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27 December 2019

Typhoid fever |ICDS Supervisor|ICDS Supervisor Exam Kerala PSC

Typhoid fever, transmission, treatment, prevention |ICDS Supervisor|ICDS Supervisor Exam Kerala PSC

In this post, Typhoid one of the Infections spread by food and water is explainedDefinition of Typhoid, Mode of transmission of Typhoid, Communicability, Diagnosis of Typhoid fever, Methods of treatment of Typhoid Fever, Age groups affected by Typhoid, and Prevention of the spread of Typhoid are explained below

In the previous posts, we already discussed the types of dehydration in Diarrhoea is explained. Diarrhoea, one of the Infections spread by food and water is explained in another post. The Types of Diarrhoea and the pathogens of Diarrhoea are explained in detailOther Infections spread by water are Typhoid, Paratyphoid fever, Poliomyelitis, Hepatitis A and Hepatitis E. Those will be explained in the coming posts. Immunization and Vaccines are important topics for ICDS Supervisor Exam

Kerala PSC and other states PSC's are conducting Exams for ICDS Supervisor. Study materials are available for other topics also like Home ScienceFood and NutritionPsychologyPhysiologyMicrobiologySociology and Nutrition and Health for ICDS Supervisor Kerala PSC Exam

Typhoid fever, transmission, treatment, prevention 

Definition of Typhoid:

Typhoid fever (also known as enteric fever) is a severe systemic infection caused by the Gram negative bacterium Salmonella typhi. 

Ingestion of a large number of organisms is usually necessary for the disease to occur unless there is achlorhydria.

The organisms are absorbed from the gut and transported via the bloodstream to the liver and spleen. 

They are released into the blood after 10 to 14 days. This is when the symptoms begin. The organisms localize in the lymphoid tissue of the small intestine, which can bleed and perforate. 

This is the main cause of death from typhoid fever.

Mode of transmission of Typhoid fever

Typhoid fever is spread via the fecal-oral route, usually through contaminated food and water.

Organisms only infect humans, so spread comes from infected excreta of a human with typhoid, or from a carrier. 

Polluted water is the most common source of typhoid, but shellfish gathered from sewage-contaminated beds and raw vegetables fertilized with night soil are high-risk foods. 

The incubation period is from 10 to 21 days.

Communicability of Typhoid fever

Most patients who have typhoid will excrete organisms at some stage of their illness. 

About 10% who have typhoid fever excrete the organisms for approximately three months after the acute stage of the illness and 2 to 5% of untreated patients become long-term carriers. 

Incidence of becoming a carrier increases with age, especially in females.

Epidemiological summary of Typhoid fever

The organism responsible for typhoid fever was first isolated in 1880, but epidemics of the disease were believed to be the cause of many deaths as far back as the early 17th century. 

Typhoid fever affects 17 million people in the world annually, with
approximately 600 000 deaths. 

Typhoid is predominantly a disease of countries with poor sanitation and poor standards of personal and food hygiene. 

Multi-drug resistant strains have been reported in Asia, the Middle East, and Latin America.

Manifestations of Typhoid fever

• In the early stages of fever, severe headache, constipation, and a dry cough may be present.

• The fever rises in a “step ladder” pattern for 4 or 5 days.

• Abdominal tenderness and an enlarged liver or spleen may occur.

• The pulse can often be slower than would normally be anticipated considering the patient’s temperature.

• After 7 to 10 days, the fever reaches its peak and a rash may appear on the upper abdomen and back as sparse, slightly raised, rose-red spots, which fade on pressure and are usually only visible on white skin.

• Diarrhoea may develop later, together with bronchitis; the patient may also show signs of confusion.

• If untreated, complications can occur during the second week of the illness; these include weakness, dehydration, and most commonly intestinal bleeding and perforation.

• Other complications may affect any patient because of the occurrence of septicaemia during the first week. 

These may include cholecystitis, pneumonia, myocarditis, arthritis, osteomyelitis and meningitis.

• Bone and joint infection is seen, especially in children with sickle cell disease.

Age groups affected by Typhoid fever

Typhoid can affect any age.

Prognosis of Typhoid fever

Case-fatality rates of 10% can be reduced to less than 1% with appropriate antibiotic therapy.

Diagnosis of Typhoid fever

Blood culture is the most important method for diagnosis.

 Isolation of the organism from the stool is more common in the second and third weeks of the illness. 

In some cases, isolation of the bacteria in the urine can be used as a diagnostic method. 

Methods of treatment of Typhoid fever

Four different antibiotics are often used for treatment: Ciprofloxacin, Co-trimoxazole, Amoxycillin and Chloramphenicol.

Unfortunately, as with many Salmonella, S. typhi is becoming resistant to many antibiotics and some isolates are only sensitive to Ciprofloxacin.

Treatment must continue for two weeks (10 days in the case of Ciprofloxacin) and it is common for the patient to remain pyrexial for five days following commencement of treatment. 

Effective treatment does not always prevent complications, the disease recurring or the patient becoming a carrier.

 A chronic carrier may be treated for four weeks with aminoquinalones and in some cases it may be necessary to perform a cholecystectomy, as the gallbladder can act as a reservoir for the S.typhi organisms.

Prevention of spread of Typhoid fever

Prevention of spread is dependent upon:

Clean water supply: protection and chlorination of public water supplies is necessary.

Good sanitation: ensuring there is no backflow connection between sewers and water supplies;

disposal of human excreta must be carried out in a safe manner and toilets must be fly-proof.

 Public education on food, water and particularly hand washing hygiene; 

the importance of handwashing is especially vital for food handlers and those caring for patients and/or children 

Treatment of carriers: this can often be very difficult to implement, but spread through carriers is unusual if good personal hygiene is practised and stools are disposed of hygienically.

Selective immunization of groups: during an epidemic in an endemic country, selective immunization of groups such as school children, institutionalized people and healthcare workers is of great benefit. 

Travellers from an industrialized country to an endemic area should seek vaccination.

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