The current outbreak of multi drug resistant variant of typhoid fever in Pakistan is a great deal of concern. Typhoid Fever, also called as “Enteric Fever” is an acute multi system illness mostly affecting the gastro intestinal tract. It is a bacterial infection and its primary cause is Salmonella Typhi and to a lesser extent Salmonella paratyphi. Much common in the developing countries, typhoid often transmits through the ingestion of contaminated food. According to WHO, “Between 11 and 21 million cases and 128,000 to 161,000 typhoid-related deaths occur annually worldwide.”
Causes of Typhoid Fever
Typhoid is an extremely contagious infection and food contamination is a major cause. The bacteria are passed in the stool of the infected patient which further contaminates the food and water causing the spread. Poor sanitation and unhygienic conditions are the leading causes of typhoid infection. Moreover a small group of people, who recover from this infection become asymptotic carriers of typhoid and continue to pass the bacteria in their stools even after adequate treatment with antibiotics.
Children and travelers are at a high risk of getting infected by typhoid. According to a research study at Children’s Hospital Quetta in the year 2011-2012, following conclusion was made, “Total of 2964 clinically suspected patients were screened for typhoid fever. Of these, 550 (18.6%) patients were positive serologically. The higher prevalence of the disease in hot summer season and increasing pattern of the disease was observed in summer days. The disease was higher in school age children under 5-10 years”.
Another Research study conducted in Gujarat, Pakistan in 2016 mentions, “The age group 21-30 was highly affected by typhoid infection. Water quality, vaccination and season have great impact on burden of typhoid fever in population.”
Symptoms of Typhoid Fever
3 weeks. With prompt treatment, patients get better clinically within 5 to 7 days. The following are the commonly present symptoms of typhoid fever: 1.High grade Fever. (Temperature may reach 104.9F) 2. Initially constipation followed by Diarrhea. 3. Headache. 4. Loss of Appetite and Weight loss. 5. Abdominal pain. 6. Nausea and vomiting. 7. Typical abdominal rash knows a “Rose Spots”. If not treated adequately the patient’s condition may worsen and enter a state known as “The Typhoid State”. In this the patient becomes delirious and is unable to move due to severe exhaustion.
Diagnosis of Typhoid
Medical and travel history plays a very important role in making the diagnosis of enteric fever. Furthermore two major blood tests include: 1. Typhi Dot – Less reliable 2. Blood Culture – More sensitive and specific
How to manage a patient with typhoid fever?
The conservative management includes Intravenous fluids to prevent dehydration and electrolyte imbalance. Treatment of includes prescribing antibiotics like Ciprofloxacin, Ceftriaxone, Azithromycin, and Cefixime
What is Multidrug resistant typhoid fever?
In the recent years, typhoid fever has a new resistant variant in which the infection is resistant to multiple antibiotics. Most commonly the resistance against Ciprofloxacin and azithromycin is making the treatment a challenge for the doctors. This outbreak of multi drug resistant (XDR) typhoid fever was first reported in Hyderabad, Pakistan in 2016. Lahore and Karachi are also being affected by this serious form of infection since the start of 2019. The following, measures must be taken to prevent any form of typhoid fever; 1. Washing of hands with soap before eating food and after using lavatories. 2. Use of boiled water for drinking purposes. 3. Better sewerage system. 4. Vaccination of people travelling to the regions of outbreak (South Asia). 5. Avoidance of self-medication and compliance to antibiotics.
These measures if implemented well will surely help in controlling the deadly XDR typhoid fever and will help in preventing further spread of the resistant variant in Pakistan. If you have symptoms similar to that of typhoid, book an online appointment or confirm it with diagnostictests.