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Do You Really Have Typhoid Fever? Probably Not


What Is Typhoid Fever?


Typhoid fever is caused by a type of bacteria called Salmonellae typhi (S. typhi) that infects the digestive system and causes fever, abdominal pain and may be life-threatening if untreated. It is also called enteric fever. This entity is misdiagnosed, over-diagnosed and over-treated in Nigeria today.

Salmonellae are present worldwide but more common in areas where sewage management and water sanitation are inefficient. Poor personal hygiene and overcrowding also aid transmission. It is estimated that about 11 to 20 million people get sick from typhoid every year with between 128 000 and 161 000 deaths recorded. The bacteria are commonly encountered in South East Asia, Africa, South America and Central America. It is a common cause for consultation in clinics across Nigeria.

Typhoid is transmitted via contaminated food, water or milk handled by infected people or which have come in contact with their stools. Flies and other insects may also transmit the bacteria by perching on the stools of infected humans. The transmission of Salmonellae has also been noted in cases of sexual intercourse involving direct contact between the anus and the mouth.  The bacteria may also survive freezing and drying which makes canned food items a potential source of infection.

When the bacteria get into the small intestine, it causes damage to the cells of the surface of the intestine. It gains entry into the bloodstream and spreads to the liver and gall bladder where it multiplies and re-enters the blood at intervals, causing symptoms. In some people, their body is able to deal with the bacteria, and they experience a few or no symptoms. However, they are carriers and may transmit the infection to others for up to a period of one year.


What Are The Symptoms Of Typhoid Fever?

 

From the time of exposure to the bacteria, it takes between 10 and 14 days for symptoms to develop. The symptoms are often non-specific.



      I.        Fever: The fever increases in severity throughout the course of the week and continues into the second and third week and may reach 40? C (104? F) or higher

     II.        Headaches: Initially mild but gradually worsens by the start of the second week. It becomes severe and may prevent one from carrying out the activities of the day. There may be a regression in awareness, confusion and delirium and in some cases, psychosis.

    III.        Cough and Sore throat: May last for between 1 and 4 days.

   IV      Abdominal discomfort, pain and bloating

     V.        Nausea and vomiting: These are not seen in all infected persons but may occur during the first week of infection.

   VI.        Constipation and subsequently diarrhoea (which may be up to 20 stools in one day!). The stool often contains mucus or blood, is watery and may be of small or large volume.

  VII.        Enlarged abdomen due to an enlargement of the liver and spleen at the end of the week.

 VIII.        A rash develops in the second week (called Rose Spots) in some patients but may be difficult to see in some people.

   IX.        A general feeling of unwellness, fatigue and loss of appetite



What Complications May Arise From Typhoid Fever?


If untreated, typhoid fever is often fatal and may cause varying complications across the body's systems. There is often erosion in the intestines where the bacteria first infect, causing intestinal bleeding which may be mild or moderate. Other complications include:


1.     Perforation of the intestine which may require surgery.

2.     Inflammation of the covering of the brain (called meningitis). 

3.     Inflammation of the kidneys (called nephritis). 

4.     Inflammation of the liver (called hepatitis). 

5.     Inflammation of the veins (called thrombophlebitis). 

6.     Deafness. 

7.     Hair loss. 

8.     Bone infection. 

9.     Lung infection. 

10.  Seizures. 


These complications are more likely in people with poor immune defences, for example, people living with HIV, people on chemotherapy for cancer, children under five, people with diabetes, people living with sickle cell disease, people with inflammatory bowel disease, and people on steroid therapy.

How Is A Diagnosis Of Typhoid Fever Made?

A diagnosis of typhoid fever is made after due consultation with a doctor who will ask you a few questions, examine you and order tests which are often blood tests. The test of choice is a blood or stool culture. Here, a blood or stool sample is examined in the laboratory for the presence of Salmonella.

The Widal test is inappropriate for making a diagnosis of Typhoid fever. It is unspecific, may give a false-positive result in vaccinated individuals, in individuals with infections due to other causes, in individuals with severe malaria and also in healthy individuals.

A single Widal test result cannot provide a reliable diagnosis and using that alone leads to misdiagnosis and false diagnosis. All results must be correlated with clinical symptoms, as dictated by the standard treatment guideline developed by the Federal Ministry of Health.

How Is Typhoid Fever Treated?

Typhoid fever is treated using antibiotics. Different types of antibiotics may be used while the result of the tests is awaited however, indiscriminate use of antibiotics is frowned upon due to cases of drug resistance. Pain relief medications may also be offered to deal with muscle pain and headaches.

 

How Can You Prevent Typhoid Fever?


Prevention of typhoid fever is hinged on maintaining proper sanitation. Ensuring proper hygiene by food handlers is also necessary. A typhoid fever vaccine offers protection for several years (two to three years for the injectable vaccine and five to seven years for the oral vaccine). Other tips for preventing typhoid fever are:

  •          Ensure that food items are properly cooked before ingestion. Eat them while they are still hot.

  •          Avoid raw milk and products made from raw milk

  •          Avoid putting ice in drinks, especially when you travel.

  •          Drink safe bottled water

  •          Wash your hands thoroughly and often, especially after contact with farm animals, pets or after using the toilet

  •          Wash fruits and vegetables before eating them. 

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