Prevention of typhoid fever
By Dr Rotimi Adesanya
Recently , there has been a lot of public outcry over repeated cases of misdiagnosis of typhoid fever . Nigerians deserve to know what this disease is all about ; how it can be detected , treated and prevented.
Typhoid fever is an acute illness associated with fever caused by the
Salmonella typhi bacteria . It can also be caused by Salmonella paratyphi , a related bacterium that usually causes a less severe illness. The bacteria are deposited in water or food by a human carrier and are then spread to other people in the area .
Typhoid fever is contracted by drinking or eating the bacteria in contaminated food or water . People with acute illness can contaminate the surrounding water supply through stool , which contains a high concentration of the bacteria . Contamination of the water supply can , in turn , taint the food supply. The bacteria can survive for weeks in water or dried sewage .
After the ingestion of contaminated food or water , the Salmonella bacteria invade the small intestine and enter the bloodstream temporarily . The bacteria are carried by white blood cells in the liver , spleen , and bone marrow , where they multiply and re -enter the bloodstream . If a test result isn’ t clear , blood samples will be taken to make a diagnosis.
The Widal test may suggest infection with Salmonella typhi . But they are not diagnostic because of the number of false – positive and false- negative . Isolation of Salmonella bacteria that causes typhoid ) from cultures of stool , blood , urine , or bone marrow are necessary to confirm the diagnosis of typhoid fever .
The incubation period is usually one to two weeks , and the duration of the illness is about three to four weeks . Symptoms include : Poor appetite , headaches , generalised aches and pains , fever , lethargy , diarrhea and chest congestion may develop some, and abdominal pain and discomfort are common . The fever becomes constant . Improvement occurs in the third and fourth week in those without complications . About 10 per cent of people have recurrent symptoms after feeling better for one to two weeks . Relapses are actually more common in individuals treated with inappropriate dosing of antibiotics.
Typhoid fever is treated with antibiotics which kill the Salmonella bacteria . Prior to the use of antibiotics, the fatality rate was 20 per cent. Death occurred from overwhelming infection, pneumonia , intestinal bleeding , or intestinal perforation. With antibiotics and supportive care , mortality has been reduced . With appropriate antibiotic therapy, there is usually improvement within one to two days and recovery within seven to 10 days.
Several antibiotics are effective for the treatment of typhoid fever . Chloramphenicol was the original drug of choice for many years . Because of side effects, chloramphenicol has been replaced by other effective antibiotics. Those who become chronically ill ( about three to five per cent of those infected ) , can be treated with prolonged antibiotics. Often , removal of the gallbladder , the site of chronic infection, will provide a cure .
Prevention is the best way to protect the child against typhoid fever . Some simple steps to reduce chances of catching this infection are listed below :
Drink pure or bottle water
Contaminated drinking water is a common source of the infection. Boil your water and allow it to cool before drinking or stick to purified water .
Teach children to wash hands frequently. Wash with warm , soapy water before eating food . Also wash after using the toilet . Public education campaigns encouraging people to wash their hands after defecating and before handling food are an important component in controlling spread of the disease . Alcohol- based hand sanitiser can kill germs when water is not available .
Wash fruits and vegetables thoroughly
Raw fruit or vegetables may have been washed in contaminated water . There is the need to rewash the fruits and vegetables thoroughly.
Typhoid immunisation / vaccination
Typhoid vaccine is readily available and can be used in children from two years of age . Adults can also be given the typhoid vaccination to prevent them from typhoid fever . For those travelling to high – risk areas , vaccines are now available .
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