typhoid

Every year, approximately 20 million cases of typhoid fever, and its milder version paratyphoid, occur in World Health Organisation's South East Asia region, which includes India. This results in around a million deaths. The exact Indian statistics are unknown. Although the disease is supposed to be notified to relevant government health authorities when it occurs, this seldom happens. Our illnesses are treated by a plethora of private practitioners of various systems of medicine, with very little networking or government supervision.

This is in stark contrast to the US, which has around 400 cases annually (mostly imported). Even a century ago, the US public health system was very active and backed to the hilt by the police. In 1860, the US had an asymptomatic typhoid carrier nicknamed "typhoid Mary" (actual name: Mary Mallory). She worked in several places as a cook. She did not wash her hands frequently and consequently managed to infect several hundred people and kill 50. She was tracked down and quarantined for more than 20 years till her death. In India, cooks and other labour are unregulated. They do not undergo regular health checkups. Unauthorised food stalls dot the countryside. The servers seldom wear gloves, nor do they wash hands frequently.

Typhoid and paratyphoid bacteria are ingested with contaminated food and water. (Ice cream and cream cakes are notorious). It takes one to three weeks for the symptoms of fatigue, headache, loss of appetite, diarrhoea, a red rash and fever (which starts at around 100°F and then increases to 102°F-104°F) to appear. Complications like intestinal bleeding and perforation occur in the second or third week. (This accounts for the age-old habit of keeping people with fever on a soft and bland diet.)

A history of risk of infection and a gradual onset of fever that increases in severity raise the suspicion of typhoid or paratyphoid fever if the symptoms mentioned earlier are present. Infection with typhoid or paratyphoid fever causes very low-grade septicemia. A single blood culture is positive in only half the cases. Bone marrow culture is positive in about 80 per cent of the cases. Stool and urine cultures become positive later.

Popular tests like the Widal test are unreliable. It can be negative in up to 30 per cent of culture-proven cases of typhoid fever. It can give false positive results if the infection is due to other gram negative organisms, or malaria, typhus or medical conditions like liver cirrhosis. Two blood samples taken a week apart showing a rising Widal titer are more reliable. The newer "Typhidot" tests are more accurate, but need to be done a minimum of five days after the onset of the fever. This is to allow antibodies time to develop.

Typhoid can be treated with a wide range of newer antibiotics. Choloromycetin, the antibiotic widely used earlier, is not popular now as it not only has dangerous side effects but many typhoid bacteria are also resistant to it. Treatment should be continued for 10-14 days and not stopped when the patient is symptomatically better.

After apparent recovery, some people harbour typhoid bacteria in their gall bladder, intestines or kidney. They do not have fever, but continue to shed bacteria in their motion and urine. They are a danger to others as they spread the disease far and wide.

Typhoid can be prevented with immunisation. Both injectable and oral forms of vaccine are available and can be taken after the age of two. Vaccination has to be repeated every three years since immunity wanes after that time.

To protect yourself against food borne diseases like typhoid:

• Drink only boiled or bottled water.
• Do not put ice into drinks unless the ice is made from boiled or mineral water.
• If you eat street food, avoid raw fruits and vegetables
• Eat food that has been thoroughly cooked and is steaming hot

Immunise yourself and your family. The vaccine costs less than Rs 500.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in