Typhoid fever is caused by Salmonella typhi, the typhoid bacillus. At present, there are 107 different strains of the bacteria.
Typhoid fever is a water- and food borne infection which had come under control with antibiotic treatment but has recently developed resistant strains.
Typhoid fever is transmitted by food and water contaminated by the feces and urine of patients and carriers. Polluted water is the most common source of typhoid. In addition, shellfish taken from sewage contaminated beds, vegetables fertilized by nightsoil and eaten raw, contaminated milk and milk products have been shown as a source of infection.
Typhoid fever is characterized by the sudden onset of sustained fever, severe headache, nausea, severe loss of appetite, constipation or sometimes diarrhoea.
Severe forms have been described with mental dullness and meningitis. Case-fatality rates of 10% can be reduced to less than 1% with appropriate antibiotic therapy.
INCIDENCE AND DISTRIBUTION
Typhoid fever affects 17 million people worldwide every year, with approximately 600,000 deaths. The number of sporadic cases of typhoid fever has remained relatively constant in the industrialized world, and with the advent of proper sanitary facilities, has been virtually eliminated in many areas. Most cases in developed countries are imported from endemic countries. Strains resistant to chloramphenicol and other recommended antibiotics have become prevalent in several areas of the world. Multidrug resistant strains have been reported from Asia, the Middle East and Latin America.
Until 1948, little other than supportive measures could be offered the typhoid patient, but with the discovery of the antibiotic chloramphenicol, mortality was markedly reduced. Drug resistance began to emerge in the early 1970s in Mexico and Vietnam, and within a few years, 75% of all cases in Vietnam were resistant. In industrialized countries, the resistance rates are around 5% of all cases.
Protect and chlorinate public water supplies. Provide safe water supplies and avoid possible back flow connections between sewers and water supplies.
Dispose of human feces in a sanitary manner and maintain fly-proof latrines.
Use scrupulous cleanliness in food preparation and handling. Educate the public regarding the importance of hand washing: this is important for food handlers and attendants involved in the care of patients and/or children. Thorough and frequent hand washing is essential, especially after a bowel movement.
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