Typhoid Fever

Typhoid Fever: Overview

Typhoid fever is a condition in which there is typically fever and marked abdominal symptoms consisting of ulceration of the bowels.

Causes and Development; Contributing Risk Factors

Typhoid fever is an acute systemic disease caused by salmonella typhi.  It is an infectious disease and poor sanitation combined with an infestation of flies is most often responsible for this disease.  Contaminated water or food is the usual source of infection.

Certain people, known as "carriers", may spread the disease.  After a patient has recovered from the disease, the bacteria may still survive in the gall-bladder for years, so that the patient becomes a carrier.  If such a carrier is employed in preparing or serving food, the infection can spread.  In a few cases, flies may bring the germs into the house and contaminate the food.  Germs enter the body through the mouth, causing irritation and ulceration of the lower small bowel.

The condition is common in tropical countries with poor sanitation.

Signs and Symptoms

It takes from 10 days to two weeks for this disease to develop.  The child-patient feels chilly, tired and weak, suffering from headache and loss of appetite, followed by backache and either diarrhoea or constipation.  Many patients also have bronchitis, so that in the early stages of typhoid the disease may appear similar to pneumonia.

The fever is of uncertain duration and liable to frequent relapses.  The temperature rises and remains high for about 10 days to two weeks.  It has tendency to rise in the evening and fall in the morning.  Skin eruptions tend to appear in the second week and if proper care is not taken, inflammation of the bones and ulceration of the bowels may occur.  The loss of appetite is more apparent.  The tongue becomes dry and is coated with white patches in the central region of its surface.  The fever gradually comes down to normal by the end of the fourth week.

Diagnosis and Tests

Laboratory findings include:
  • Positive blood culture for S.  typhi during the first 10 days (90%); fewer than 30% are positive at the end of the third week
  • Positive bone marrow culture for S.  typhi occurs even when blood cultures are negative.
  • Positive stool culture for S.  typhi after 10 days, especially during third to fifth week (85%); stool culture may remain positive for more than 1 year in 3% of patients, who are termed chronic enteric carriers.  The bacilli are harbored in the gallbladder.
  • Positive urine culture for S.  typhi during third to fourth week (25%)
  • Leukopenia – 4000/ul – 6000/ul in first two weeks; 3000/ul – 5000/ul in second two weeks
  • Normochromic, normocytic anaemia – chronic-disease type
  • Proteinuria during febrile period
  • No increase in sedimentation rate
  • Serologic tests are nonspecific.

Treatment and Prevention

Complete bed rest and careful nursing is essential for the patient, who should be given a simple liquid diet such as milk, barley and fruit juices.  Orange juice will be especially beneficial; in fact an exclusive diet of orange juice diluted with warm water can be taken for the first few days of the treatment with highly beneficial results.  In typhoid fever, the digestive power of the body is seriously hampered, and the patient suffers from blood poisoning called toxaemia.  The lack of saliva coating the tongue often diminishes the patient's thirst for water as well as desire for food.  The agreeable flavor of orange juice helps greatly in overcoming these drawbacks.  It also gives energy, increases urinary output and promotes body resistance against infections, thereby hastening recovery.  If possible, a warm-water enema should be given daily during this period to cleanse the bowels.

Cold compresses may be applied to the head in case the temperature rises above 103°F.  If this method does not succeed, cold pack may be applied to the whole body.

After the temperature has come down to normal and the tongue has cleared, the patient may be given fresh fruits and other easily digestible foods for 2-3 days.  For drinks, unsweetened lemon water or plain water, either hot or cold, may be given.  Thereafter, the patient may be allowed to gradually embark upon a well-balanced diet according to age.  The emphasis should be on fresh fruits and raw or lightly-cooked vegetables.

Prevention is achieved by ensuring a clean water supply, proper disposal of sewage and implementation of anti-fly measures.  All drinking water should be either boiled or thoroughly purified.  Milk should be pasteurized or boiled.  People who handle food should be carefully screened to be sure that they are not carrying the germs of typhoid.

Typhoid