What is typhoid fever?

Typhoid fever is a life-threatening illness caused by the bacteria called Salmonella typhi and paratyphi. Persons with typhoid fever carry the bacteria in their blood and their gut. Typhoid fever remains a serious health problem in the developing countries like Kenya. In countries like ours where typhoid fever is common, most cases result from contaminated drinking water and poor sanitation.

How many people are affected? 
It affects an estimated 26 million or more people each year worldwide. The exact number of people affected in Kenya is not clear.

How does the disease present?
Signs and symptoms are likely to develop gradually — often appearing one to three weeks after exposure to the disease (this is called the incubation period). The symptoms of typhoid are not very specific.

Symptoms of Early illness

• Fever that starts low and increases daily, possibly reaching as high as 40.5 C
• Headache
• Weakness and fatigue
• Muscle aches
• Sweating
• Dry cough
• Loss of appetite and weight loss
• Abdominal pain
• Diarrhea or constipation
• Rash
• Extremely swollen abdomen

Features of advanced disease
This is likely to occur if you don’t receive treatment. You may
Become delirious(confused)
Lie motionless and exhausted with your eyes half-closed in what’s known as the typhoid state.

Who are Typhoid carriers?
Even after treatment with antibiotics, a small number of people who recover from typhoid fever continue to carry the bacteria in their gut. One of the most common places where typhoid is carried is called the gallbladder and can often for years. These people shed the bacteria in their faeces and are capable of infecting others, although they no longer have signs or symptoms of the disease themselves.

What are the possible Complications of Typhoid?
Bleeding from your gut (Intestinal bleeding) or Perforation. : Usually develops around the third week of illness. Usually such patients present with severe abdominal pain, nausea, vomiting and bloodstream infection (sepsis). This life-threatening complication requires immediate medical care.
Inflammation of the heart muscle/valves (myocarditis and Endocarditis)
Pneumonia
Inflammation of the pancreas (pancreatitis)
Kidney or bladder infections
Infection and inflammation of the membranes and fluid surrounding your brain and spinal cord (meningitis)
Psychiatric problems, such as delirium, hallucinations and paranoid psychosis(madness)

How is the diagnosis made?
The diagnosis is usually confirmed by identifying Salmonella typhi in a culture of your blood or other body fluid or tissue. This is routinely done in a medical laboratory. For the culture, a small sample of your blood, stool, urine or bone marrow is placed on a special medium that encourages the growth of bacteria. A bone marrow culture often is the most sensitive test for S. typhi. Always insist to have a culture done before starting typhoid treatment.

What are the options for treatment?
Antibiotics: Antibiotics work by killing the bacteria in your body. Emergence of antibiotic-resistant bacteria is a growing problem in the treatment of typhoid fever. In recent years, S. typhi also has proved resistant to Septrin and ampicillin. Luckily enough there are still enough good antibiotics to treat typhoid fever. Your doctor will choose the best drug for treating Typhoid.

Drinking fluids. This helps prevent the dehydration that results from a prolonged fever and diarrhea. If you’re severely dehydrated, you may need to receive fluids through a vein.
Surgery. If your intestines become perforated, you’ll need surgery to repair the hole.
Most people with typhoid fever feel better within a few days of starting antibiotic treatment, although a small number of them may die of complications. Vaccines against typhoid fever are available, but they’re only partially effective. Vaccines usually are reserved for those who may be exposed to the disease or are traveling to areas where typhoid fever is common (e.g tourists)

What can we do to prevent Typhoid?
(Safe drinking water, improved sanitation and adequate medical care)
Wash your hands. Frequent hand-washing in hot, soapy water is the best way to control infection. Wash before eating or preparing food and after using the toilet. Carry an alcohol-based hand sanitizer for times when water isn’t available.
Avoid drinking untreated water.
Avoid raw fruits and vegetables. “Boil it, cook it, peel it, or forget it”

Choose hot foods. Avoid food that’s stored or served at room temperature. Although there’s no guarantee that meals served at the finest restaurants are safe, it’s best to avoid food from street vendors — it’s more likely to be contaminated.

Prevent infecting others (by Taking your antibiotics, Wash your hands often and Avoid handling food