TYPHOID FEVER : SYMPTOMS, TREATMENTS, PREVENTION AND CONTROL.

Typhoid fever (enteric fever) is a life threatening disease caused by the bacterium, Salmonella typhil. This fever is contracted by the ingestion of the bacteria-contaminated food or water. Typhoid fever is still common in the developing world, where it affects about 21.5 million person every year (1 million in India. Patients with acute typhoid fever may contaminated the surrounding water through defection. The bacterium multiples in the gall bladder, bile ducks and liver and passes into the bowel. The bacteria can survive for weeks in water or dried sewage. 

Symptoms :

The incubation period is usually 1 to 2weeks and the duration of illness is about 4 to 6 weeks. The patient experiences

• Poor appetite
• Abdominal
• Headache
• Generalized ache and pain
• Lethargy
• Intestinal bleeding or perforation after 2 to 3 weeks of infection 
• Diarrhea or constipation

People with typhoid fever usually have a sustained fever as high as 103 degree fever to 104 degree fever. Rose spots on the abdomen of a person with typhoid fever may appear. Chest congestion develops in many patients, and abdominal pain and discomfort are common. Improvement occurs in the third or fourth weeks in those without complication. Arround 10% of the patients have recurrence (relapse) after feeling better for one to two weeks. Relapses are actually more common in individuals treated with antibiotic. Typhoid is diagnosed by WIDAL TEST. 

Infection and transmission :

After the ingestion of the contaminated food or water, the salmonella bacteria invade the small intestine and enter the blood stream temporally. Salmonella typhil lives only in the human host. The bacteria are then carried by the white blood cell to the liver, Spleen and bone marrow. They multiply in the cells of these organs and reenter the bloodstream. Following this, the patient develops symptoms, including fever. They invade the gallbladder, biliary system and the lymphatic tissues of the bowel. Here they multiply in a high number. The bacteria pass into the intestinal tract and can be identified in cultures of the stool.

     A number of persons recover from typhoid fever but continue to carry the bacteria. They are known as carriers. Transmission takes place by eating contaminated food or drinking contaminated water and beverages. Therefore typhoid fever is more prevalent in areas of the wold, where sanitation is poor.

Treatment :

Typhoid fever is treated  with antibiotics. Resistance to multiple antibiotics is gradually increase in salmonella. Reduce susceptibility to fluroquinolones (e.g. ciprofloxacin) and the emergence of multi-drug resistance has complicated the treatment procedure, especially in those who have acquired infection from South Asia. Antibiotic susceptibility testing may help in deciding an appropriate therapy. The choice of antibiotic therapy includes fluroquinolones for susceptible infection, Ceftriaxone and Azythromycine for establish infections. Persons who do not get treatment may continue to have fever for weeks or months and as many as 20% may die from complicated of the infection.

Prevention and Control :

There are several way one can practice to avoid typhoid bacteria contraction.

• Avoid apparently contaminated food and drink.
• Get Vaccinated against typhoid fever.
• Drink packaged water with statutory quality marketing on the bottle or boiled water brought to room temperature. Bottled carbonated water is proved to be safer than uncarbonated water.
• Ask for drinks without ice unless the ice is made from bottled or boiled water. Avoid Popsicles and flavored ice that may have been made with contaminated water.
• Eat food that has been thoroughly cooked and that is still hot and streaming.
• Avoid raw vegetables and fruits. These may be washed properly and then peeled.
• Avoid food and beverages from street vendors. 

Typhoid fever vaccines have been successfully developed and commercialized. There are two type of vaccines are 1) Vi antigen vaccine  2) Oral ty21a vaccine. It is also cure able with these vaccines.