Death by Thphoid

Typhoid is known as enteric fever. It is an acute infection of the intestine. It is characterized by persistent fever, slow pulse, and abdominal tenderness. It is the most common in Kathmandu and other rural parts of the country. It is highly communicable disease. The people suffer from heavy loss of manpower.

Causative organism

This illness is caused by bacterium named Salmonella typhi. It is a rod shaped motile, gram-negative bacillus bacterium. It measures 1.0 to 1.5 μm in length. This bacterium affects human intestine.

Mode of infection

Typhoid is transmitted through contaminated food and water. It is also spread by intestinal discharges. Any person carrying Salmonella typhi in his intestinal tract can also spread the disease to others even though the person himself may not be suffering from the disease. These are healthy carriers. Flies also play role in transmitting bacteria.

Incubation period

The incubation period is 2 weeks on an average.

Symptoms

It is characterized by following symptoms:

Classically, the course of untreated typhoid fever is divided into four individual stages, each lasting approximately 1 week.

First week:

In the first week, there is slowly rising temperature with relative Bradycardia, malaisc, headache and cough. Epitaxis is seen in a quarter of cases and abdominal pain is also possible. There is Leukopenia with Eosinypenia and relative Lymphocytosis, a positive diazo reaction and blood cultures are positive for Salmonella typhi or paratyphi. The classic widal test is negative in the first week.

Second week:

In the second week of the infection, the patient lies prostrated with high fever in plateau around 40⁰C and bradycardia (Sphygmo-thermic dissociation), classically with a dicrotic pulse wave. Delirium is frequent, frequently calm, but sometimes agitated. This delirium gives to typhoid the nickname of “nervous fever”. Rose spots appear on the lowest chest and abdomen in around 1/3 patients. There are rhonchi in lung bases. The abdomen is distended and painful in the right lower quardant where sound can be heard. Diarrhea can occur in this stage: six to eight in a day, green with a characteristic smell, comparable to pea-soup. However, constipation is also frequent. The spleen and liver are enlarged (hepatosplenomegaly) and tender and there is elevant of licer transa minases. The Widal reaction is strongly positive with antiO and antiH antibobies. Blood cultures are sometimes still positive at this stage.

Third week:

In the third week of typhoid fever a number of complications can occur:

• Intestinal hemorrhage due to bleeding in congested peyer patches; this can be very serious but is usually non-fatal.

• Intestinal perforation in distal ileum: this is a very serious complication and is frequently fatal. It may occur without alarming symptoms until septicaemia or diffuse peritonitis sets in.

The fever is still very high and oscillates very little over 24 hours. Dehydration ensues and the patient is delirious (typhoid state). By the end of third week defervescence commences that prolongs itself in the fourth week.

Control

Antibiotics effective in enteric fever are:

Preventive measures

i. Proper sanitation (Health education)

ii. Personnel cleanliness

iii. Sanitary disposal of human excreta

iv. Protection and purification of water

v. Immunization against typhoid (TAB) vaccine.

Some famous person who suffered this disease

•William Wallace Lincoln, third son of President Abraham Lincoln and Mary Todd Lincoln

• President John Adams’s wife Abigail Adams

• Alexander the Great (Typhoid is one of many possibilities of his cause of death)