TYPHOID IN ENGLISH

                                        

                                          TYPHOID IN ENGLISH

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 TYPHOID-

           Typhoid is a systemic bacterial disease with   onset of sustained fever, marked headache, malaise, anorexia, relative bradycardia, splenomegaly, nonproductive cough in the early stage of the illness. The disease is clinically characterized by a typical continuous fever for 3 to 4 weeks. It is also known as enteric fever.

CAUSATIVE AGENT-

           The typhoid is caused by a bacteria salmonella typhi, salmonella paratyhi A and salmonella paratypi B. S. typhi survives intracellularly in the tissues of various organs. Man is the only known reservoir of infection in the form of cases and carriers

HOW IT SPREADS-

           Typhoid is transmitted via the faecal-oral route or urine-oral routes. This may take place directly through soiled hands contaminated with faeces or urine of cases or carriers, or indirectly by the ingestion of contaminated water, milk and/or food. In this ay it also becomes a water borne, food borne and milk bonre disease.

           It is also a vehicle borne disease as flies may infect uncovered foods after taking bacteria from infected faeces in which the organism then multiplies to infect the food or water or milk. Important vehicles in some countries include shellfish (particularly oysters) from sewage-contaminated water reservoirs.

SIGN AND SYMPTOMS-

           Typhoid patients have following symptoms-

           Fever , rising with step ladder fashion.

           Sore throat

           Cough

           Headache,

           Malaise (General sense of being unwell.)

           Abdominal pain

           Constipation

           After 7-8 days fever becomes constant.

           Splenomegaly,

           Abdominal distension and tenderness,

           Bradycardia

           The rash (rose spots) commonly appears during the second week of disease. The individual spot, found principally on the trunk, is a pink papule 2-3 mm in diameter that fades on pressure. It disappears in 3-4 days.

           Complications-

           Intestinal haemorrhage is manifested by a sudden drop in temperature and signs of shock, followed by dark or fresh blood in the stool. Intestinal perforation is most likely to occur during the third week. Less frequent complications are urinary retention, pneumonia, thrombophlebitis, myocarditis, psychosis, cholecystitis, nephritis and osteomyelitis.

DIAGNOSTIC INVESTIGATIONS-

           1. Blood investigations- Diagnosis of typhoid fever depends on the isolation of pathogenic organism from blood.

           2.Blood culture - Blood culture is the mainstay of diagnosis of this disease.

           3. Stool Examination – Pathogenic organism may be isolated from stool of the patient.

           4. Serological test- Felix-Widal test measures agglutinating antibody levels against 0 and H antigens. Usually, 0 antibodies appear on day 6-8 and H antibodies on day 10-12 after the onset of disease

           5. Rapid test kit- A number of commercial rapid format serological test-kits for anti-dengue IgM antibodies have become available in the market.

TREATMENT-

           Mild cases of typhoid are well treated by antibiotics and symptomatic treatment. The drug of choice for typhoid includes chloramphenicol, ampicillin, amoxicillin and trimethoprim sulfamethoxazole. Patients seriously ill and profoundly toxic may be given steroids also.

PREVENTION-

Ø  Early detection and prompt treatment of cases is the best strategy to prevent further spread of typhoid

Ø   As a rule, cases should be isolated till three bacteriologically negative stools and urine  reports, are obtained on three separate days.

Ø     Stool and urine are sole sources of infection. They should be received in closed containers and disinfected with 5 per cent cresol for at least 2 hours

Ø   All soiled clothes and linen should be soaked in a solution of 2 per cent chlorine and steam-sterilized.

Ø  Health education regarding the importance of handwashing. Suitable handwashing facilities, particularly for food handlers and attendants involved in the care of patients and children, should be provided.

Ø   Environmental sanitation abolishing breeding places of flies is also a good measurement to prevent spread of typhoid.

Ø  Use best possible cleanliness in food preparation and handling. Pay particular attention to the storage of salads and other foods served cold. These provisions apply to home and public eating places.

Ø   Use best possible milk hygiene practices such as pasteurization and refrigeration of milk.

Ø  Since carriers are the ultimate source of typhoid fever, their identification and treatment is one of the most radical ways of controlling typhoid fever Typhoid carriers should be excluded from handling food and from providing patient care. Identify and supervise typhoid carriers . Carriers are identified by cultural and serological examinations

Ø  Immunization with typhoid vaccine is a good method of prevention of typhoid. The Vi polysaccharide vaccine is recommended at the age of 2-5 years. Only 1 dose is required, and the vaccine confers protection 7 days after injection. An oral, live vaccine using S. Typhi strain Ty21a (requiring 3 or 4 doses, 2 days apart) is also available.