TYPHOID FEVER

Typhoid fever, also known simply as typhoid, is a symptomatic bacterial infection due to Salmonella Typhi.Symptoms may vary from mild to severe and usually begin six to thirty days after exposure.Often there is a gradual onset of a high fever over several days.

SIGN & SYMPTOMS

In the first week, the body temperature rises slowly, and fever fluctuations are seen with relative bradycardia Faget sign, malaise, headache, and cough. A bloody nose epistaxis is seen in a quarter of cases, and abdominal pain is also possible. A decrease in the number of circulating white blood cells leukopenia occurs with eosinopenia and relative lymphocytosis; blood cultures are positive for Salmonella typhi or S. paratyphi. The Widal test is negative in the first week.

In the second week of the infection, the patient lies prostrate with high fever in plateau around 40 °C (104 °F) and bradycardia sphygmothermic dissociation or Faget sign, classically with a dicrotic pulse wave. Delirium is frequent, often 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 a third of patients. Rhonchi are heard 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, comparable to pea soup, with a characteristic smell. However, constipation is also frequent. The spleen and liver are enlarged (hepatosplenomegaly) and tender, and liver transaminases are elevated. The Widal test is strongly positive, with antiO and antiH antibodies. Blood cultures are sometimes still positive at this stage.

CAUSES

The bacterium that causes typhoid fever may be spread through poor hygiene habits and public sanitation conditions, and sometimes also by flying insects feeding on feces.

PREVENTION

Two typhoid vaccines are licensed for use for the prevention of typhoid the liveR, oral Ty21a vaccine sold as Vivotif by Crucell Switzerland AG) and the injectable typhoid polysaccharide vaccine (sold as Typhim Vi by Sanofi Pasteur and 'Typherix by GlaxoSmithKline. Both are 50 to 80% protective and are recommended for travellers to areas where typhoid is endemic. Boosters are recommended every five years for the oral vaccine and every two years for the injectable form. An older, killed-whole-cell vaccine is still used in countries where the newer preparations are not available, but this vaccine is no longer recommended for use because it has a higher rate of side effects (mainly pain and inflammation at the site of the injection.

TREATMENT

Antibiotics, such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, amoxicillin, and ciprofloxacin, have been commonly used to treat typhoid fever in microbiology.Treatment of the disease with antibiotics reduces the case-fatality rate to about 1%.