Typhoid fever is the infectious disease, the pathogen of which is bacillus containing endotoxin. Long time they can persist in water, sewage, various foods, on the surface of vegetables, fruit, intensely multiply in milk. Emedicine cites:
“Salmonella typhi has been a major human pathogen for
thousands of years, thriving in conditions of poor
sanitation, crowding, and social chaos. It may have
responsible for the Great Plague of Athens at the end of
the Pelopennesian War. The name S. typhi is derived from
the ancient Greek typhos, an ethereal smoke or cloud that
was believed to cause disease and madness. In the advanced
stages of typhoid fever, the patient’s level of
consciousness is truly clouded…”
The source of infection is sick, convalescent man and bacteria carrier. Excreted with excrements pathogens infect the subjects of environment, water and food. The pathogen gets into the organism through the mouth from dirty hands, unboiled water of open reservoirs and wells, or raw milk etc.
In digestive tract the pathogen implements into the lymphatic formations of small intestine, leading to swelling and formation of deep ulcers. Typhoid bacteria penetrate to the blood flow and circulate up to the end of hectic period. As a result of bacteriemia the pathogen gets into the various organs and tissues, affects cardiovascular and nervous system by the influence of endotoxins.
The incubation period lasts 10-14 days. The beginning of the disease in most cases is gradual. In the early phase there are such symptoms: general weakness, indisposition, loss of appetite, headache, poor sleep. This is the premonitory period continuing for 1-2 days. Then the temperature rises gradually, reaching by the 5-7-th days 38,5-39,5°C. The temperature stays at this level for 2-3 weeks. The temperature curve often becomes wavy.
On the 3rd and 4th days of illness the patient is pale, indifferent to the surrounding, adynamic. The skin is dry and hot. In lungs there are single dry rales. Pulse is rapid, heart sounds are muted, blood pressure decreases.
At the end of the 1st week of illness the tongue is thickened, has white fur, visible teeth marks on the lateral surface. Abdomen is swelled. Stool is slowed, liver and spleen are enlarged. The skin of abdomen, chest is covered with pink round spots (roseola), 3-4 mm in diameter. Gradually headache and insomnia continue increasing.
Without treatment a lot of complications appear on the 3rd week (intestinal bleeding, ulcer perforation). After the 4th week of disease the temperature has lower daily fluctuations, and then becomes normal, the period of recovery begins. But later on the relapse is possible.
In order to diagnose the disease it is necessary to take into account patient’s anamnesis, epidemiological data, but the results of laboratory examination play the primary role. The most important analysis is the determination of pathogen in blood and bacterial
All patients are subject to compulsory hospitalization, an should be on strict bed rest. The diet should be mechanically and chemically gentle. But undoubtedly the main treatment is represented by drugs, especially antibiotics. Wikipedia, the free encyclopedia reads about it:
“Typhoid fever in most cases is not fatal. Antibiotics,
such as ampicillin, chloramphenicol, trimethoprim-
sulfamethoxazole, Amoxicillin and ciprofloxacin, have been
commonly used to treat typhoid fever in developed
countries. Prompt treatment of the disease with antibiotics
reduces the case-fatality rate to approximately 1%.”
Bu the most important thing is the prevention of the disease. This is early diagnostics and hospitalization of patients, disinfection of the pesthole. Feces and vomit masses must be neutralized, disinfected before running into the sewerage system or a dumb well. Patient’s dirty underwear must be presoaked in some anti-infective agent, for example chloramines before its boiling. The personnel of the infection department should strictly keep to the requirements of disinfection after the examination, caring out various procedures, feeding and taking care of the patient.
It is necessary to maintain good sanitary condition of populated areas, to ensure proper water supply and sewer system, to carry out sanitary and educational work directed to the development of health care skills among the population. Healthy people, who had close contact with typhoid fever patient, must be under medical observation during 25 days with mandatory daily temperature measurement, a single analysis of faeces and urine for typhoid bacteria. When at least minor symptoms of the disease are observed the man should be hospitalized in the infectious department. Chronic bacteria carriers are subjected to systematic observation.
But in order to avoid such a disease it is possible to preserve the organism from it. Vaccination is the only way out. It is vitally important at the yearly ages for children as well as for adults who are going to visit countries, where typhoid fever is still widely spread. The examples of such vaccines are Ty21a (Vivotif Berna, Swiss Serum and Vaccine Institute) and ViCPS (Typhim Vi, Pasteur Merieux) represented by injections and capsules, rather easy in use under doctor’s control.
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