Typhoid Fever

Typhoid Fever is an infection, resulted from a bacterium called salmonella typhi. The typhoid organism is shed in the infected individual’s urine and in feces. Improper washing of hands after urination or defecation can spread salmonella typhi in water or food supply. Flies can transmit the bacteria from feces to food.

In rare cases, hospital workers can progress typhoid fever by handling infected patient soiled bed linens. Typhoid bacteria enters the Typhoid Fevergastrointestinal tract and gains access to the blood. Large and small intestine inflammation follows. In severe typhoid fevers, which can be fatal, the infected tissue develops a bleeding sore and can perforate. Approx. 3% of the individuals with salmonella typhi infection without getting treatment, shed bacteria in their stools for more than a one year. Some of these people never experience typhoid fever symptoms. Most of about two thousand carriers of this infection in the United States are elderly females, who have chronic gallbladder diseases.

Generally, the symptoms of typhoid fever start slowly, eight to fourteen days after getting infection. The symptoms include nosebleeds, fever, cough, headaches, abdominal pain, constipation, tenderness, sore throat, joint pain, and a fever. If not treated, the temperature of body gradually increase two to three days and remains at 103 to 104 degrees for ten to fourteen days, beginning to decrease slowly at the end of the 3rd week and reaching normal levels during the 4th week.

Such fever is frequently accompanied by extreme exhaustion and a slow heartbeat. Coma, stupor, or delirium can happen in severe typhoid fever. In approx.  10% of the individuals, pink, small spots clusters appear on the abdomen and chest during the 2nd week of the disease and lasts for two to five days.

In some cases, typhoid fever results in pneumonia-like symptoms, the symptoms similar to urinary tract infection, or only a fever. The typhoid fever diagnosis may be confirmed by determining bacteria in blood, urine, stool cultures. Although, most individuals recover completely, complications may happen, especially in people, whose treatment was delayed or who were not treated at all. Bleeding of the intestine happens in many individuals; approx. 2% of them have significant bleeding. Generally, the bleeding happens during the 3rd week of disease.

Intestinal perforations happen in 1 to 2% of individuals and causes extreme pain of the abdomen as the intestine’s contents infect the cavity of the abdomen (peritonitis). Pneumonia can progress during the 2nd or 3rd week and are generally caused by a pneumococcal infection. Liver or bladder infections also can occur. Bacteremia (blood infection) sometimes leads to osteomyelitis (bone infection), meningitis, urinary or genital infections, glomerulitis, or endocarditis. Infection of the muscle may lead to abscess.

In approx. 10% of untreated individuals, initial infection’s symptoms reoccur two weeks after the typhoid fever breakout. For unknown reasons, an antibiotic used during the initial disease increases recurrence rate from 15-20%. When antibiotic are taken for the relapse, the typhoid fever dissipates much faster that it did in the initial illness, but sometimes, another relapse happens. The oral vaccines against typhoid fever offer up to 70% protection. It’s given only to individuals who have been exposed to the bacteria and to people at high risk, such as individuals, who travel to places, where such a disease is common.

Travelers to those places must avoid using leafy raw vegetables and other food stored or served at room temperatures. Water must be chlorinated or boiled before drinking. With quick antibiotic treatment, more than 99% of people with typhoid fever recover. For the people, who are very young, old, or who are malnourished, typhoid fever may be fatal.

Signs of poor prognosis and severe infection are shock, coma, and stupor. Convalescence can last few months, but antibiotics decrease typhoid fever’s complications and its severity. Such antibiotic as Chloramphenicol is used around the world. In more severe cases, when an individual is in shock, comatose, or delirious, a corticosteroid is prescribed to decrease inflammation of the brain.

Frequent meals are required due to gastrointestinal bleedings. In some cases, food is given intravenously unless the patient can digest food. Patients, who have intestinal perforation, require antibiotics that kill the abroad bacteria and, and a possible operation to remove or repair the intestine’s perforated area.

For relapses, antibiotics are generally required for only five days. In individuals (carriers) without any symptoms, typhoid fever may be fully eradicated after four to six weeks post antibiotic treatment.

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