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Typhoid fever
Typhoid Fever
Typhoid fever can be taken as an index of general sanitation situation of any countryTyphoid fever is quite common health problem in our context. It is prevalent in all parts of the world where water supply and sanitation situation is sub-standard.

The disease is rare in developed countries where most of the cases that occur are either acquired abroad or imported by immigrants. In Nepal typhoid is one of the commonest endemic disease. Though studies are non-conclusive, it is the commonest cause of continuous high fever lasting for more than one week. 'Typhoid' is commonly used layman term for such continuous fever. Its incidence is around five to 15 in 1000 population in our part of the world.

Typhoid fever is the result of systemic infection mainly by Salmonella typhi, which is found only in man. It is a communicable disease and is transmitted through contaminated water, milk, food etc and houseflies are common causes of transmission whereas direct transmission from soiled hands contaminated with faeces or urine also plays significant role in our context. The typhoid bacteria can survive in water for seven days, whereas it can survive for more than a month in ice, ice-cream, milk and longest in wet soil and sewage.

So vegetables grown on sewage farms or washed in contaminated water are a positive health hazard. These factors are compounded by factors like pollution of drinking water supplies, open field defecation and urination, low standards of food and personal hygiene and ignorance about health. Typhoid fever, therefore should be regarded as an index of general sanitation situation of any country.

The disease may occur at any age but highest incidence is found in 5 to 20 year age group. In older age group, low incidence may be due to acquired immunity through the previous exposure.

It is clinically characterized by otherwise unexplained high grade continuous fever for two to four weeks, associated and generalized body ache, headache. Sometimes cough and constipation are also present. Appetite is grossly decreased and patient gets weaker soon after the beginning of illness. Joint pain and skin rashes can also occur. The disease might occur only in mild form also. Moreover, it may be present only in the carrier stage, i.e., the infected individual may not have any symptoms but can be a significant source of transmission to others. This is the most dangerous form of infection. The diversity of clinical presentation and the capacity of typhoid bacteria to survive in adverse environmental conditions is thus responsible for its higher incidence.

What to do?
When an individual has symptoms as mentioned above s/he has to consult a general physician. Clinical evaluation and examination of blood, stool and urine helps to establish the diagnosis. Early diagnosis should be the rule.

Mild cases can be treated by oral antibiotics, whereas serious cases or those resistant to oral antibiotics need to be admitted in hospitals. For complete cure, one has to continue antibiotic drugs in adequate doses and periods prescribed by a doctor. Urine or stool infected person should be properly disposed or disinfected. In carriers, the typhoid bacteria remain in silent form in gall bladder and becomes a constant source of infection to others. It can be identified by cultural and serological examinations. Prolonged medical examination should be instituted to carriers and sometimes surgical removal of gall bladder is carried out.

It is a commonly preventable disease and if untreated, most of the cases die within one to two months due to systemic infection and perforation of intestine. Improvement in sanitation indefinitely plays vital role in its prevention. Health education and general public awareness is equally important. Now different vaccines are under trial in prevention of typhoid fever.

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