Typhoid fever is an acute communicable disease caused by Salmonella typhi. The term ‘enteric fever’ includes both typhoid and paratyphoid fevers. In the clinical symptoms the paratyphoid fever shows no remarkable difference from typhoid fever.
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Typhoid fever occurs in all parts of the world and throughout the year but more in summer and rainy season. The disease affects all ages but more common between 10 to 30 years. It is most common among school going children. An attack of typhoid fever gives a fairly lasting immunity but second attack may also occur.
Causative Organism:
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Typhoid fever is caused by Salmonella typhi and paratyphoid fever is caused by Salmonella paratyphi A, B or C.
Mode of Spread:
Poor sanitation, open air defecation and urination; low standard of living, unhygienic food, contaminated milk and water; illiteracy and health ignorance are responsible for the spread of typhoid fever. Flies also play a significant role in the spread of this disease.
The disease occurs in healthy persons when they take water, milk and food which* is contaminated by the stools and urine of the patient or disease can be transmitted directly through contaminated hands or fingers with stools of the patient.
Incubation Period:
Incubation period varies from 7 to 28 days (average is 14 days).
Signs and Symptoms:
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Early symptoms include nausea, vomiting, diarrhea or constipation, cough, headache, slow pulse rate and fever. In later symptoms i.e. in the second week the fever goes on rising by about one degree every day and reaches to 39.5°C to 40°C which continues for 2-4 weeks. The fever does not come down despite preliminary treatment.
The patient feels weakness, tired, there is weight loss, poor appetite and may have pain in the abdomen and enlargement of spleen. If no further complications are involved, recovery begins in the third week. The fever subsides only when specific treatment is given against typhoid or paratyphoid.
Prevention and Control:
(i) Contaminated water is the main mode of spread of this disease so water must be protected from contamination with faeces, urine and sewage. Safe drinking water should be made available to the public.
(ii) Water and milk should be consumed only after proper boiling.
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(iii) Human excreta and urine which are the major sources of transmission of the disease should be disposed of in a sanitary way.
(iv) Strict sanitation control should be observed in and around the houses.
(v) Alt eatables should be protected from flies. Raw vegetables and fruits should be washed properly before consuming. Cut fruits and sweetmeats should be covered so as to protect them from dust and flies.
(vi) Antifly measures should be taken.
(vii) Public should be educated for sanitation and personal hygiene.
(viii) All acute cases should be detected, notified and isolated at the earliest.
(ix) Public should be immunised with TAB vaccine which contains S. typhi, S. paratyphi A and S. paratyphi B.
Immunisation is done by injecting subsequently two doses each of 0.5 ml at an interval of 7 to 10 days. Booster doses are required to be given every third year. After injection TAB vaccine causes local reaction, pain, headache, mild fever and swelling.
Treatment:
(i) Give complete rest to the patient.
(ii) Give nourishing diet to the patient. Fresh juice of citrus fruits will be quite helpful.
(iii) Chloramphenicol is the drug of choice which should be given by mouth in doses of 500 mg four times a day until the temperature is normal say about 10 days then it is given in doses of 250 mg eight hourly for another 3-4 days to avoid relapse which is very common.
(iv) Stools and urine should be passed in a closed container containing some disinfectant. The container should be cleaned immediately after passing the stools or urine.
(v) All beddings, bed sheets, towels, pillow covers and other articles used by the patient should be thoroughly disinfected and cleaned.
(vi) Great care should be taken for personal hygiene of the patient.