Typhoid (also called enteric fever) is a disease caused by
the bacteria called Salmonella typhi. Infection with Salmonella typhi occurs from patients or from carriers,
through infected water (or other fluids), food, fingers, flies, and other objects
(fomites). Therefore the disease spreads through the feco-oral route. Carriers
are those who carry the germs in their bodies, but do not suffer from the
disease. Ln typhoid, this may happen in those who have recovered from the disease,
but continue to harbour the germs and excrete them in their feces. If the
stools are not properly disposed, or if hands are not washed after defecation,
items such as water and food may get contaminated, leading to infection of
others. The germs get into the intestinal tract, and cause ulcers in the small
intestine. They also get into the blood stream and invade other tissues and
organs such as muscles, liver, spleen, heart. During the last few decades, with
improvement in hygiene and sanitation, the incidence of typhoid is low.
Manifestations of typhoid
About 6 to 14 days after the germs enter the body, the
patient develops fever, which continues for a long period (weeks) unless proper
treatment is taken. Headache, usually confined to the forehead, is often
present. The tongue is often dry and furred. There may be abdominal pain.
Enlargement of the spleen is a common finding. Although constipation is a
feature in adults, diarrhea often occurs in children. During the second week
of the illness, diarrhea is frequent. At this stage, intestinal perforation (i.e.
a rupture of the intestine at the site of an ulcer) or bleeding (from the
intestinal ulcers) may occur. These complications are not often seen nowadays,
due to early diagnosis and treatment with appropriate antibiotics. If typhoid
is suspected during the first week of fever, the diagnosis can be confirmed by a
blood (clot) culture; it is more usual to confirm it after 7 days, by doing a
SAT (Standard Agglutination Test).
Treatment
Doctor will advice you to bed rest and a have a diet
that is nutritious, but with very little residue (in view of the intestinal
ulcers). Milk, egg, strained soups and rice cungee, yoghurt, jelly, fruits
(without skin and seeds), beverages, etc. are suitable. Fever is treated with
paracetamol, except that aspirin should not be given. The Specific drugs that
destroy the germ are chloramphenicol, ampicillin, cotrimoxazole and
ciprofloxacin.
Prevention
Improvement in hygiene and sanitation play a major role in preventing the typhoid. Proper
disposal of feces, boiling of drinking water, careful preparation of food,
washing hands well after using the toilet and before meals are very important
in preventing the disease. A vaccine called TAB was used earlier; this does not
give complete protection. A new effective vaccine is now available; it is given
as a single injection; the protection lasts for three years. An oral vaccine is
also available.
Paratyphoid is a disease very much like typhoid, but milder. It is caused by the germ, Salmonella paratyphi. The management is the same as
for typhoid.
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