TYPHOID FEVER KILLS AGAIN

TYPHOID FEVER KILLS AGAIN

As a resident of Nigeria, a third world country in Africa, whenever I think of typhoid fever I feel dreadful, especially after the numerous times I myself have falling prey to this highly resistant and recurring illment.
Since typhoid fever seem to be a very popular illment in Nigeria, it never really got to me that it is also a ‘’KILLER DISEASE’’ until it hit very close to me.
Brother A is a very close friend and a fellow church member. I remembered asking about him in Church one Sunday, because he was not in church service that day, and I know him to be a very serious church goer, never missing church service.
Latter that day, I and some church members went to visit him at home, and found him very ill and weak. We quickly rushed him to the nearest General Hospital, where the doctors confirmed that he has typhoid fever, he was admitted and treatment commenced.
The next day I received a call from one of the church members, who informed me that my friend, Brother A has died early that morning, he died from complications of typhoid perforation. That really got to me and up till this day remains with me.

Typhoid fever, also known as enteric fever, is a potentially fatal multisystemic illness caused primarily by Salmonella typhi. The protean manifestations of typhoid fever make this disease a true diagnostic challenge. The classic presentation includes fever, malaise, diffuse abdominal pain, and constipation .Untreated, typhoid fever is a grueling illness that may progress to delirium , obtundation, intestinal hemorrhage, bowel perforation, and death within one month of onset. Survivors may be left with long-term or permanent neuropsychiatric complications.
Typhoid fever is a bacterial disease, caused by Salmonella typhi. It is transmitted through the ingestion of food or drink contaminated by the faeces or urine of infected people.

SYMPTOMS

Typhoid fever is characterized by a sustained fever as high as 40 °C (104 °F), profuse sweating,gastroenteritis, and nonbloody diarrhea. Less commonly a rash of flat, rose-colored spots may appear.
Classically, the course of untreated typhoid fever is divided into four individual stages, each lasting approximately one week. In the first week, there is a slowly rising temperature with relative bradycardia, malaise, headache and cough. A bloody nose (epistaxis) is seen in a quarter of cases and abdominal pain is also possible. There is leukopenia, a decrease in the number of circulating white blood cells, with eosinopenia and relative lymphocytosis, a positive diazo reaction and blood cultures are positive for Salmonella typhi or paratyphi. The classic Widal test is negative in the first week.
In the second week of the infection, the patient lies prostrated with high fever in plateau around 40 °C (104 °F) and bradycardia (Sphygmo-thermic dissociation), classically with a dicrotic pulse wave. Delirium is frequent, frequently calm, but sometimes agitated. This delirium gives to typhoid the nickname of "nervous fever". Rose spots appear on the lower chest and abdomen in around 1/3 patients. There are rhonchi 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 with a characteristic smell, comparable to pea-soup. However, constipation is also frequent. The spleen and liver are enlarged ( hepatosplenomegally) and tender and there is elevation of liver transaminases. The Widal reaction is strongly positive with antiO and antiH antibodies. Blood cultures are sometimes still positive at this stage. (The major symptom of this fever is 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:

[1]Intestinal hemorrhage due to bleeding in congested Peyer’s patches ; this can be very serious but is usually non-fatal.
[2]Intestinal perforation in distal ileum: this is a very serious complication and is frequently fatal. It may occur without alarming symptoms until septicaemia or diffuse peritonitis sets in.
[3]Encephalitis
[4]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 delirious (typhoid state). By the end of third week the fever has started reducing ( defervescence). This carries on into the fourth and final week.

TRANSMISSION
S typhi has no nonhuman vectors. The following are modes of transmission:
[1]Oral transmission via food or beverages handled by an individual who chronically sheds the bacteria through stool or, less commonly, urine
[2]Hand-to-mouth transmission after using a contaminated toilet and neglecting hand hygiene
[3]Oral transmission via sewage-contaminated water or shellfish (especially in the developing world)


DIAGNOSIS/TESTS
In order to make a typhoid fever diagnosis, a doctor will ask a number of questions about the patient's recent medical and travel history, perform a physical exam, and recommend certain tests. As part of diagnosing a typhoid fever bacterial infection, the doctor will also rule out other causes of possible typhoid fever symptoms, such as viral hepatitis, mononucleosis, and malaria (to name a few).
Diagnosis is made by any blood, bone marrow or stool cultures and with the Widal test (demonstration of salmonella antibodies against antigens O-somatic and H-flagellar). In epidemics and less wealthy countries, after excluding malaria, dysentry or pneumonia, a therapeutic trial time with chloramphenicol is generally undertaken while awaiting the results of Widal test and blood cultures.
The term "enteric fever" is a collective term that refers to typhoid and paratyphoid.

ULTRASOUND SCAN IN THE DIAGNOSIS OF TYPHOID FEVER
In endemic areas like Nigeria, ultrasound findings of hepatomegaly, splenomegaly, ileal and cecal thickening, mesenteric lymphadenopathy and thick-walled gallbladder are diagnostic features of typhoid. Ultrasound can be a non-invasive, economical and a reasonably sensitive tool for diagnosing typhoid when serology is equivocal and cultures are negative. So abdominal ultrasound scan is a vital initial diagnostic tool in assessing typhoid fever. It has also being found to be very useful in areas of typhoid intestinal perforation, because it can locate the site of perforation and also identified fluid collections [peritonitis].


TREATMENT/PREVENTION
Typhoid fever can be treated with antibiotics. However, resistance to common antimicrobials is widespread. Healthy carriers should be excluded from handling food.
In many developing nations, the public health goals that can help prevent and control typhoid — safe drinking water, improved sanitation and adequate medical care — may be difficult to achieve. For that reason, some experts believe that vaccinating high-risk populations is the best way to control typhoid fever.
Two vaccines are currently in use — one is injected in a single dose, and the other is given orally over a period of days. Neither is 100 percent effective, and both require repeat vaccinations.
If you're traveling to an area where typhoid fever is endemic, consider being vaccinated. But because the vaccine won't provide complete protection, be sure to follow these guidelines as well:

[1]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 sanitizer for times when water isn't available.
[2]Avoid drinking untreated water. Contaminated drinking water is a particular problem in areas where typhoid is endemic. For that reason, drink only bottled water or canned or bottled carbonated beverages, wine and beer. Carbonated bottled water is safer than uncarbonated bottled water is. Wipe the outside of all bottles and cans before you open them. Ask for drinks without ice. Use bottled water to brush your teeth, and try not to swallow water in the shower.
[3]Avoid raw fruits and vegetables. Because raw produce may have been washed in unsafe water, avoid fruits and vegetables that you can't peel, especially lettuce. To be absolutely safe, you may want to avoid raw foods entirely.
[4]Choose hot foods. Avoid food that's stored or served at room temperature. Steaming hot foods are best. And although there's no guarantee that meals served at the finest restaurants are safe, it's best to avoid food from street vendors — it's more likely to be contaminated.

To prevent infecting othersIf you're recovering from typhoid, these measures can help keep others safe:

[1]Wash your hands often. This is the single most important thing you can do to keep from spreading the infection to others. Use plenty of hot, soapy water and scrub thoroughly for at least 30 seconds, especially before eating and after using the toilet.
[2]Clean household items daily. Clean toilets, door handles, telephone receivers and water taps at least once a day with a household cleaner and paper towels or disposable cloths.
[3]Avoid handling food. Avoid preparing food for others until your doctor says you're no longer contagious. If you work in the food service industry or a health care facility, you won't be allowed to return to work until tests show that you're no longer shedding typhoid bacteria.
[4]Keep personal items separate. Set aside towels, bed linen and utensils for your own use and wash them frequently in hot, soapy water. Heavily soiled items can be soaked first in disinfectant.

JOAS MEDICAL DIAGNOSTIX Ikotun Lagos Nigeria ,have a well equipped computerised laboratory and also a 4D Colour Doppler Ultrasound Scan. We also have qualified, very experienced and licensed medical laboratory scientists and Clinical Specialist Sonographers. We offer accurate Typhoid Fever Testing like blood and stool cultures, including Widal Tests and General Abdominal Ultrasound Scan. We also offer other laboratory tests. If you suspect you have Typhoid fever or other feverish conditions, contact JOAS MEDICAL DIAGNOSTIX Ikotun Lagos Nigeria.

Regards
Dr. Victor Efughi
Consultant Clinical Specialist Sonographer

For FREE Consultation and FREE Counseling. Also for Quality and Accurate Medical Diagnostic Tests Contact
JOAS MEDICAL DIAGNOSTIX

JOAS MEDICAL DIAGNOSTIX-------WE ARE AN ULTRAMODERN MEDICAL IMAGING CENTER. WE ARE EXPERTS IN ULTRASOUND SCAN SERVICES, 3D/4D COLOUR DOPPLER SCAN SERVICES, X-RAY/RADIOLOGY SERVICES, ECG SERVICES, INFERTILITY SERVICES, HSG SERVICES, LABORATORY SERVICES,BLOOD BANKING SERVICES , DNA SERVICES, AND HEALTH CONSULTANCY/COUNSELLING SERVICES.
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