Notes on clinical findings, mode of transmission and treatment of Typhoid Fever

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Definition:

It is an infectious disease caused by a nitro-organist called typhoid bacillus. It is characterized clinically by a prolonged fever with involvement of lymphoid tissues an; considerable constitutional it disturbances.

Mode of Transmission:

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The Typhoid bacilli are present in large number in the urine and stools of the patient. It is conveyed to head the persons in food or water, contaminated by it. The bacilli are also present in the intestine, gall bladder an urinary organs of the persons, those who have recovered from the disease and may contaminate food or drink by handling it, the fly plays an important part in spreading the infection. It carries the germs and discharges them ob food in its excreta and vomit.

Nurses and sick attendant who are not careful in cleaning their hands run the risk of catching it. The bacilli can remain active outside the bog for a long time and grow readily in food, milk and fresh Salt water. The disease is prevalent in all the countries the world but is more common where sanitary arrangement as regards water supply and disposal of sewage are not satisfaction factory. One attack, as a rule, gives immunity for life- Incubation Period:

The incubation period of typhoid fever is 14 but in some cases may be as short as 5 and as long as 21 days.

Clinical Features:

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The onset of the disease is gradual and the patient does not feel sufficiently ill for the first 4 to 5 days. A dull headache, lassitude, incapacity for much physical or mental work, loss of appetite and aching of the limbs and back are present from the beginning which slowly increase and compel the patient to take to bed. In some cases, there is bleeding from the nose.

The temperature shows a rise of 1 to 2 degrees in the evening and a slight fall in the morning and it reaches 103 or 104 degrees in a week’s time and remains for some days. Constipation which is present in the beginning gives place to diarrhea. The stools are watery, grayish brown in color and called “Pea-soup” stools of typhoid. The pulse rate becomes low being about 100 per minute. Sudden rise in pulse rate will indicate the onset of some Complication such as bleeding from the bowels, pneumonia etc.

The tongue becomes dry and coated with a thick layer of dark fur in the middle, leaving the sides and the tip which are clear and pink red in color. The spleen gets enlarged and the abdomen distended and tender on pressure. By the time these symptoms are fully developed and the patient passes in to a state of prostration known as the Typhoid state.

Profound nervous depression is seen, which are tremors of the tongue, hesitating speech, twitch­ing of muscles and passing of the stool and urine in the bed. Sleeplessness is present from the beginning and is very troublesome.

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However, the typhoid fever does not always run the typical course described above. Instead of a gradual on set it may come on suddenly with chills and fever which does not follow the usual course. In infants and young children the early symptoms are vomiting, diarrhea or convulsions. In older children the disease usually runs a mild course. Prevention:

Isolation:

If a patient suffers or suspected to be suffered from typhoid, should be immediately transferred to the hospital. Because absolute bed rest, constant watch­ing and a careful nursing are essential for early recovery with minimum complications. The patient should not be allowed to move from the bed even to the latrine or urinal.

Treatment:

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The diet is a very important element in the treatment of typhoid. The following items may be included in the diet which should be varied from day to day: milk, fruit juice, plain water and barley, sago, thin- bread, biscuit, rice, eggs, chicken, butter etc. But the patient should be given liquid diet as long as the tempera­ture is above 100 degrees. The mouth and coated tongue should be cleaned several times during the day, particularly before feeding. At the time of rise of high temperature cold sponging, ice cap and head washing should be done. Chloromycetin is the drug of choice it is found to shorten the duration of the disease and prevents complications. It should be continued in a milder dose for a week, after the temperature is normal, as otherwise relapse is likely to take place.

Disinfection:

The infection of typhoid is conveyed in food and drinking water which are contaminated by the faucal -matter or urine of a patient or a carrier, and flies play an important role in spreading the infection. So the food and drink should be protected from flies. 1 he stools and urine passed by the patient should be immediately treated with some strong antiseptic lotion and kept under cover, better to be put under the soil

Inoculation:

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Every person visiting or residing in an; epidemic area and all the residents in the house should get themselves inoculated by TAB vaccine which is a triple vaccine for typhoid and paratyphoid—A and B, as soon as possible. The immunity lasts for two years and so. It can be given at any age upwards of 1 year.

Health Education:

All contacts should be instructed in matters of personal hygiene like proper hand washing with soap and water after toilet and after attending the patient or handling infected materials The people in rural areas should -be educated to stop open air defecation and to construct and use sanitary latrines The people should be taught how to preserve and prepare all foods in a proper way. Foods should be protected from flies and dusts by careful coverings.

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