Typhoid Fever

Jonas Rafael S. Galeos Western Mindanao State University College of Nursing October 13, 2011

ABSTRACT In order to facilitate the treatment of patients infected with these bacteria and to study the epidemiology of infections and identify patients who become asymptomatic carriers of these organisms, it is important to study and research the cause of infection. The other aim of this research is how to avoid from getting infected and also enumerate some preventive measures. In this research I gather information from medical books and some information in the internet to identify the microorganism responsible for the bacterial infection. I also present the mode of transmission, signs and symptoms, treatment and vaccines. Infections can occur whilst visiting areas where the disease is endemic (Asia and Latin America for example). Prevention is the key to avoiding such infections. Well-cooked food and bottled water usage will prevent, to a great extent, typhoid infections. This simple research will help readers to be cautious in preparing and eating their food.

INTRODUCTION Salmonella typhi is a very contagious infection in the intestines that affects the whole body. It is called by bacteria called Salmonella typhi that is found in the stools of an infected person. Most people in the United States get typhoid as a result of visiting another country. Typhoid is spread when a person eats food or water contaminated by human waste (stool or urine) containing Salmonella typhi bacteria. Typhoid fever mostly preys upon people from the United States who visit other countries, because in a foreign country food and drink may have been handled by a person who is shedding Salmonella typhi or if the bacteria gets into the water you use for washing or drinking. Salmonella typhi hides in beverages, most commonly milk or water. It also hides in food that is usually a foreign delicacy of some sort that has been contaminated by Salmonella typhi in some way. Typhoid fever usually causes high fever, head ache, sore throat, vomiting, diarrhea, skin rash, weakness, or inability to think clearly. The symptoms take about two weeks to go away if they don't lead to death. This bacterial pathogen is considered extremely dangerous and is probably armed. Salmonella typhi has been on the loose

for many years and was caused a lot of havoc and done a lot of damage over the years.

TRANSMISSION The bacteria that cause typhoid fever Salmonella typhi spreads through contaminated food, drink, or water. If you eat or drink something that is contaminated, or from contaminated soil or water, or from toxins produced by an infectious organism. The bacteria enters your body, and goes into your intestines, and then into your bloodstream, where it can travel to your lymph nodes, gallbladder, liver, spleen, and other parts of the body. Other primary cause of Salmonella typhi infection can also be by eating food from an animal infected with an infectious agent, or from food that is contaminated from the food handler (who is infected with Salmonella typhi infection), or from contaminated soil or water, or from toxins produced by an infectious organism. A few people can become carriers of Salmonella typhi and continue to release the bacteria in their stools for years,
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spreading the disease. Typhoid fever is common in developing countries, but fewer than 400 cases are reported in the U.S. each year. Most cases in the U.S. are brought in from overseas. S typhi has no nonhuman vectors. The following are modes of transmission: Oral transmission via food or beverages handled by an individual who chronically sheds the bacteria through stool or, less commonly, urine Hand-to-mouth transmission after using a contaminated toilet and neglecting hand hygiene Oral transmission via sewage-contaminated water or shellfish (especially in the developing world) An inoculum as small as 100,000 organisms causes infection in more than 50% of healthy volunteers.

TYPHOID SYMPTOMS According to the Center for Diseases Control (CDC), typhoid symptoms are: sustained fever as high as 103 to 104 F (39 to 40 C). Patients also experience stomach pains, headache, diarrhea (although constipation is also possible) and/or loss of appetite. The incubation period is usually one to two weeks. The duration of the illness is about four to six weeks. A characteristic type of rash, called "rose spots," may appear in some cases of typhoid. These rose spots are about 1/4 inch red spots that appear usually on the abdomen and chest. Mortality rates are low if treated soon after it is diagnosed. The treatment consists of antibiotic therapy. Strains of resistant S. typhi have developed due to the overuse of antibiotics or prescribed antibiotic courses that haven't been concluded. ROSE SPOTS
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The symptom most commonly used to diagnose typhoid fever is the rash which accompanies the disease. This is because the rash, known as rose spots, is the only symptom specific to the typhoid bacteria. The New York Times Health Guide on
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Typhoid describes the rash as spots, generally less than a 1/4-inch across, and completely flat. They develop predominantly on the chest and abdominal region. Unfortunately, not all cases of typhoid will demonstrate this symptom. EARLY ILLNESS
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Victims begin experiencing symptoms anytime between one and three weeks after exposure to the bacteria occurs. In children, onset of severe symptoms may occur rapidly, but in older victims, the disease is likely to begin mildly and develop over time. The Mayo Clinic gives a specific time line for symptoms and complication development. This time line suggests that during the first week of illness, a fever, headache, sore throat and upset stomach may occur. These symptoms may be accompanied by a general sense of weakness. The upset stomach often becomes diarrhea in children, but is more likely to present as severe constipation in adults. During the second week of the disease rose spots often occur on the chest and belly. At this time, the patient also commonly experiences a continued high fever, weight loss and a distended abdomen. Constipation and diarrhea also typically continue. Diarrhea is said to look like pea soup, in both color and consistency.

LATER STAGES
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During the third week the rash disappears and the patient enters the typhoid state. The typhoid state is a term used to describe a motionless state with closed or half-closed eyes, when the patient seems to drift in and out of consciousness. During the typhoid state, lifethreatening complications are most likely to occur. The turning point occurs during the fourth week of the disease. The fever drops gradually and returns to normal over the course of a week to 10 days. Victims should be observed for a period of at least two weeks for reoccurrence.

TREATMENT Fluids and electrolytes may be given through a vein (intravenously). Appropriate antibiotics are given to kill the bacteria. There are increasing rates of antibiotic resistance throughout the world, so your health care provider will check current recommendations before choosing an antibiotic. The list of treatments mentioned in various sources for Salmonella typhi

infection includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

Rehydration, antibiotics in susceptible patients Salmonella Typhi is more prevalent in developing countries and those travelling overseas are more at risk. It is the cause of typhoid or enteric fever. Treatments include:
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Prevention
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Vaccination prior to travel Be cautious with food and drinks - use bottled water, and consume foodstuffs that have been cooked and are still hot, or eat fruit and vegetables that can be peeled.

Antibiotics
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Should be started at the first suspicion of disease rather than waiting for confirmatory tests

Hospitalisation and supportive care

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For severe disease

Public Health measures

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Finish antibiotics Strict hand washing

Ensure follow-up testing to confirm clearance of the organism

PREVENTION Typhoid fever infections occur when people eat food or drink beverages that have been handled by a person who is shedding S. typhi or if sewage contaminated with the bacterium gets into the water people use to drink or wash food. This is why typhoid is more persistent in countries where poor hygiene is widespread. Infections can occur whilst visiting areas where the disease is endemic (Asia and Latin America for example). Prevention is the key to avoiding such infections. Well-cooked food and bottled water usage will prevent, to a great extent, typhoid infections. Vaccination, although not 100% effective, exists for travellers going to endemic regions.

Vaccines are recommended for travel outside of the U.S., Canada, northern Europe, Australia, and New Zealand, and during epidemic outbreaks. Immunization is not always completely effective and at-risk travellers should drink only boiled or bottled water and eat well cooked food. Experimentation with an oral live attenuated typhoid vaccine is now underway and appears promising. Adequate water treatment, waste disposal, and protection of food supply from contamination are important public health measures. Carriers of typhoid must not be allowed to work as food handlers.

CONCLUSION I conclude that the transmission of Salmonella typhi has no nonhuman vectors. Knowing how to prevent the spread of the bacteria using the aseptic techniques will help an individual avoid the spread of the bacterial infection. One will be cautious and informed about Environmental and behavioral risk factors that are independently associated with typhoid fever that include eating food from street vendors, living in the same household with someone who has new case of typhoid fever, washing the hands inadequately, sharing food from the same plate, drinking unpurified water, and living in a household that does not have a toilet.

REFERENCES Crump et al (2004). The global burden of typhoid fever. Bull World Health Organ. 82(5):346-53. URL: http://www.medscape.com/medline/abstract/15298225 Holt et al (2008). High-throughput sequencing provides insights into genome variation and evolution in Salmonella Typhi. Nature Genetics 40, 987 - 993 Rowland HA. The complications of typhoid fever. J Trop Med Hyg. Jun 1961;64:143-52. Rowland HA. The treatment of typhoid fever. J Trop Med Hyg. May 1961;64:101-10. Rubin FA, Kopecko DJ, Sack RB, et al. Evaluation of a DNA probe for identifying Salmonella typhi in Peruvian and Indonesian bacterial isolates. J Infect Dis. May 1988;157(5):1051-3.