Toria is not one to complain about her health, by the time she does, one can be certain it’s serious. So it was quite an issue on Sunday this week, when she kept on about a nagging pain. “I’m not feeling too well. There is this pain in my lower abdomen. It’s making me really uncomfortable.” Initially, no one gave her moaning much attention, but when she kept it up all day, some helpful suggestions began to materialize. ”
It’s probably constipation or an ulcer,” a friend suggested. “Perhaps it’s that time of the month,” another pointed out. But none of these suggestions did much to assuage Toria’s discomfort or help identify the true cause of her pain. It was not until the very next day when she broke out into a very high fever and red skin rash that she was taken to the local clinic that a diagnosis of typhoid fever was confirmed. But Toria was dumbstruck. Typhoid? How on earth did I contract typhoid, she asked no one in particular.
How people get infected
Ouite easily of course, explained the healthcare professionals. Typhoid is an acute illness associated with fever caused by the Salmonella typhi bacteria. They told Toria, the disease can also be caused by Salmonella paratyphi, a related bacterium that usually causes a less severe illness. Salmonella bacteria spread through contaminated food, drink, or water.
Typhoid fever is contracted by drinking or eating the bacteria in contaminated food or water. People with acute illness can contaminate the surrounding water supply through stool. Contamination of the water supply can, in turn, taint the food supply. The bacteria can survive for weeks in water or dried sewage. About 3-5 percent of people become carriers of the bacteria after the acute illness. Others suffer a very mild illness that goes unrecognized. These people may become long-term carriers of the bacteria — even though they have no symptoms — and be the source of new outbreaks of typhoid fever for many years.Typhoid fever is common in Nigeria, but not all cases are reported.
After the ingestion of contaminated food or water, the Salmonella bacteria invade the small intestine and enter the bloodstream temporarily. The bacteria are carried by white blood cells in the liver, spleen, and bone marrow, where they multiply and reenter the bloodstream. People develop symptoms, including fever, at this point. Bacteria invade the gallbladder, biliary system, and the lymphatic tissue of the bowel. Here, they multiply in high numbers. The bacteria pass into the intestinal tract and can be identified in stool samples. If a test result isn’t clear, blood samples will be taken to make a diagnosis.
Although people with typhoid fever sometimes become sick suddenly, signs and symptoms are more likely to develop gradually after exposure to the disease.
In the first week, of illness you’re likely to experience fever, that starts low and increases daily, followed by headache, weakness and fatigue. A dry cough, loss of appetite and abdominal pain, diarrhoea or constipation and a skin rash usually follow.
Some people with typhoid fever develop a rash called “rose spots,” which are small red spots on the abdomen and chest. If there is no adequate treatment, you may enter a second stage during which you become very ill and experience continuing high fever, diarrhea or severe constipation, considerable weight loss and extremely distended abdomen. By the third week, you may become delirious or get into what’s known as the typhoid state. Improvement may come slowly during the fourth week.
Fluids and electrolytes may be given through a vein (intravenously), or you may be asked to drink uncontaminated water with electrolyte packets. 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. Symptoms usually improve in 2 to 4 weeks with treatment. The outcome is likely to be good with early treatment, but becomes poor if complications develop.
These range from intestinal hemorrhage and intestinal perforation to kidney failure and peritonitis.
Water treatment, waste disposal, and protecting the food supply from contamination are important public health measures. Carriers of typhoid must not be allowed to work as food handlers. Proper hand washing at all times is crucial.