Introduction:
Typhoid fever is an infectious disease of global distribution (House et al., 2001). It is a systemic infection caused by Salmonella enterica serotype typhi, remains an important worldwide cause of morbidity and mortality (Crum, 2003). It is a prolonged febrile illness and continues to be a health problem in developing countries where there is poor sanitation, poor standard of personal hygiene and prevalence of contaminated food.
Multi-Drug Resistant Salmonella Typhii
The emergence of multi drug resistance to S. typhi (MDRST) has been of major concern in recent years. MDRST is defined as strains of S. typhi resistant to all three first line antibiotics for typhoid fever.
Symptoms of Typhoid Fever:
Symptoms Typhoid fever is characterized by high fever, paradoxical bradycardia, and rose colored rash out of which the most common complaints were headache, abdominal pain and diarrhea. Patient suffering from typhoid fever may develop the symptoms like digestive hemorrheges, ileocaecal perforation, encephalitides, myocarditides, enterobacterial superinfections, ileal perforation, pancreatitis, acute pancreatitis, intestinal perforation, bowel perforation, infarction abscess, hepatic dysfunction and hepatic abscess. It causes septicemia of digestive origin that can cross the placenta resulting in chorioamniotitis. Maternal fetal infection with S. typhi can lead to miscarriage fetal death, neonatal infection as well as diverse maternal complication. Hydatid disease of the liver complicated by Salmonellosis and Cerebral S. typhimurium abscess in a patient with stroke have been reported. S. typhi infection in children younger than five years of age has also been done. The complications of typhoid fever in children include generalized edema. Inflammation and acute myocarditis in non-typhoid salmonella infection were also reported.
Diagnosis:
The samples used to detect salmonella organism are blood, urine, stool and bone marrow. The gold standard of bacteriological confirmation of typhoid fever is the bone marrow culture, which is positive in 85 to96% of cases, even when the patients have received antibiotics. Typhoid fever had been diagnosed earlier by blood culture and widal test. Widal test remained the common test for typhoid detection.
In the early stages, diagnosis may be based on clinical symptoms. In the first week of infection, laboratory tests such as the Widal test may give a false negative result due to the test's poor sensitivity and specificity.
Treatment:
Antibiotic treatment is therefore started on the basis of suspicious symptoms and this is called empirical treatment. Oral antibiotics usually need to be taken for a period of 7 to 14 days.
Over the years, many antibiotics that used to be effective against typhoid have now become ineffective due to the typhoid bacteria developing resistance against the drugs. For example, chloramphenicol used to be one of the most successful therapies for treating typhoid, whereas now, many strains of salmonella have become resistant to the agent in endemic regions.
Today, the most commonly used drugs in the include ciprofloxacin in the case of non pregnant women and ceftriaxone for women who are pregnant or in children who may not be suitable for ciprofloxacin treatment.
To eliminate the risk of treating the infection with an ineffective antibiotic, usually an antibiotic sensitivity test is performed The antibiotics that are successful in killing the bacteria are then administered to the patient.
Usually, symptoms start to resolve within 2 to 3 days of starting the antibiotic. However, the complete course of the antibiotic needs to be taken to prevent recurrence or spread of the disease in cases where the infection has not been completely eliminated.
Aside from the use of antibiotics, home treatment should also include complete bed rest, a diet of regular and healthy meals and the intake of plenty of water.
Surgical Care:
Surgery is usually indicated in cases of intestinal perforation. Most surgeons prefer simple closure of the perforation with drainage of the peritoneum. Small-bowel resection is indicated for patients with multiple perforations.
If antibiotic treatment fails to eradicate the hepatobiliary carriage, the gallbladder should be resected. Cholecystectomy is not always successful in eradicating the carrier state because of persisting hepatic infection.
Personal hygiene and good sanitation are important in preventing spread of typhoid fever.
Kishwar Hayat Khan. Recent advancement in typhoid research- a review. http://www.researchgate.net/publication/257141539
Dr Ananya Mandal, MD,http://www.news-medical.net/health/Typhoid-Treatment.aspx
http://emedicine.medscape.com/article/231135-treatment#d6
All accessed 10/08/2015.
