Typhoid fever


By DR YLM
  • Health
  • Sunday, 26 Jan 2003

By DR YLM

The most common source of typhoid is polluted water.

NOW that recent news articles about typhoid have surfaced again, I’m getting a little spooked out by the food that I eat outdoors. What is typhoid?  

Typhoid is an infectious disease caused by the bacteria called Salmonella typhi. It spreads when you eat food or drink water contaminated by this bug.  

Oh, you mean it’s the same as a case of salmonella?  

There are lots of salmonella bacteria. They all belong in the same family. They all cause different variations of infection. For example, there’s Salmonella typhi and Salmonella paratyphi, Salmonella choleraesuis and Salmonella enteritidis. They usually result in disease only when there is poor hygiene and overcrowding. The clinical manifestations of these range from food poisoning to severe diarrhoea and dysentery. Typhoid is what happens when S. typhi infects your body.  

What has typhoid got to do then with Typhoid Mary? Did she start it? Is she a woman in the first place?  

She certainly is! It would be pretty bad karma if one were to name a ship Typhoid Mary. Scholars believe that the first typhoid outbreak was documented in Virginia, US, killing over 6,000 settlers between 1607 and 1624.  

Probably, many outbreaks have occurred before then, but the world was still in the dark ages and documentation was questionable. Typhoid Mary was the best known carrier of the disease, but no ? typhoid started long before her.  

Her real name was actually Mary Mallon. She was a cook in New York in 1906. She is believed to have infected 53 people, five of whom died. After being identified as a carrier, she was detained for three years. They released her on the promise that she would never again handle food. But nope, five years later, she spread typhoid to 25 other people again.  

How would I know if I have typhoid?  

Well, there is an incubation period of 10 to 14 days. Then it starts with a headache. After that, the fever sets in. In classical typhoid, the fever comes on and off (remittant), but increases in a step-ladder severity over the next three to four days. Along with that, you may get vague non-specific symptoms like a cough, sore throat and constipation.  

In the typical typhoid case, you get constipation for the first week and then diarrhoea late in the disease. In the first week, your heart rate may also be pretty slow compared with the severity of your fever.  

During the second week, there may be a typical rash on your abdomen and chest lasting for two to three days. These are called “rose spots” because of their pale red colour. If you press on them, they will blanch.  

In the third week, complications can set in. Very severe forms of typhoid have been reported with altered behaviour and meningitis. There may also be pneumonia, urinary tract infection, and your red blood cells may break apart (haemolyse). This happens because typhoid spreads throughout the whole body and its organs, and the body’s immune system is now trying to fight back. In the fourth week, there is a gradual return to health. Of course, not all cases are so classic. In many a case, the infected patient experiences only a few of these symptoms, especially with superior antibiotic care these days.  

This sounds horribly dangerous. Can one die of typhoid?  

With antibiotics, fatal cases are now reduced to less than 1%. In general, typhoid affects 17 million people worldwide. About 600,000 deaths occur, mostly due to the patients not getting the right therapy on time. This generally happens in places without proper sanitation.  

You mentioned typhoid is transmitted through food and water. The bacteria just swims in the water? How does it get there?  

Again, this is a contamination issue. The food and water has to be contaminated first by the faeces and urine of patients and carriers.  

The most common source of typhoid is polluted water. As for food, shellfish (just like in the case of Hepatitis A) taken from sewage-contaminated beds are a common source.  

If your vegetables have been fertilised by nightsoil and plucked to be eaten raw, this is another avenue. Basically, the advice is: “Boil it, cook it, peel it or forget it.”  

That’s why public water should always be chlorinated and cleaned. Human faeces must always be disposed of properly. And food handlers should always be advised to wash their hands after going to the toilet, and to use the cleanest methods possible in handling food.  

Typhoid Mary was a carrier. What’s this I keep hearing about carriers?  

These are people who carry the bacteria without showing symptoms of the disease.  

Some of them harbour the bacteria in their gallbladder for years, and keep on excreting them in their faeces. Some people who have recovered from typhoid may become carriers.  

Is there any hope?  

Of course there is. Antibiotics such as cloramphenicol, ciprofloxacin and ceftriaxone can be used. Carriers can also be cured by these antibiotics. There are some typhoid vaccines that confer protection. This would require frequent boosters every two to five years. 

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