Typhoid Fever

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by: dr. Jodie Pratama Wijaya

What is thyphoid fever ?

            This disease is rare in developed countries. However, thyphoid fever attract the attention of countries in the world. Thyphoid fever or in Indonesia we called it thyphus spreads through contaminated food and water or through physical touch from infected people. Common signs and symptomps are high fever, dizziness, chest pain, and constipation or diarrhea. When treated with antibiotics, mostly people who suffer from thyphus will feel better within a few days, even tough on a small scale there are complications or even death. A vaccine against thyphoid fever is available. But only some of them are effective. Vaccines are usually given to those who will or are traveling to a place where thyphus is common.

Symptomps of thyphoid are not typical. Often the early symptomps of thyphoid look like flu symptomps or sore throat. At a later stage thyphoid symptomps are also often like dengue fever. Thphoid symptomps include :

  • Pain in the first week when the bacteria is first affected, the signs and symptomps obtained will be as follows : Fever, usually around 39,4 degrees C or 40 degrees C. Dizziness lack and fatigue, sore throat, chest pain, diarrhea or constipation, also some rash on the skin. Children tend to have diarrhea when they are attacked by bacteria that cause thyphus, while adults are usually feel constipated. In the second week, a small rash/red spots appear on the skin. This rash is temporary, usually disappears in 2 or 5 days.
  • Pain in the second week if you don’t get treatments for thyphoid fever, it’s likely that the second week will get worse with signs like : High fever will continue diarrhea is longer or severe constipation, weight loss, stomach will enlarge/bulge.
  • Pain in the third week. In the third week, thyphus sufferers will felt sleep disorder and the body will be feel very exhausted so that the eyes can only open just a half. This is the time when thyphus is really severe. The threat of complications will begin at this stage if not handled properly.
  • Pain in the fourth week. Improvement will appear slowly in this fourth week. Fever will gradually decrease until body temperature returns to normal within a week to a 10 days. But this symptom can return again 2 weeks later after the fever falls, if not handled properly.


Causes & Risk Factors

Thyphoid fever is caused by virulent bacteria called Salmonella thyphi. Although, they are not bacteria that cause salmonellosis (another serious infection that attacks the intestines). The route of spread of bacterials that causes thyphoid fever spreads through contaminated food and drink and usually also through direct contact with someone who has been infected. In developed countries where thyphus is endemic, most cases occur because the drink is contaminated and the water quality is not good. In general, people who travel are exposed to the spread of bacteria and then spread it again through feces. This meant that salmonella thyphi spreads through human feces and sometimes urine of infected people. You can get an infection if you eat food from someone who is infected with thyphus and has not washed his hands. You can also be infected through drinks contaminated with thyphoid-carrying bacteria. Even after treatment with antibiotics, few people do recover from thyphus but some of them will continue because the bacteria will nest in their intestines or bile up for up to several months. These people are referred to as chronic thyphoid carriers, because they have bacteria in their feces and easily transmit other people even though they no longer have thyphoid symptoms.

 Factors that affecting

Thyphoid fever are a serious threat to the world – especially in developing countries – thyphus attacks more than 21 million people each year according to data from the Centre for Disease Control and Prevention (CDC) of a world organization. This disease is endemic in India, Southeast Asia, Africa, South Africa and many others areas. Worldwide, children are at the highest risk of thyphoid, even tough they have lower symptoms than adults. If living in a country where thyphus is rare, there is a risk of infection if :

– Work or travel where thyphoid fever is endemic.

– Working as someone who handles clinical microbiologists dealing with almonella thyphi bacteria.

– Have physical contact with someone who is infected or has just recovered from thyphoid fever.

 – Have a weak immune system against drugs such as corticosteroids or have disease such as HIV/AIDS.

– Drinking water contaminated with S. Thyphi

When complication of intestinal bleeding occur the most serious complication that occurs in thyphoid fever is the occurrence of intestinal bleeding, which may occur in the third week after being attacked by a virus. About 5% of people who suffer from thyphus experience this complication. Intestinal bleeding is often characterized by a drop in blood pressure drastically followed by the appearance of blood in the stool. A hollow bowel appears when the small intestines or large intestines forms a hole, causing intestinal contents to leak into the abdominal cavity and triggers sign and symptoms such as infection with severe abdominal pain, nausea , vomiting and infection in the bloodstream. This is very dangerous and requires medical treatment. Other complications that may occur. Complication that may occur are: Inflammation in the heart muscle (myocarditis), pneumonia, inflammation of the pancreas, infection of the kidneys bladder, Infection of the spine (osteomyelitis), infection and inflammation of membranes and fluids that surround the brain and spinal cord (meningitis) psychological problems such as desire, paranoid hallucinations and psycosis. With the right treatment, almost everyone in industrialized countries is cured from thyphus. Without treatment, some people may not survive the complications of this disease.

Life Style & Home Care

Antibiotics that are often prescribed in the United States, doctors often prescribe ciprofloxacin for adults and those who are not pregnant. Ceftriaxone (an Injection antibiotics) is an alternative for pregnant women and children who are not likely to use ciprofloxacin. This drug can cause side effects, and long term use can lead to the development of bacterial antibiotics resistant strains. Problems with antibiotics resistance in the past, the drug of choice was chloramphenicol. Doctors no longer use it, because of side effects, high recurrence rates and extensive bacterial resistance. In fact, the presence of antibiotics-resistant bacteria is a growing problem in the treatment of thyphus, especially in developing countries. In recent years, S. thyphi has also been shown to be resistant to trimethoprim-sulfamethoxazole and ampicillin. Relief therapy other treatment steps aim to treat symptoms including: this helps prevent dehydration resulting from prolonged fever and diarrhea. If you suffer from severe dehydration, you may need to drink fluids through the blood vessels in your arms (intravenously). High calorie foods can help replace nutrients lost when you are sick.

Thyphoid fever diet

Patients with thyphoid fever during treatment must follow dietary guidelines recommended by doctors for consumption, including :

  • Foods that are enough fluids, calories, vitamins & protein.
  • Doesn’t contain a lot of fiber
  • Doesn’t stimulate and doesn’t cause a lot of gas
  • Soft food is given during rest
  • To return to “normal” food, do it gradually along with mobilization. For example, the first and second days of soft food, the third day of ordinary food, and so on.

Prevention of thyphoid fever

Prevention of thyphoid fever can be done by improving hygiene and environmental sanitation and health education. Immunization using oral vaccines (Vi Polysaccharida capular antigen) has been wisely used. At present prevention of Salmonella germs can be done by vaccination named chotipa (cholera-thyphoid- parathyphoid) or thypa (thyphoid-parathyphoid). For children aged 2 years who are still vulnerable, they can also be vaccinated.