10 Things to know about Typhoid in Kenya

  1. If you have no fever you do not have typhoid – Fever is a cardinal symptom of Malaria fevertyphoid. The classical fever of typhoid rises gradually over 4 to 5 days and ends up as a high grade fever.
  2. What causes typhoid? – Typhoid is caused by a bacteria of the Salmonella group. One can be infected by;
    1.  Salmonella typhi
    2. Salmonella paratyphi  – which causes a less serious illness.
  3. Salmonella typhi causes a very serious illness – A person suffering from typhoid typhoid3due to Salmonella typhi will very likely be admitted in a hospital for proper management. My rule of thumb is that if you walk into a medical facility by yourself in your usual happy way then you most likely do NOT have typhoid. If you are carried by two or more people then you may have typhoid. A person suffering from typhoid is generally unwell for 2-4 weeks even with treatment. It takes a while to recover from an acute infection of typhoid.
  4. How does one get typhoid? – Typhoid is acquired when one ingests food or water that is contaminated with the salmonella bacteria. A person who is a carrier of the organism or suffering from the disease who comes into contact with their faecal material and does not wash their hands properly, will spread the bacteria to others when they touch food or water.
  5. Symptoms of typhoid – The  symptoms of typhoid include;
    1. Fever
    2. Initial constipation then followed by diarrhea +/- vomiting
    3. Malaise, muscle and joint pains
    4. Other symptoms that may occur include skin rash, cough and epistaxis (nose bleeding).
  6. How do we diagnose typhoid?
    1. The gold standard for diagnosis of typhoid is blood culture in order to grow the bacteria.typhoid 8
    2. Widal test – This is now obsolete in many centers due to its unreliability
    3. Salmonella antigen or antibody test – This is now widely in use as the test can either be positive or negative and does not require any other interpretation.typhoid8
  7. What is the treatment of typhoid? – Treatment of typhoid involves;
    1. typhoid1Fluid and electrolyte replacement – As noted earlier, serious vomiting and diarrhea occurs with typhoid and this can be fatal if not properly managed. This is why most patients end up in the hospital.
    2. Fever and pain management
    3. Antibiotics for 10-14 days minimum.
  8. Complications of typhoid
    1. Intestinal complications – untreated infection can lead to perforation of the intestines or bleeding from the intestines and this can be fatal.
    2. Septicemia – Presence of actively dividing bacteria in blood is septicemia. These bacteria can then find their way to any organ causing illness. These may be to the bones, lungs, kidneys, heart or gall bladder.
  9. Healthy carriers of typhoid – These are people we refer to as chronic carriers of typhoid. Once infected by typhoid, about 5% of people become chronic carriers of typhoid4typhoid. They usually show no symptoms but continue to shed the organism through their fecal matter. These people will then continue to have on and off positive test results without showing actual symptoms of typhoid. They may have on/off abdominal discomfort and should then be checked for gall bladder disease. The most famous chronic carrier is Typhoid Mary.typhoid2
  10. How do we control transmission of typhoid?
    1. Maintaining high hygiene standards is the most important way to control transmission of the disease. This means that we should all ensure that the food we eat and the water we drink has not been contaminated with human fecal material. This means that toilets and latrines are away from kitchen areas, we wash our hands well after visiting the toilet and we eat at establishments that maintain high hygiene standards.typhoid5
    2. Screening and treatment of food handlers – It is mandatory in many countries, including Kenya, for food handlers to undergo annual screening for salmonella. As we said earlier, there are chronic carriers of salmonella who show no symptoms but who can transmit disease. Food handlers, refers to people working in the kitchens as well as anyone selling fresh meats, fruits and vegetables.
    3. Vaccination – There are vaccines available against Salmonella typhi and these are given once every 3 years. This can be given to high risk individuals or people travelling to high risk areas if deemed necessary.




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