There has been an outbreak of Typhoid Fever in some parts of Lusaka which has been making headlines recently.
Today I would like us to briefly tackle this subject and also compare it to Covid 19.I will try to answer the following questions. What is typhoid fever, how does it come about, what are some of its signs and symptoms, what are the complications if not treated and are there any similarities to Covid 19? How can the worst be prevented?
WHAT IS TYPHOID
FEVER?
Typhoid fever is a gastrointestinal infection caused by a bacteria called Salmonella enterica typhi . It is a serious health threat in the developing world, especially for children. The disease can be fatal if left untreated.
WHAT BRINGS IT ABOUT/HOW IS IT TRANSMITTED: THE 5 Fs
fecal-oral transmission route
The bacteria that causes typhoid, Salmonella typhi, mainly spreads through what is known as the fecal-oral route. This means the bacteria is passed in the feces and sometimes in the urine of infected people to the new hosts (the uninfected). If one eats food that has been handled by someone who has typhoid fever and who hasn’t washed carefully after using the toilet, one can become infected. The bacteria multiply in the intestinal tract and can spread to the bloodstream. Paratyphoid fever, a similar illness, is caused by Salmonella enterica paratyphi A, B, and C.
In most developing countries Zambia inclusive, most people become infected by drinking contaminated water. The water is usually contaminated as result of communication between the sewer system and source of water. This is common in settlement areas especially high density areas where the people build houses without proper planning from local authority. The infection may also spread through contaminated food and through direct contact with someone who is infected.
. The 5 Fs (feces, fingers, flies, fields, fluids, food), show pathways of fecal–oral disease transmission.
SIGNS AND SYMPTOMS
The signs and symptoms for typhoid fever can be grouped in early and late. These tend to develop gradually often appearing one to three weeks after exposure to the disease. Depending on the virulence of the infection symptoms can range from mild to severe. The illness is characterized by extreme fatigue and increasing fever. Other symptoms include headache, lack of appetite, malaise, and an enlarged liver. Sometimes patients have diarrhea, constipation, or a rash on their trunk. Severe symptoms may appear 2 to 3 weeks after onset of the illness and may include intestinal hemorrhage or perforation. In some people, signs and symptoms may return up to two weeks after the fever has subsided.
signs and symptoms earlier in the illness
• fever that starts low and increases daily, possibly reaching as high as 40.5 C / 104.9 F)
• headache
• weakness and fatigue
• muscle aches
• sweating
• dry cough
• loss of appetite and weight loss
• stomach pain
• diarrhea or constipation
• rash
• extremely swollen stomach
• enlarged liver.
later illness
Without treatment, one may:
• become delirious
• lie motionless and exhausted with the eyes half-closed in what’s known as the “typhoid state”.
The life-threatening complications often develop at this time.
SIMILARITES WITH
COVID-19
As you may know by now, Covid 19 comes in many ways, although the most common is respiratory there are other forms such the gastrointestinal (gi) presentation and others. And it is this rare form of Covid that may mimic Covid 19. My first and rare patient with gi presentation of Covid 19 was on a 17 year old boy in the early months of isolation at levy Covid center in May 2020. Levy was then the only Covid center in the country.
The boy came in presenting with a fever, diarrhea, vomiting, loss appetite and signs of dehydration. All the tests were done but were negative, including typhoid .The only test that was positive was for Covid 19.
TREATMENT AND
VACCINES.
Unlike Covid 19 ,typhoid has treatment. It can be treated by some antibiotics like ciprofloxacin and fluid replacement. Please note due to their continued abuse, the antibiotic resistance to Salmonella typhii is increasing worldwide. There is also surgical intervention in case of intestinal complications were the intestines are perforated. Most people who have typhoid fever feel better a few days after they start antibiotic treatment, but a small number of them may die of complications. Vaccines are available against typhoid though are less effective.
COMPLICATIONS
Typhoid fever can complicate in very serious and life threatening conditions of which without immediate medical intervention can be fatal.
Intestinal bleeding or perforation ( holes).
There could be intestinal bleeding or perforations (holes ) in the affected intestine .This is the most serious complications of typhoid fever and one of the most common. These complications usually develop in the third week of illness.
In the event where the small or large intestines develop a hole, the contents from the intestine leak into the stomach and can cause severe stomach pain, nausea, vomiting and bloodstream infection (sepsis).
This life-threatening complication requires immediate medical intervention.
Other possible complications(less common)
• could be complications that may affect the heart muscle and valves such as myocarditis and endocarditis
• infection of major blood vessels
• can complicate into pneumonia
• can lead to kidney or bladder infections
• can lead to meningitis which is the infection and inflammation of the membranes and fluid surrounding your brain and spinal cord
• can also lead to mental health problems such as delirium, hallucinations and paranoid psychosis
With quick treatment, most people recover from typhoid fever. However, without or delayed treatment, some people may not survive complications of the disease. So please don’t hesitate to sick medical help as soon as you notice the above symptoms .But the best is to prevent the infection in the first place.
TYPHOID CARRIERS
Typhoid is sometimes a complicated disease to completely eradicate. This is because even after antibiotic treatment, a small number of people who recover from the disease continue to harbor the bacteria. These people no longer have signs or symptoms of the disease themselves. They are known as chronic carriers.
Sad enough these carriers still shed off the bacteria in their feces and are capable of infecting others. A well documented case is that of Mary Mallon famously known as “Typhoid Mary” who is alleged to have infected 53 people with Typhoid 3 died whilst working as a maid. This was between 1900 to 1907 in New York, USA.
PLEASE LET US AVOID THE “TRIPLE TROUBLE”
The fact there is typhoid outbreak is evident enough that the hygiene levels are way below par in some parts of Lusaka. The poor hygiene led to contamination of drinking water with human excreta. This should be a strong warning that if people don’t change their way of doing things, eating habits, disposal of waste etcetera, we risk having an outbreak of Cholera in forthcoming rainy season.
And then with the same poor hygiene habit will favour the spread of Covid 19 which will be “triple trouble” .I don’t want to wake up to such a terrible reality because that would be difficult or impossible to handle. Typhoid vaccines also require repeated doses over time due to waning immunity. Since Vaccines against typhoid fever are only partially effective, adherence to public health measures is key in prevention.
Please let us improve on our hygiene standards. Please strive to drink clean water (boil or chlorinate it), build toilets in designated places and make proper use of them, try to always mask up and indeed get vaccinated.
ONE ZAMBIA, ONE NATION, UNTIL THEN ALUTA CONTINUA.
