Illnesses

TYPHOID FEVER
[From The Centers for Disease Control; www.cdc.gov] "Typhoid fever is a life-threatening illness caused by the bacterium Salmonella Typhi. In the United States, it is estimated that approximately 5,700 cases occur annually.  Most cases (up to 75%) are acquired while traveling internationally. Typhoid fever is still common in the developing world, where it affects about 21.5 million persons each year.
          Salmonella Typhi lives only in humans. Persons with typhoid fever carry the bacteria in their bloodstream and intestinal tract. In addition, a small number of persons, called carriers, recover from typhoid fever but continue to carry the bacteria. Both ill persons and carriers shed Salmonella Typhi in their feces (stool).
          The symptoms of typhoid fever usually develop one to two weeks after a person becomes infected with the Salmonella typhi bacteria. If typhoid fever is not treated, the symptoms will develop over four weeks, with new symptoms appearing each week. With treatment, the symptoms should quickly improve within three to five days."

[From The National Health Service; www.nhs.uk] The first week: Symptoms of typhoid fever during the first week of infection include: (1) a high temperature (fever) that can reach 103–104F, which usually increases throughout the day before falling the following morning; (2) abdominal pain; (3) constipation or diarrhea - adults tend to get constipation and children tend to get diarrhea; (4) vomiting – this usually affects children rather than adults; (5) a dry cough; (6) a dull headache that can be felt at the front of the head; (7) severe mental confusion, such as not knowing where you are or what is going on around you; (8) a skin rash made up of pink spots that are 1–4cm wide – there are usually fewer than five spots; (9) a feeling of being increasingly very unwell.

The second week: In the unlikely event that you do not get treatment, the symptoms above will become more severe in the second week. You may also have:a swollen abdomen; a slow heartbeat.

The third week: During the third week, the symptoms of typhoid fever include: (1) loss of appetite; (2) weight loss; (3) physical exhaustion; (4) bouts of foul-smelling, yellow–green, watery diarrhea; (5) severe swelling of the abdomen; (6) rapid breathing; (7) a deterioration of your mental state, such as severe confusion, apathy and, in some cases, psychosis (where a person is unable to tell the difference between reality and their imagination),

Complications caused by typhoid fever usually only occur in people who have not been treated with antibiotics. In such cases, about 1 in 10 people will experience complications, which usually develop during the third week of infection. The two most common complications that can occur in untreated typhoid fever are: (1) internal bleeding in the digestive system; (2) perforation (splitting) of a section of the digestive system or bowel, which spreads the infection to nearby tissue

Internal bleeding - Most internal bleeding that occurs in typhoid fever is not life threatening, but it can make you feel very unwell. Symptoms include: (1) feeling tired all the time; (2) breathlessness; (3) pale skin; (4) irregular heartbeat; (5) vomiting blood; (6) passing stools that are very dark or tar-like. A blood transfusion may be required to replace any lost blood, and surgery can be used to repair the site of the bleeding.

Perforation - Perforation is potentially a very serious complication. This is because bacteria that live in your digestive system can move into your stomach and infect the lining of your abdomen (the peritoneum). This is known as peritonitis.

Peritonitis is a medical emergency because tissue of the peritoneum is usually sterile and germ-free. Unlike other parts of the body, such as the skin, the peritoneum does not have an inbuilt defence mechanism for fighting infection.

In cases of peritonitis, an infection can rapidly spread into the blood (sepsis) before spreading to other organs. This carries the risk of multiple organ failure and, if it is not treated, death. The most common symptom of peritonitis is sudden abdominal pain that gets progressively worse.

Peritonitis requires admission to hospital where you will be treated with injections of antibiotics to get rid of the infection. Surgery will then be used to seal the hole in your stomach wall.