Diarrhoea is NOT a common symptom of typhoid, the patients rather suffer from constipation.
So no diarrhoea does not mean, no typhoid.
The most
striking symptoms are the consistent high fever, the headache and the mental state of relative
lassitude. So it could be confused with malaria, but with abdominal discomfort.
I was in a
fortunate situation to not having to consider malaria when practicing in
Lesotho where we managed a typhoid outbreak with a 1000(!) cases in the
timespan of 6 weeks.
When
checking up on it I found a nice summary of clinical features:
"There is no group of signs which is characteristic, indeed it is
often the absence of signs in a patient who has had a fever for a few days, and
who looks ill, lies listless, speaks little, and likes to be left alone, which
suggests typhoid." With regards Aad
……………
I thought
I’d write to you advising you about our Typhoid
experience, since our son had it early on in the year and we always think
we are immune to these kinds of things!
Our son
suddenly fell ill and in a matter of minutes had excruciating chest pain,
shortness of breath, became delirious (from the fever) & couldn’t walk or
talk. I rushed him to AMI on Lanark Rd, and I must commend the staff on
their professionalism and excellent care. Once they stabilised him, they
began to run all sorts of tests and he tested positive for Typhoid. We
were very surprised with the results.
He was
discharged and sent home once the Dr was satisfied and was given oral treatment
to continue at home as they had already administered his first dose
intrevenously, to kick start the process. Our son is quite a tough boy
and never complains from pain and normally bounces back quickly. He slept
for the next 24 hours and then relapsed the following evening. I took him
to our GP first thing in the morning, who re-examined him, and sent him for
more tests and explained his symptoms in more detail - which was useful in
understanding what to expect and how to treat. It took him about three
weeks to recover and longer for his body to completely regain its strength.
The main things to be aware of;
1) Every
one is different and so in our son’s case he had no diarrhoea or vomiting.
2) High
Fever is classic symptom - to the point where it is impossible to control.
You have to do what ever works for the particular patient to keep the
temperature down, alternate ponstan & painstop (by now he had unbearable
headache & nausea so the painstop was effective) and bathing in tepid
water.
3) Keep
fluids up (try get them to sip rehydrate solution) because even if the patient
doesn’t have diarrhoea/vomiting they are becoming dehydrating from excessive
sweating/fever fits. If you at any time feel you cannot cope at home or
become concerned take them to hospital so that the temperature, pain and
dehydration can be treated more effectively and to ensure they don’t run the
risk of other complications.
4) His
spleen was enlarged and all his glands were enlarged and generally felt washed
out - so sleep is the best - he slept for days and days on end. I gave
him what ever he felt like eating, which was mostly dry toast and very light
food.
5) Its
important to go to a dr for check ups, Typhoid can affect certain organs, so
its best to ensure that there are no unnecessary complications.
6) Typhoid
bacteria requires aggressive treatment and even if the patient is feeling
better, it isn’t recommended for them to dive back into normal activities as it
is common for them to relapse. Once the treatment has been completed, the
patient should take a good course of probiotics and consider a course of vit B
injections as their immune system is depleted.
7) Follow
up tests with the necessary samples, to ensure the patient is no longer
carrying the bacteria.
Advice;
1) Wash
hands all the time and dry them properly. Bacteria can live for
upto 14 days on notes (money)!
2) Ensure
raw fruit & vegetables are washed with uncontaminated water
3) Ensure
cooked meals are prepared properly in sanitised area’s
4) Only
drink safe water, this includes ice!
5) Don’t
share bottles/cups/utensils
6) Try not
to use un-sanitised lavatories
There is no
need to become paranoid and cover yourself in gloves, spraying everything in
sight with antibacterial. Just be aware, take more care with hygiene,
trust your instincts and inform those around you. As mentioned before every patient is different, so not all
patients are required to be quarantined no one that had contact with our son
caught it from him.
TYPHOID
FEVER
Typhoid Fever is an acute disease caused by THE SALMONELLA
TYPHIMURIUM.
It is a generalised Infection, most important
features are ulcerations in the terminal portion of the small intestine.
PRINCIPAL SYMPTOMS
Common in developing countries
High Fever with a relatively slow pulse
A ROSE COLOURED ERUPTION with an enlarged spleen
Sweating and generalised aches and pains
Headaches and Diarrhoea
Poor appetite and stomach pains
ETIOLOGY: The typhoid Bacillus is a short, gram-negative,
rod shaped organism
It may live for extended periods of time outside of the
human body in water or in the soil.
It resists freezing but is destroyed by boiling water
The germ enters the body via the gastro-intestinal tract and
is discharged in the faeces and urine of patients with typhoid fever
When typhoid bacilli enters the body they are carried first
to the mesenteric lymph nodes and then to the thoracic duct through which
they enter the blood stream and are carried to all the tissues and organs of
the body.
The ultimate source of the TYPHUS BACILLI is the faeces and
urine of patients with typhoid fever or typhoid carriers.
Improper disposal of excreta allows the bacilli to get into
drinking water (ie from shallow wells, underground systems or streams),or into
or upon the soil where they may contaminate vegetables that are eaten.
Typhoid carriers who prepare food may transfer the bacilli
to milk or other articles of food.
Most large epidemics of Typhoid have been traced to
unhygienic water supplies, correct water purification has reduced the incidence
of typhoid; most cases, which occur in the larger cities, may be traced
to carrier, eating of raw veggies and fruits or seafood grown in
contaminated waters.
ATTENDANTS who nurse patients with Typhoid fever may
contract the disease as a result of handling the patients, bedclothes, bedpans
and urinals.
PATHOLOGY
The most important lesions of typhoid are found in the small
intestine.
Early in the disease, Payers patches and the solitary lymph
follicles of the ileum become red and swollen, due to the engorgement of the
vessels and the outpouring of monocyctic cells. Later the swollen regions
slough out, leaving ulcers of variable depth. These may bleed or may
penetrate entirely through the coats of the intestine. If the patient
recovers the ulcers heal without scar tissue.
Coincident with the changes in Payers patches, the
mesenteric lymph nodes become enlarged due to similar engorgement and
exudation. The spleen becomes enlarged, soft and greyish red.
Endothelial cells accumulate in other organs such as liver
and lung, to a lesser degree. Inflammation of liver and lung occurs in most
cases, pneumonia in some. Lesions also occur frequently in arteries and veins.
These may lead to haemorrhage from the nose or bronchi, or thrombosis of
the veins of legs and arms.
SYMPTOMS:
The incubation period is less than three weeks, in most
cases. The onset is fairly gradual, during the first week, accompanied by
malaise, frontal headaches, cough constipation or slight diarrhoea with
occasional nose bleeds.
By the end of the first week the temperature is usually high
with slight fluctuation; slow pulse, often diacritic ( i.e. one heart beat or
two arterial pulsations.)
Enlarged spleen, tender and distended abdomen, rose spots,
appearing on abdomen and chest, leucopaenia is present, WBC below five
thousand.
During the second and third week Temp remains high spots
tend to fade, the abdomen may become distended and in severe cases delirium
supervenes. \during these periods typhoid bacilli can be recovered from
urine and stool.
The blood usually gives positive agglutinations for the
typhoid bacilli by the end of the second week.
The temperature declines after the fourth week but can
continue unabated.
COMPLICATIONS
The most serious are haemorrhage and perforation. Nursing
staff would notice reddish brown or black stools restlessness, pallor,
rapid weak pulse, falling blood pressure
There would be severe abdominal pain, and shock
followed by abdominal tenderness, rigidity and signs of acute peritonitis.
Further complications are diarrhoea, pneumonia,
cholycystitis, thrombophlebitis,( mostly occurs in one of the femoral veins)
Relapse may occur after an apparent recovery, and further symptoms of typhoid
would be apparent.
TREATMENT
Chloromycetin is usually the antibiotic of choice. It
does not kill the organism but it inhibits the growth, therefore is
requires continuation for up to 10 days, followed by a reduced dose
for three to four weeks to prevent a relapse.
Supportive treatment consists entirely of nursing care and
diet. Rest should be nearly as absolute as possible.
Sufficient fluids should be given to keep the urinary output
above 1500cc.daily.
Should constipation occur avoid the use of strong laxatives.
Fats and fruit in the diet should be reduced, and reduction
of carbohydrates, should distention be noticed.
Should perforation occur, immediate surgery would be
necessary
Nurses in contact with typhoid patients need to be
particularly careful in the cleanliness of their hands. No nurse should fail to
take a “booster” injection every two years when dealing with these patients.
All patients should contact their General Practitioners for
investigations and treatment
All Borehole water requires investigation
All drinking should be boiled or thoroughly purified,
milk should be pasteurized or boiled.
People who Handle food should be screened to ensure they are
not carriers
TYPHOID has occurred in this country. People who visit
affected areas and do not take preventative measure against this disease are
likely to suffer with typhoid and will infect others in other areas.
WE need to be reminded to practice personal and
environmental hygiene at all times
Typhoid is spread from drinking water or food that is
contaminated. Flies can contribute to the spread of typhoid.
Vaccines should be available.
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