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Treating typhoid

  • Published at 03:50 pm June 21st, 2013

Typhoid fever is a major cause of illness in most developing countries, including Bangladesh. A recent estimate found that 22 million new typhoid cases occur each year in the world, with some 200,000 of these resulting in death. Bangladesh is located in a region where typhoid is highly endemic.

A review of ICDDR,B Dhaka hospital’s records of typhoid patients admitted from January 2010 to December 2012 showed that typhoid fever is prevalent throughout the year in Dhaka. Young children and young adults are the common sufferers of this illness, while older patients with typhoid fever are rare among the admitted patients in ICDDR,B Dhaka hospital. Vaccination of children at a young age might prevent them from getting this illness.

The cause

Typhoid fever is a bacterial disease, caused by Salmonella typhi. Typhoid and paratyphoid fevers are caused by the bacteria Salmonella typhi and Salmonella paratyphi respectively. Typhoid fever and paratyphoid fever are clinically indistinguishable diseases, collectively called enteric fever.

Both are characterised by the sudden onset of sustained fever, severe headache, nausea, loss of appetite, constipation or sometimes diarrhoea. Case-fatality rates of 10% can be reduced to less than 1% with appropriate antibiotic therapy. Paratyphoid fever is similar in its symptoms to typhoid fever, but tends to be milder, with a lower fatality rate. 

How it affects people

Though children are more likely than adults to get typhoid, adults tend to have worse symptoms. Typhoid fever is transmitted through the ingestion of food or drink contaminated by the faeces or urine of infected people. Symptoms usually develop one to three weeks after exposure, and may be mild or severe. They include high fever, malaise, headache, constipation or diarrhoea, rose-coloured spots on the chest, and an enlarged spleen and liver. A healthy carrier state may follow acute illness.

How is typhoid fever diagnosed?

If a physician suspects typhoid based on the physical symptoms mentioned above, he will order a blood culture to specifically identify the Salmonella typhi bacteria. He will also conduct a detailed medical and travel history to assess your exposure to the bacteria. Additional tests used to diagnose typhoid fever include enzyme-linked immunosorbent assay (ELISA) and a fluorescent antibody test.

How to treat

Typhoid fever can be treated with antibiotics. If it is not treated, it can kill up to 30% of people who get it. However, resistance to common antimicrobials is widespread. It is better to start antibiotics after getting a blood culture report.

Healthy carriers should be excluded from handling food. Additional treatment for typhoid includes drinking fluids to prevent dehydration and having a healthy diet to ensure the absorption of nutrients.

How can typhoid fever be prevented?

Typhoid fever can be prevented through proper sanitation and hygiene. If you drink water, buy it bottled or bring it to a rolling boil for one minute before you drink it.

Ask for drinks without ice, unless the ice is made from bottled or boiled water.

Eat food that have been thoroughly cooked and that are still hot and steaming.

Avoid raw vegetables and fruits that cannot be peeled. Vegetables like lettuce are easily contaminated and are very hard to wash well.

When you eat raw fruits or vegetables that can be peeled, peel them yourself. Wash your hands with soap first. Do not eat the peelings.

Avoid food and beverages from street vendors. It is difficult for food to be kept clean on the street, and many travellers get sick from food bought from street vendors.

There are two vaccines that are recommended by the World Health Organization.

They are usually only given to those who are travelling to typhoid endemic areas, and they are 50-80% effective at preventing typhoid.

Before receiving this vaccine, you should talk to your doctor and act accordingly.