TYPHOID

Typhoid fever : Typhoid fever is an acute infections disease caused by Salmonella typhi.
Mode of transmission : Faeco oral route or urine oro route.
Incubation period : 10 days to 15 days and with a range of 5 days to 3 weeks
Clinical manifestations
- Continuous fever for 3 to 4 weeks associated with chills and high fever. The fever ascends in a step ladder fashion.
- During the prodormal stage there is malaise, headache, cough and sore throat, often with abdominal pain, constipation, especially in early stage or pea soup diarrhoea.
- Urine and stool culture is positive for salmonella.
- In the later phase spleenomegaly, abdominal distension and tenderness, relative bradycardia, dicrotic pulse.
- The rash (rose spots) commonly appears during the second week of disease.
Complications : Complications occur in about 30 percent of untreated cases. Intestinal haemorrhage is manifested by a sudden drop in temperature and signs of shock followed by dark or fresh blood in the stool. Intestinal perforation is most likely to occur in the third week.
Less frequent complications are urinary retention, pneumonia, thrombophlebitis, myocarditis, psychosis, cholecystitis, Nephritis and osteomyelitis.
Treatment
The drugs of choice for treatment of typhoid fever are chloramphenicol, ampicillin, amoxicillin and trimethoprim – sulfamethoxazole can be given in divided doses according to physician’s level.
Plenty of water to be given and bland and easily digestible diet to be given.
Control Measures
1. Control of reservoir
2. Control of sanitation
3. Immunization
1. Control of reservoir
i. Early Diagnosis : Stools are important investigations in the diagnosis of cases.
ii. Notification : This should be done where such notification is mandatory.
iii. Isolation : Since typhoid fever is infectious and has a prolonged course, cases should be isolated till three bacteriologically negative stools and urine reports.
iv. Disinfection : Stools and urine are the sole sources of infection. They should be received in closed containers and disinfected with 5% cresol for at least 2 hours.
All soiled clothes and linen should be soaked in 2% chlorine solution and steam sterilized.
All health care providers should disinfect their hands, follow-up examination of stools and urine should be done for typhoid 3 to 4 months.
Carriers should be identified by cultured and serological examination. All carriers  should be given an intensive course of ampicillin or amoxicillin (4-6 gms/day) together with probenecid (2g/day) for 6 weeks. The carriers should be kept under surveillance. They should be prevented from handling food, milk or water for others. Health education regarding washing of hands with soap, after defecation or urination and before preparing food is an essential.
2. Control of sanitation
Protection and purification of drinking water supplies, improvement of basic sanitation and promotion of food hygiene.
3. Immunization
Polysaccharide is given in single dose subcutaneous or intra muscular. Protection reach 28 days after infection. Live oral Ty21 a vaccine capsule is administered on days 1, 3 and 5 irrespective of age, one hour before a meal with cold or lukewarm milk or water. Protection commences 2 weeks after taking the last capsule and lasts for atleast 3 years.