and abdomen in around a third of patients. There are rhonci in lung bases. The abdomen is distended and painful in the right lower quadrant, where borborygmi can be heard. Diarrhea can occur in this stage: six to eight stools in a day, green, comparable to pea soup, with a characteristic smell. However, constipation is also frequent. The spleen and liver are enlarged and tender, and there is elevation of liver transaminases. The widal test is stongly positive , with antiO and antiH antibodies. Blood cultures are sometimes still positive at this stage. The major symptom of this fever is that the fever usually rises in the afternoon up to the first and second week.

 

  • In the third week of typhoid fever, a number of complications can occur: Intestinal haemorrhage due to bleeding in congested Peyer’s patches; very serious but is usually not fatal. Intestinal perforation in the distal ileum: this is a very serious complication and is frequently fatal, itmay occur without alarming symptoms until septicaemia or diffuse peritonitis sets in. Encephalitis. Neruropsychiatric symptoms with picking at bedclothes or imaginary objects. Metastatic abscesses, cholecystitis, endocarditis and osteitis. The fever is still very high and oscillates very little over 24 hours. Dehydration ensues, and the patient is delirous. One third of affected individuals develop a macular rash on the trunk.Plateler count goes down slowly and risk of bleeding rises. By the end of third week, the fever starts subsiding. This carries on into the fourth and final week.

 

Transmission

The bacterium that causes typhoid fever may be spread through poor hygiene habits and public sanitation conditions, and sometimes also by flying insects feeding of feces. Public education campaigns encouraging people to wash their hands after defecating and before handling food are an importan component in controlling spread of the disease.

 

Prevention

Sanitation and hygiene are the critical measures that can be taken to prevent typhoid. Typhoid does not affect animals, and therefore, transmission is only from human to human. Typhoid can only spread in environments where human feces or urine are able to come into contact with food or drinking water. Careful food preparation and washing of hands are crucial to prevent typhoid.

There are two vaccines licensed for use for the prevention of typhoid: the live, oral Ty21a vaccine and the injectabke Typhoid polysaccharide vaccine. Both  are 50% to %80 protective and are recommended for travellers to areas where typhoid is endemic. Boosters are recommended every five years for the oral vaccine and every two years for the injectable form. There exists an older, killed whole cell vaccine that is still used in countries where newer preparations are not available, but this vaccine is no longer recommended for use because it has higher rate of side effectes such as pain and inflammation at the site of the injection.

 

Treatment

The rediscovery of oral rehydration therapy in the 1960’s provided a simple way to prevent manyof the deaths of diarrheal diseases in general.

Where resistance is uncommon, the treatment of choice is fluoroguinolone such as ciprofloxacin. Otherwise, a third generation cephalosporin such as ceftriaone or cefotaxime is the first choice. Cefixime is a suitable oral alternative.

Typhoid fever, when properly treated, is not fatal in most cases. Antibiotics, such as ampicillin, chloramphelicol, trimethoprim-sulfamethoxazole, amoxicillin and ciprofloxacin, have been commonly used to treat typhoid fever in microbiology.

When untreated, typhoid fever persists for three weeks to a month.

 

Surgery

Surgery is usually indicated in cases of intestinal perforation. Most surgeons prefer simple closure

of the perforation with drainage of the peritoneum. Small bowel resection is indicated for patients with multiple perforations.

If antibiotic treatment fails to eradicate the hepatobiliary carriage, the gallbladder should be resected. Cholecystectomy is not always successful in eradicating the carrier state because of the persisting hepatic infection.

 

Epidemiology

In 200n, typhoid fever caused and estimated 21.7 million ilnesses and 217,000 deaths. Its incidence is highest in childern and young adults between 5 and 19 years old. These cases as of 2010 caused about 190,000 deaths up from 137,000 in 1990. Infants, childeren, and adolescents ,n south central and Southeastern Asia experience the greates burden of illness. Nonetheless, outbreaks of typhoid fever are frequently reported from sub-Saharan Africa and countries in Southeastern asia. Historically, in the pre-antibiotic era, the case fatality rate of typhoid fever was individuals who are infected will develop a chric infection in the gall bladder. Since Typhi is human restricted, these chronic carriers become the crucial reservoir, which can persist for decades for further spread of the disease, further complicating the identification and treatment of the disease. Lately, the study of typhi associated with a carrier at he genome lever provides new insights into the pathogenesis of the pathogen.

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Kadir Timuçin Güneren
F*** the medicine!
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