HEALTH

Protection from typhoid fever

TYPHOID fever is unique to humans. It remains a significant health problem in many developing countries and poses a risk to travellers who visit the endemic regions. The number of cases has continued to rise. The risk of typhoid fever should not be underestimated as a travel-related illness.

Epidemiology and clinical presentation: The risk of acquiring typhoid fever varied from country to country and was highest for travellers to India and Pakistan, with over 400 cases per million compared with Mexico with 34 per million and Europe with 0.6 cases per million. However, the incidence of typhoid fever has decreased from one case per 100,000 population to 0.2 cases per 100,000 in the USA and 2/3 cases is accounted for by international travellers.

Typhoid and paratyphoid fever are often referred to as enteric fever. Causative organisms are Saimonella typhi for typhoid fever and Salmonella paratyphi A, Salmonella schottmuelleri, and Salmonella hirschfeldii for paratyphoid fever. They have essentially same clinical picture.

Humans are the only host and reservoir of enteric fever. This infection is acquired by ingesting food and water contaminated by typhoid carrier. The incubation period i.e. period from infection to symptoms is seven to 21 days and is influenced by number of organisms ingested.

The initial symptoms are fever, headache, and either constipation or diarrhoea, neurological symptoms include confusion, dizziness and occasionally psychosis.

There are several signs characteristic of typhoid . Fever is seen in almost all cases and the pulse may be slow relative to temperature. Rose spots are seen in 13-46 per cent of cases. The abdomen is usually tender with decreased bowel sounds/hypoactive. Liver enlargement is seen in 25-50 per cent of patients. Spleen enlargement is seen in 40-60 per cent of patients. Neurological signs of confusion and altered level of consciousness are seen in 10 per cent of patients.

Diagnosis is confirmed by isolation of organism from blood, bone marrow, the urine or the stool. Cultures of the organisms from the bone marrow yield positive result in 90 per cent of cases. Stool culture is positive during the incubation period and again during third and fourth week of illness.

Serological tests are helpful in diagnosis in about 50 per cent of the cases.

Treatment: Many antimicrobial agents are effective against typhoid fever. Choloramphenicol and ampicillin are the commonly used drugs in many parts of world. Drugs such as trimethoprim-sulfamethoxazole, third generation cephalosporins and oral quinolones all have been shown to be very effective.

Protection from typhoid fever.

General measures:- A traveller bound for developing countries must abide by certain general safety measures concerning food and water consumption. One should ingest only bottled or carbonated beverages or hot drinks e.g. coffee and tea. Unpasteurised dairy products, tap water, and ice should be avoided. One should refrain from eating raw vegetables and salads. Travellers should be warned to be especially wary of lettuce, as it is difficult to clean. Rich and creamy sauces should be avoided because these may provide a good medium for a variety of pathogens. One should avoid food prepared by street vendors.

— Dr G.S. Grewal

Hospital officials deny allegations
From Our Correspondent

Ludhiana Aug 6 — Responding to a news item published in Ludhiana Tribune on July 21, the management of Dr B.L. Kapoor Memorial Hospital here has denied that it had collected any money from the shopkeepers through underhand means. The president of the hospital managing society, Mr Mohan Lal Jhanji, and the general secretary, Mr Kundan Lal Malhotra, claimed that certain shopkeepers, who had carried out extensions in their shops at their own level, had contributed money willingly to the hospital management and all the amount so paid had been duly entered in the books of account of the hospital.

They further maintained that the amount of donations offered by the shopkeepers were not fixed by the management and nobody was compelled to pay money for the extensions carried out in the shops.

Meanwhile, the Kapoor market traders association has also asserted in a written statement that no money was paid through ''under hand means'' by the shopkeepers to the hospital management for extensions in their existing shops.