Typhoid fever

(Survival manual/6. Medical/b) Disease/Typhoid fever)

Definition
<http://www.mayoclinic.com/health/typhoid-fever/DS00538>
Typhoid fever is caused by the bacteria Salmonella typhi. Typhoid fever is rare in industrialized countries; however, remains a serious health threat in the developing world.  Typhoid fever spreads through contaminated food and water or through close contact with someone who’s infected. Signs and symptoms usually include high fever, headache, abdominal pain, and either constipation or diarrhea.
When treated with antibiotics, most people with typhoid fever feel better within a few days, although a small percentage may die of complications. [Please keep in mind, of the many diseases one might contract in the aftermath of a SHTF situation, your chance of recovery and-or rate of recovery is in part, related to your overall state of health, nutrition, access to sanitary water and protection from exposure, as well as the medical care given. Mr Larry]
Vaccines against typhoid fever are available, but they’re only partially effective. Vaccines are usually reserved for those who may be exposed to the disease or are traveling to areas where typhoid fever is common.

Symptoms
Although children with typhoid fever sometimes become sick suddenly, signs and symptoms are more likely to develop gradually — often appearing one to three weeks after exposure to the disease.
1. First week of illness
Once signs and symptoms do appear, you’re likely to experience:
•  Fever, often as high as 103 or 104 F.
•  Headache
•  Weakness and fatigue
•  Sore throat
•  Abdominal pain
•  Diarrhea or constipation
•  Rash
Children are more likely to have diarrhea, whereas adults may become severely constipated. During the second week, you may develop a rash of small, flat, rose-colored spots on your lower chest or upper abdomen. The rash is temporary, usually disappearing in two to five days.

2. Second week of illness
If you don’t receive treatment for typhoid fever, you may enter a second stage during which you become very ill and experience:
•  Continuing high fever
•  Either diarrhea that has the color and consistency of pea soup, or severe constipation
•  Considerable weight loss
•  Extremely distended abdomen

3. Third week of illness
By the third week, you may:
•  Become delirious
•  Lie motionless and exhausted with your eyes half-closed in what’s known as the typhoid state.
Life-threatening complications often develop at this time.

4. Fourth week of illness
Improvement may come slowly during the fourth week. Your fever is likely to decrease gradually until your temperature returns to normal in another week to 10 days. But signs and symptoms can return up to two weeks after your fever has subsided.

When to see a doctor
See a doctor immediately if you suspect you have typhoid fever. If you become ill while traveling in a foreign country, call the U.S. Consulate for a list of doctors.

Causes
Typhoid fever is caused by a virulent bacterium called Salmonella typhi. Although they’re related, this isn’t the same as the bacteria responsible for salmonellosis, another serious intestinal infection.

Fecal-oral route
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, where typhoid is endemic, most cases result from contaminated drinking water and poor sanitation. The majority of people in industrialized countries pick up the typhoid bacteria while traveling and spread it to others through the fecal-oral route.
This means that S. typhi is passed in the feces and sometimes in the urine of infected people. You can contract the infection if you eat food handled by someone with typhoid fever who hasn’t washed carefully after using the bathroom. You can also become infected by drinking water contaminated with the bacteria.

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

Risk factors
Typhoid fever remains a serious worldwide threat — especially in the developing world — affecting more than 21 million people each year, according to the Centers for Disease Control and Prevention. [Typhoid is out there and its serious. We in the advanced nations keep it at bay with our energy driven public health sanitary systems. As long as the health infrastructure continue working, we’re safe, but if the power goes out regionally, for a long period of time, Typhoid will be ‘just another dangerous disease’ to deal with. Mr Larry]
The disease is endemic in India, Southeast Asia, Africa, South America and many other areas.
Worldwide, children are at greatest risk of getting the disease, although they generally have milder symptoms than adults do.
If you live in a country where typhoid fever is rare, you’re at increased risk if you:
•  Work in or travel to areas where typhoid fever is endemic
•  Work as a clinical microbiologist handling Salmonella typhi bacteria
•  Have close contact with someone who is infected or has recently been infected with typhoid fever
•  Have an immune system weakened by medications such as corticosteroids or diseases such as HIV/AIDS
•  Drink water contaminated by sewage that contains S. typhi

Treatments and drugs
Antibiotic therapy is the only effective treatment for typhoid fever.
Commonly prescribed antibiotics: Ceftraixone, ciprofloxacin and levofloxacin are the drugs of choice for treatment of typhoid fever.
In the United States, doctors often prescribe ciprofloxacin for nonpregnant adults. Ceftriaxone — an injectable antibiotic — is an alternative for women who are pregnant and for children who may not be candidates for ciprofloxacin. 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. 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 in your arm (intravenously).
•  Eating a healthy diet. Non bulky, high-calorie meals can help replace the nutrients you lose when you’re sick.
•  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.
•  Symptoms may return if the treatment has not completely cured the infection.
•  When appropriate treatment is started early, the prognosis for typhoid fever is good. With treatment, the mortality rate of typhoid fever is generally under 1 percent and few complications occur.
•  Even with treatment, however, approximately 20 percent of people have another episode (relapse) of typhoid fever, although the relapse is usually not as severe as the first infection. Certain factors that can increase the risk for a relapse include:
_  Age over 50
_  Presence of gallstones
_  Female gender.

Prevention
In many developing nations, the public health goals [read: infrastructure] that can help prevent and control typhoid — safe drinking water, improved sanitation and adequate medical care — may be difficult to achieve. For that reason, some experts believe that vaccinating high-risk populations is the best way to control typhoid fever.
Two vaccines are currently in use — one is injected in a single dose, and the other is given orally over a period of days. Neither vaccine is 100 percent effective, and both require repeat immunizations as vaccine effectiveness diminishes over time.

If you’re traveling to an area where typhoid fever is endemic, [or it becomes endemic in your community] consider being vaccinated. But because the vaccine won’t provide complete protection, be sure to follow these guidelines as well:
•  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. Carry an alcohol-based hand sanitizer for times when water isn’t available.
•  Avoid drinking untreated water. Contaminated drinking water is a particular problem in areas where typhoid is endemic. For that reason, drink only bottled water or canned or bottled carbonated beverages, wine and beer. Carbonated bottled water is safer than uncarbonated bottled water is. Wipe the outside of all bottles and cans before you open them. Ask for drinks without ice. Use bottled water to brush your teeth, and try not to swallow water in the shower.
•  Avoid raw fruits and vegetables. Because raw produce may have been washed in unsafe water, avoid fruits and vegetables that you can’t peel, especially lettuce. 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.
[Typhoid prevention techniques are similar to those for ‘Travelers diarrhea’.]

To prevent infecting others
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.
<http://www.mayoclinic.com/health/typhoid-fever/DS00538>