When food poisoning causes a high fever

Children under the age of five are more vulnerable to developing severe disease and complications from salmonella. — Positive Parenting

You may not be familiar with the bacteria called Salmonella typhi, but you probably have heard of typhoid fever.

As the name of the disease implies, a high fever is the signature symptom of the infection.

It is a bacterial disease that can easily occur when food or water supply become contaminated with this microorganism.

It can easily spread from person to person, commonly from anyone who handles food (e.g. cooks/chefs, restaurant/kitchen workers, caregivers, etc).

This is especially true if food handlers start working as soon as their symptoms have cleared, as the bacteria still remains active then and is therefore transmissible to others.

Although the authorities require food workers to be vaccinated against typhoid (and to have their vaccinations updated every three years), quite a number slip through administrative cracks.

These include, for instance, those operating small-scale food/drink businesses from home, as well as undocumented foreign workers.

Easy to miss

Salmonella is a pathogen that often causes food-related symptoms such as fever, headache, nausea, vomiting, intermittent constipation with diarrhoea, and abdominal cramps.

The word “salmonella” is actually used for both the bacteria and the disease it causes.

Most people refer to salmonella (the disease) as food poisoning, as the source of infection usually comes from food, with symptoms appearing within 12-72 hours.

Food poisoning by non-typhoid Salmonella species (i.e. not S. typhi) is seldom life-threatening for most healthy adults.

However, children below the age of five, the elderly and people with weakened/compromised immune systems face a higher risk of more severe symptoms or developing complications.

S. typhi is more dangerous as it is infectious and can affect the entire body.

During the incubation period, typhoid fever displays no signature signs or symptoms.

What is worse is that the signs and symptoms that appear later can be non-specific, making it easy to miss the diagnosis in the beginning.

As the disease progresses, some of the more common signs and symptoms include loss of appetite, feeling sick or unwell, having headaches and/or body aches, and possibly fever.

Some people may develop a rash.

Leaving it untreated may lead to a high fever (up to 40°C or higher that may last up to three weeks), abdominal pain, intestine perforation and disseminated blood infection.

It can also affect other organs in the body.

There is even a small chance (3-5%) that the patient becomes a carrier of typhoid.

Be wary of hygiene

As mentioned earlier, typhoid spreads through the unhygienic handling of food by an infected food handler.

Food or water sources can also be contaminated by direct or indirect contact with an infected person’s faeces.

Floods can further spread the disease.

Typhoid fever can also happen in urban areas.

There’s the abundance of roadside, “tepi longkang” (“by the drain”) and mamak stalls where many of us eat at or takeaway from without a second thought.

It’s in our best interest not to assume that they are clean and hygienic, especially if they have no access to running water, which makes it challenging for the operator to maintain proper hand hygiene or general cleanliness.

Other possible contaminated foods include shellfish that are caught from polluted waters, are undercooked or eaten raw (e.g. etak, cockles, kupang, clams and oysters); raw vegetables (e.g. lettuce and ulam); drinks and cold desserts prepared from unknown, contaminated water sources; and raw milk.

Therefore, it is important to avoid eating raw vegetables or fruits and iced drinks from questionable sources.

Eat only thoroughly cooked food and drink only boiled or bottled water, especially during reported outbreaks of foodborne illnesses like typhoid fever.

Hygiene is absolutely crucial, especially when it comes to food and drinks.

As an extra precaution, get vaccinated against typhoid fever if you live in, or plan to travel to, an area where typhoid is endemic, such as Kelantan (due to floods and poor rates of treated water usage), parts of northern/western Africa, most South Asian countries, parts of Indonesia and Peru.

Regardless of the length of your stay, this advice applies, whether it is for a local family foodie adventure or an overseas trip.

Datuk Dr Zulkifli Ismail is a consultant paediatrician and paediatric cardiologist. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners. For further information, please email [e-mail]. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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