Typhoid Fever
DEFINITION:
Typhoid fever [noun] (medical) a dangerous type of infectious disease, caused by germs in food or drinking water.
General informations
Typhoid fever, also known as enteric fever or abdominal typhus, is caused by the bacterium Salmonella enterica serovariante typhi (Salmonella Typhi). Man is the only vector of the disease which, if left untreated, has a mortality rate of over 10%.
Transmission mode
During infection, people with typhoid fever carry bacteria in the blood and intestines. Most patients are contagious until the end of the first week of recovery, but 10% of the untreated individuals disperse the bacteria for up to three months after recovery. 2-5% of untreated people can also become a chronic carrier of the disease by continuing to disperse bacteria. The bacteria then pass from the intestine and blood into the feces and urine of infected people, allowing the transmission of the infection to other individuals.
The transmission can take place directly through the faeces or, more frequently, indirectly, through the ingestion of food or drinks handled by infected people or through the contamination, through the sewage discharges, of the water used for drinking or washing the food.
Typhoid fever is more widespread in areas with greater environmental degradation, where hygiene conditions are poor. Even the seabed can be contaminated by sewers and as a result, raw molluscs and crustaceans eaten are an important source of contagion. In poor hygiene conditions even milk can be easily contaminated. Flies can contaminate foods which then in turn contaminate humans.
In the event of epidemics, a frequent source of contagion is represented by contaminated water sources.
Symptoms and diagnosis
Typhoid fever is a systemic disease characterized by progressive onset fever.
After a week or two of incubation, the body temperature rises between 39 and 40 degrees. The other symptoms related to this pathology are a widespread sense of weakness, cough, roseole (characteristic macular exanthems on the trunk), enlarged spleen and liver, abdominal pain, headache and loss of appetite.
In some cases, diarrhea and intestinal bleeding or perforation are also observed. Without treatment, the disease progresses with sustained fever, bradycardia, hepatosplenomegaly, abdominal symptoms and in some cases pneumonia. From the third week onwards, untreated cases can manifest even very serious gastrointestinal complications.
The only way to safely ascertain the disease is by analyzing a blood or stool sample.
Prevention
Prevention of typhoid fever can be carried out through personal hygiene education, in particular washing hands after using the bathroom and before contact with food, checking sewer systems and flies (which can carry the bacterium).
Even the individual can and must comply with a series of rules to avoid contagion, especially if he is in countries where the disease is widespread. Fundamental for those who go to risk areas is to avoid certain types of food (especially raw) and drinks (unpasteurized milk). It is always advisable to drink sealed mineral water or, if it is not available, bring the water to a boil for at least one minute before drinking it. Drinks must be without ice and food well cooked. Raw fruit and vegetables should be avoided or carefully peeled before a meal.
Vaccination against typhoid fever can be indicated for those who plan to travel to countries where the disease is widespread. The vaccination cycle must begin at least a week before departure, but keep in mind that it is not always effective (therefore the elementary hygiene standards mentioned must always be respected) and that after a few years the recall should be made if the need for coverage persists.
Vaccines for travelers are often in a combined form: typhoid anti-fever can for example be administered together with anti-hepatitis A. In this case, the vaccine must be administered in a single dose at least four weeks before departure.
Since in some countries there may be the possibility of resistance of microorganisms to antibiotics, two vaccines have been developed: the vaccine containing live germs of the attenuated mutant strain Ty21a, oral, with a protection rate of around 67% up to seven years later the last dose; and the vaccine based on capsular polysaccharides (Vi Cps), injectable, with a protection rate of 72% after a year and a half and 50% after three years.
There are some limitations for these vaccines (for example incompatibility with some antimalarial drugs), so it is always essential to consult a travel medicine center to evaluate the risk-benefit balance of the use of these vaccines.
Treatment
Typhoid fever needs to be treated with antibiotics, but several forms of drug resistance have spread in recent years that could lead to an increase in disease mortality. Antibiotic therapy must be accompanied by careful monitoring of the patient.
If the fever persists after a few days of treatment, it may be necessary to change therapy. Typhoid fever patients should be assisted with precautions that aim to limit the possibility of transmission of the bacterium, including continuous disinfection of stool and urine.
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