Be wary of typhoid

Dr Tendai  Zuze

THE Minister of Health and Child Care, Dr David Parirenyatwa, recently issued an alert for typhoid fever which is a serious health threat caused by Salmonella typhi bacteria.

It spreads through contaminated food and water or through close contact with someone who is infected. In the first week of illness, signs and symptoms of typhoid include fever, headache, weakness and fatigue, dry cough, loss of appetite, abdominal pain, rash, diarrhoea and sometimes even constipation.

If you don’t receive treatment by the second week, you may enter a second stage during which you become very ill and experience continuing high fever, severe diarrhoea or constipation, weight loss or distended abdomen.

By the third week of typhoid fever you may become delirious or go into what is called a typhoid state where you become lethargic and lie motionless and exhausted with eyes half closed. It is in this third week that life threatening complications develop.

Improvement may come slowly during the fourth week. Your fever is likely to decrease gradually until your temperature returns to normal in another week or so. But signs and symptoms can return up to two weeks after your fever has subsided.

The bacteria that cause typhoid fever spread through contaminated food or water and occasionally through direct contact with someone who is infected. In developing nations, like ours, most cases result from contaminated drinking water and poor sanitation. You can contract the infection if you eat food handled by someone with typhoid fever who hasn’t washed carefully after using the toilet.

Even after treatment with antibiotics, a small number of people who recover from typhoid fever continue to harbour the bacteria in their intestinal tracts or gallbladders, often for years. These people, called chronic carriers, shed the bacteria in their faeces and are capable of infecting others, although they no longer have signs or symptoms of the disease themselves.

The most serious complication of typhoid fever, intestinal bleeding or perforation, may develop in the third week of illness. Intestinal bleeding is often marked by a sudden drop in blood pressure and shock, followed by the appearance of blood in your stool.

A perforated intestine occurs when your small intestine or large bowel develops a hole, causing intestinal contents to leak into your abdominal cavity and triggering signs and symptoms such as severe abdominal pain, nausea, vomiting and bloodstream infection (sepsis). Other complications include pneumonia, pancreatitis, kidney or bladder infections, meningitis, psychiatric problems and death.

Antibiotic therapy is the only effective treatment for typhoid fever. Commonly used antibiotics include ciprofloxacin and ceftriaxone. These drugs can cause side effects, and long-term use can lead to the development of antibiotic-resistant strains of bacteria.

Other treatment steps aimed at managing symptoms include:

Drinking fluids. Fluids, especially oral rehydration solution, prevent the dehydration that results from a prolonged fever and diarrhoea. If you’re severely dehydrated, you may need to receive fluids through a vein in your arm (intravenously).

Eating a healthy diet. Nonbulky, high-calorie meals can help replace the nutrients you lose when you’re sick.

While there are vaccines to prevent typhoid, the following simple measures are also useful:

Wash your hands. Frequent hand-washing is the best way to control infection. Wash your hands thoroughly with hot, soapy water, especially before eating or preparing food and after using the toilet.

Avoid drinking untreated water. Contaminated drinking water is a particular problem in areas where typhoid is endemic. Boil drinking water or use chlorine or other water purification chemicals. Carbonated bottled water is safer than uncarbonated bottled water. Wipe the outside of all bottles and cans before you open them. Ask for drinks without ice.

Avoid raw fruits and vegetables. Because raw produce may have been washed in unsafe water, avoid fruits and vegetables that you can’t peel. To be absolutely safe, you may want to avoid raw foods entirely.

Choose hot foods. Avoid food that’s stored or served at room temperature. Steaming hot foods are best. And 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.

If you’re recovering from typhoid, these measures can help keep others safe:

Wash your hands often. This is the single most important thing you can do to keep from spreading the infection to others. Use plenty of hot, soapy water and scrub thoroughly for at least 30 seconds, especially before eating and after using the toilet.

Clean household items daily. Clean toilets, door handles, telephone receivers and water taps at least once a day with a household cleaner and paper towels or disposable cloths.

Avoid handling food. Avoid preparing food for others until your doctor says you’re no longer contagious. If you work in the food service industry or a health care facility, you won’t be allowed to return to work until tests show that you’re no longer shedding typhoid bacteria.

Keep personal items separate. Set aside towels, bed linen and utensils for your own use and wash them frequently in hot, soapy water. Heavily soiled items can be soaked first in disinfectant.

If you think you have typhoid, please visit the nearest health centre.