Typhus

Typhus

Typhus has been known since the mid-16th century and has been researched more and more over the centuries. It is a disease that is still widespread around the world today and is mainly due to poor hygiene conditions. Around the world, around 20 million people contract typhus every year, and the disease is fatal for around 200,000.

What is typhoid?

The disease is mainly prevalent in developing countries and plays a minor role in Europe and North America. It is an infectious disease that manifests itself as fever and diarrhea. For what does the abbreviation cd stand for, please visit usvsukenglish.com.

It is transmitted by the “Salmonella Typhi” bacteria. During the incubation period (usually around 6-30 days), the pathogens penetrate the intestinal wall. They then enter the bloodstream via the lymphatic system and trigger the actual disease. The name of salmonella is derived from the ancient Greek word “typhos” which means “mist” or “mist”. This term was used because patients complained of a “foggy mental state.”

The name of the pathogen was officially changed over time to “Salmonella enterica ssp. enterica Serovar Typhi” was changed, whereby both designations are still used. The disease is also often referred to as “ typhus fever ”. A distinction is made between the actual “typhus abdominalis” (abdominal typhus or abdominal typhus) and a weaker form of the disease, the so-called ” paratyphoid fever “.

Causes

As already mentioned, the infection occurs through bacteria. After major typhoid epidemics at the beginning of the 20th century, research into the disease found that the bacteria were mainly transmitted “faecal-orally”. At that time, people’s awareness of hygiene was not very developed.

The bacterium was often spread through food and drinking water. A practical example of this is the poor or no separation of latrines from cooking areas, drinking water supply or storage. Furthermore, little importance was attached to washing hands. Intensive cleaning of hands after going to the toilet, before operations or in relation to kitchen hygiene only became mandatory after this knowledge.

These are also the reasons why typhus nowadays mainly occurs in poorer, so-called Third World countries that have poorer infrastructure. Direct human-to-human transmission is possible but very unlikely. The greatest risk of infection is through smear infections via food or water. Children up to the age of nine or people with a weakened immune system have an increased risk of infection.

Symptoms, Ailments & Signs

The most common symptoms of typhoid fever are headache, fever, lethargy and significant gastrointestinal problems. The course of the disease is basically divided into four stages, in which the symptoms sometimes vary.

In the early stages, the symptoms are often limited to the usual symptoms of a cold, such as a headache, aching limbs and a slightly elevated temperature. In the following stages, the fever intensifies and consolidates at a high level. In addition, there is an increase in gastrointestinal symptoms in the form of abdominal pain, constipation or diarrhea.

Patients often suffer from loss of appetite and listlessness or, in rare cases, even from disturbances of consciousness. A characteristic symptom during this period is a greyish coated tongue, which is called “typhoid tongue”. In the final, most complicated stage, the intestinal problems usually worsen and the general condition deteriorates due to dehydration and weight loss.

At this stage, a typical form of diarrhea occurs, the so-called “pea-like” diarrhea. With this, the patient excretes the pathogens bit by bit. There is therefore a high risk of infection at this time. A rather rare but extremely characteristic symptom are “roseols”. This is a reddish rash in the form of patches on the abdomen and upper body. In rare cases, swelling of the spleen occurs.

Complications

Complications during the untreated course of the disease cannot be ruled out, especially in the last two stages. The intestinal tract in particular is a major source of danger. Due to the heavy strain on this area (weakened by the pathogen nesting, diarrhea or constipation), there is an increased risk of intestinal bleeding or intestinal perforation ( intestinal perforation ).

The latter carries a high risk of a lethal outcome. Other complications that may occur are the formation of blood clots or thrombosis, inflammation of the bone marrow or heart muscle and meningitis (inflammation of the meninges). General damage to the muscle or bone system due to exhaustion cannot be ruled out either. Children under one year are a special risk group. Infected people in this age group often have complications despite treatment.

The “permanent excretors” represent a particular danger. Usually, a patient will excrete typhoid pathogens for up to 6 months after overcoming the disease (regardless of whether with or without treatment). “Permanent excretors” are people who usually excrete pathogens until the end of their lives without continuing to suffer from the disease themselves. This poses a constant threat of infection to oneself and others.

It occasionally happens that infected people become “permanent excretors” without ever developing symptoms of the disease themselves. According to studies by the World Health Organization (WHO), around three to five percent of those infected are “permanent excretors”.

When should you go to the doctor?

If a typhoid infection is suspected, it is of the utmost importance to consult a doctor immediately. It is irrelevant whether the suspicion of symptoms or possible infection is based on a trip to a particularly endangered country.

Treatment as early as possible is of enormous importance for the course of the disease. In this context, there is also the responsibility to observe towards fellow human beings, since it is a contagious disease. Normally, it is sufficient to see a family doctor. Should the consultation of a specialist become necessary in the course of the disease, a referral can be made.

This may be necessary in the event of the aforementioned complications. As already mentioned, children under the age of one year represent a special risk group. In such a case, the initial consultation of a specialist in this disease in children is recommended.

diagnosis

Diagnosis is initially difficult in the early stages of infection. The symptoms are initially similar to harmless illnesses such as a cold, ordinary fever or gastrointestinal infections. When the first symptoms appear, it is therefore extremely important to inform the doctor treating you that you may have traveled to one of the aforementioned countries in the past.

With this information and the resulting suspicion of typhoid disease, therapeutic measures can be taken at an early stage. Otherwise, an initial misdiagnosis cannot be ruled out. Typhoid is mainly diagnosed by detecting the pathogen in the blood.

However, this is only possible after the incubation period and the penetration of the pathogen into the bloodstream. In the later course of the disease, when the bacteria begin to be excreted in the stool, they can also be detected by examining the stool. At the beginning of the incubation period, a reduced number of leukocytes (white blood cells) can occur and be an indication of an infection.

Treatment & Therapy

Basically, typhoid fever is treated with an antibiotic. In the past few decades, however, the pathogen has become resistant to certain drugs, some of which is very strong. Therefore, new active ingredients are constantly being developed and used nowadays.

Aside from the medication, patients are advised to drink enough fluids to speed up the excretion of the pathogen. You should refrain from taking anti-diarrhoeal medication, as this makes it much more difficult for the bacteria to be excreted.

A special feature of the treatment are the “permanent excretors”. The pathogens often settle in the gallbladder in these people. If antibiotics do not help in such a case, surgical removal of the gallbladder must be considered.

Outlook & Forecast

In Europe, North America and other countries with good medical care, the prognosis for typhoid fever is very good. With early and correct drug treatment, the mortality rate is less than one percent. In this case, the disease progresses with little or no complication.

Consequential or long-term damage only occurs in the rarest of cases. Without appropriate treatment, the prognosis is much worse. There is a risk of the aforementioned complications and their consequences occurring. It should also be noted that “permanent excretors” without treatment represent a long-term risk of infection for fellow human beings. The mortality rate in these cases increases significantly, up to twenty percent.

Prevention

In principle, typhoid infection can occur anywhere, so everyone is exposed to a certain risk. Vaccination is a preventive measure. This can be done either orally as a swallow vaccination or in the form of an injection. The oral vaccine is a live vaccine.

Weakened forms of the bacteria are introduced here, which counteract the actual pathogen in the event of an infection. The second variant contains an inactivated vaccine, which mainly consists of dead cell parts of the bacteria, which serve to fight an infection. Both variants do not offer guaranteed protection.

About sixty percent of vaccinated people have been shown to be protected. This usually lasts for a period of one year. Vaccination is particularly useful when traveling to regions with poor hygiene. These include Asia, India, parts of South America and North Africa. During such a trip, increased care with regard to hygiene can have a preventive effect.

These include measures such as regular, thorough hand washing, boiling drinking water and not eating raw food. However, by observing these behaviors, the risk of infection cannot be ruled out, it can only be reduced.

Aftercare

Follow-up care for typhoid fever includes a physical exam and an interview with the doctor. As part of the aftercare, the symptoms are examined again. Above all, the fever and the typical drowsiness must be clarified. If necessary, the patient can prescribe medication or refer the patient to a specialist.

If the course is positive, the disease should have subsided after a few weeks. After the follow-up care, the patient can be discharged. After contracting typhoid, the patient is immune for about a year. After this year is over, a medical check-up should be used again. The same applies if the patient was exposed to a high dose of the pathogen.

A blood test provides information about whether there are still pathogens in the blood. In the case of chronic diseases, a stool or urine sample can suffice as proof. If a chronic disease is suspected, an examination of the bone marrow can also be carried out, since the causative agents of typhoid and paratyphoid can still be found in the bone marrow for weeks or months after recovery. The family doctor or an internist takes care of aftercare for typhus. If symptoms persist, hospitalization is indicated.

You can do that yourself

Typhoid and paratyphoid are serious diseases that require medical attention. If the typical typhoid symptoms occur on vacation or during a trip abroad, it is advisable to interrupt the trip. The disease should be treated in Germany by an internist or general practitioner.

The pathogens are treated with antibiotics. When taking the medication, the prescribed time intervals must be strictly observed. The medication should be continued to the end, even if the patient recovers early. In order to avoid interactions, the doctor must be informed about any illnesses and the intake of other medications. In addition, general measures such as rest and protection apply. Because the pathogens can settle in the gallbladder, attention must also be paid to noticeable symptoms that can persist beyond the actual disease.

Diet should be changed. It is best for typhoid and paratyphoid patients to avoid raw and undercooked or sufficiently heated food. Patients with typhoid should also drink plenty of fluids. The electrolyte balance is balanced with isotonic drinks and a diet rich in vitamins and minerals. In order to avoid transmission of the pathogens to contact persons, good personal hygiene is also important. The doctor in charge can provide further tips and information on typhoid self-help.

Typhus