Typhoid Fever: Symptoms, treatment, causes, and prevention

TYPHOID FEVER

DEFINITION: - Typhoid fever is a systemic infectious disease caused by the bacterium Salmonella enterica serotype Typhi also known as s. typhi. Salmonella enterica serotype paratyphi( s. paratyphi) A, B, C cause the clinically similar condition known as paratyphoid. Typhoid and paratyphoid fever collectively referred to as enteric fever.

The contagious nature of the disease and incriminated faecally contaminated water sources in transmission was described by William Budd in 1873.

EPIDEMIOLOGY

India the typhoid fever is a major public health problem because of poor sanitation, lack of safe drinking water supply and low socioeconomic condition. That’s why in India there is lots of case of typhoid fever. The typhoid fever is usually observed throughout the year.

Age group: - mainly affect children and young adults

Gender: - more common in a male. As female are chronic carriers.

Socioeconomic factor: - Typhoid fever is a disease of poverty and associated with inadequate sanitation facilities and unsafe water supplies.

MODE OF TRANSMISSION

Typhoid fever is transmitted by the fecal-oral route, via contaminated food and water. Occasionally health care workers can acquire the disease from infected patients.

AETIOPATHOLOGY

I have lots of information regarding this section but as our motto is to explain in easy understand so I will briefly explain how bacteria enter in our bloodstream and produce typhoid fever as below,

S. Typhi is ingested with food and water (both contaminated).

Passes through the stomach and invade gut epithelium

In the small intestine invade and translocate to an intestinal lymphoid follicle

 

Some pass on to reticuloendothelial cells of liver and spleen

In the liver and spleen, they multiply

After 7 to 14 days of incubation clinical conditions such as fever appear

CLINICAL FEATURES

Prolonged fever: - initially low grade, rises progressively, and by the second week is often high and sustained. Continues fever rising in step-ladder fashion is observed

Fever including chills, headache, anorexia, cough, weakness, sore throat, dizziness, muscle pain and abdominal pain.

There are some physical sing present in typhoid fever such as coated tongue, tender abdomen, hepatomegaly and/or splenomegaly may be found.

In some patient at the end of 1^st week small maculopapular, blanching and erythematous rush typically on trunk and chest may be seen.

Constipation may present in some patient

DIAGNOSIS

Typhoid should be considered in any patient with prolonged unexplained fever with an appearance of a rose spot.

Complete blood count

Widal test is the best serological test to diagnose typhoid fever

COMPLICATION

The commonest complication is as follow

Intestinal perforation

Gastrointestinal hemorrhage

Typhoid encephalopathy

PROGNOSIS

When untreated the fever persists for 2 weeks or more and defervescence occurs slowly over the following 2 to 3 weeks. Death occurs in between 10% to 30%  of an untreated patient following complication.

PREVENTION

We can prevent typhoid fever by improving sanitation, ensuring the safety of food and water supplies, identification and treatment of chronic carries of s.typhi, and use of typhoid vaccines to reduce the susceptibility of the host to infection.

Vaccination is recommended for use in travelers to endemic areas, for household contact of typhoid carries, and laboratory workers.

There are two type of vaccine available for typhoid fever

1 Parenteral Vi polysaccharide vaccine.

2 Oral Vaccine ( S. Typhi strain Ty21a is live attenuated oral vaccine)

TREAMENT

General Management

Supportive measures such as adequate rest, tepid bath and sponging, appropriate nutrition and diet, all are important in the management of typhoid fever.

Anti-microbial therapy

There are many medicines to treat typhoid fever but without consultation with your family physician, you cannot use any antibiotics. If you have high-grade fever since 7 to 10 days without any relief in symptoms please consult your family physician for proper treatment

Dr. Amin I Bayad

(BHMS)

   

  

MEASLES : CAUSES, SYMPTOMS AND TREATMENT

MEASLES

DEFINATION: - Measles is highly contagious acute respiratory viral disease with a characteristic clinical picture, rash and a pathognomonic enanthem KOPLIK’S SPOT

CAUSES:-

Measles is a highly contagious illness caused by a virus that replicates in the nose and throat of an infected child or adult. Then, when someone with measles coughs, sneezes or talks, infected droplets spray into the air, where other people can inhale them.

The infected droplets may also land on a surface, where they remain active and contagious for several hours. You can contract the virus by putting your fingers in your mouth or nose or rubbing your eyes after touching the infected surface.

SYMPTOMS:-

The sing and symptoms of measles are appear around 10 to 14 days  after exposure to measles virus

·        Fever

·        Dry cough

·        Runny nose

·        Sore throat

·        Inflamed eyes (conjunctivitis)

·        Tiny white spots with bluish-white centers on a red background found inside the mouth on the inner lining of the cheek — also called Koplik's spots( as seen in picture)

·        A skin rash made up of large, flat blotches that often flow into one another

RISK FACTOR INCLUDE:-

UNVACCINATED: - If you haven’t received vaccines than you’re much more like to develop a disease. 

Traveling to internationally: - In developing country measles is common so if you travel to developing country than there is higher chance to catching the disease.

Vitamin A deficiency: - you are more likely to have more severed sing and symptoms if you don’t have enough vitamin A in your diet.

COMPLICATION:-

Ear Infection: - most common infection of measles is ear infection

Inflammation: - Measles may leads to inflammation of voice box(larynx)

Pneumonia: - Is common complication of measles that is some time fatal

Encephalitis: - encephalitis may occur right after measles. In about 1 into 1000 people may develop inflammation of brain.

Pregnancy problem: - If you're pregnant, you need to take special care to avoid measles because the disease can cause preterm labor, low birth weight and maternal death.

 PREVENTION: -

In 2011, 6.7 million did not receive measles vaccine in India. This could be the cause of measles outbreaks that leads to registered 29,339 measles case in India. But measles not restricted to children, adult too can develop measles.  

VACCINATION:- Routine measles vaccination for children, combined mass immunisation campaigns in country with low routine coverage, are key public strategy to reduce global measles death.

MR Vaccination program by INDIA

India, along with ten other WHO South East Asia Region member countries, have resolved to eliminate measles and control rubella/congenital rubella syndrome (CRS) by 2020. In this direction, Ministry of Health & Family Welfare has initiated measles-rubella (MR) vaccination campaign in the age group of 9 months to less than 15 years in a phased manner across the nation. The campaign aims to cover approximately 41 crore children.

The Measles-Rubella campaign is a part of global efforts to reduce illness and deaths due to measles and rubella/CRS in the country. Measles immunization directly contributes to the reduction of under-five child mortality, and in combination with rubella vaccine, it will control rubella and prevent CRS.

All children from 9 months to less than 15 years of age will be given a single shot of Measles-Rubella (MR) vaccination during the campaign. Following the campaign, MR vaccine will become a part of routine immunization and will replace measles vaccine, currently given at 9-12 months and 16-24 months of age of child.

For those children who have already received such vaccination, the campaign dose would provide additional boosting to them.

DR. AMIN I BAYAD

(BHMS)