Typhoid

Typhoid (also known as Typhoid fever) is a widespread universal bacterial disease. It is transmitted when water or food is contaminated with an infected person’s feces and ingested by another person. It has various names, including slow fever, nervous fever, gastric fever, and abdominal typhus. The impact of the disease fell drastically in the developed world when 20th century sanitation techniques became common practice. While today it remains very uncommon in the developed world, millions of people in the developing world are still infected by typhoid per year, resulting in approximately 200 000 deaths. It is usually curable, but if left untreated it can be fatal.

Symptoms

Symptoms usually appear a few weeks after the initial infection. Typhoid that is left untreated has four stages of symptoms and complications, each lasting around one week. In the first week, a fever begins to develop and a strong headache occurs along with malaise and cough (and on some occasions a bloody nose and abdominal pain). The second week sees the patient lying prostrate with a high fever that plateaus at around 104 degrees, and a resting heart rate of fewer than 60 beats a minute, which is called bradycardia. In about 1/3 of patients, rose spots appear on abdomen and lower chest. This stage also sees frequent constipation, although some patients experience diarrhea. The fever typically rises in the afternoon, while the liver and spleen become enlarged. In week 3, many symptoms and complications can occur: intestinal perforation in the distal ileum, which is serious and fatal; intestinal hemorrhage due to bleeding in congested Peyer’s patches, which is not fatal but still serious; metastatic abscesses; and neuropsychiatric symptoms. The patient becomes delirious, usually because of dehydration. By the end of the week the fever begins to subside, which also occurs during the fourth week.

Causes

Typhoid is transmitted by food or water. People who are infected become contagious before any symptoms develop, and thus can transfer the disease to other people without even knowing it. This is known as an asymptomatic carrier. It can be spread from person to person via contaminated fingers, although it is usually spread through poor public sanitation conditions and hygiene habits. In the United States, the chlorination of drinking water has caused a dramatic decrease in the spread of typhoid.

Prevention

The most important factors in preventing typhoid are sanitation and hygiene conditions. Transmission occurs only from human to human, as it does not affect animals. Thus, there are many things that can be done to prevent the spread of typhoid. Since it can only spread in environments where urine or human feces come into contact with drinking water or food, strong sanitation procedures can help eliminate it all together. Be sure to disinfect all water before drinking it by boiling it. Keep flies away from food and peel all vegetables and fruits before eating. Do not eat food from street vendors, and avoid ice cubs and ice cream. There are two vaccines available to help prevent typhoid – the Typhoid polysaccharide vaccine which is injected, and the oral Ty21a. Both are recommended for people traveling to areas where typhoid is prevalent. The WHO has more information on both vaccines, and typhoid in general.

Treatment

Some strands of typhoid have become multidrug-resistant, thus sometimes making it difficult for antibiotics to be effective. Where this kind of resistance is uncommon, however a fluoroquinolone, such as ciprofloxacin, is the treatment of choice. Otherwise, ceftriaxone or cefotaxime, which are a third-generation cephalosporin, are the first choices. Antibiotics such as chloramphenicol, ciprofloxacin, amoxicillin, and amipicllin have been commonly used to treat typhoid. Antibiotics reduce the case-fatality rate to around 1%, and typhoid in most cases is not fatal to begin with (unless not properly treated). Sometimes surgery is necessary in cases of intestinal perforation. The difficult part is getting these antibiotics to developing countries, since typhoid is extremely rare in developed countries.